They may not be as sharp as they once were. Their memories may be failing. But people with Alzheimer's can still sense when someone is talking down to them. And they don't like it any more than the rest of us do. The prevalence of "elderspeak" at the nursing home ought to be a consideration in selecting this type of senior housing. Read more:

Dr. Kristine WilliamsKristine Williams (left), a University of Kansas School of Nursing researcher analyzed everyday interactions between nursing home residents with dementia and the staff who took care of them. When the staff called residents demeaning names like "Sweetie" or "Dearie" or spoke to them in the singsong language of baby talk, the residents were twice as likely to be uncooperative as when they were spoken to in a normal adult tone.

They showed their displeasure in a variety of ways: pushing away, issuing threats, grabbing things, clenching their teeth, crying and screaming, hitting and kicking.

Williams has spent years studying how we communicate with older people. Addressing the elderly with patronizing language, particularly when they appear frail or are institutionalized in nursing homes, hospitals, or assisted living facilities a pervasive problem, she said.

It's so common that researchers have coined a word to describe it: "elderspeak."

"In our society we have negative attitudes toward aging," Williams said. "We develop negative stereotypes about (the elder's) competence."

Williams, a nurse, worked briefly in a nursing home and also provided home health care to elderly patients earlier in her career. "I recognized (elderspeak) right away working with older people," she said. "We use it all the time and don't recognize how negative it is. It's a subconscious thing."

Using elderspeak is a symptom of society's frequently negative attitudes toward elderly people, particularly those with dementia, said Michelle Niedens of the Alzheimer's Association's Heart of America chapter, based in Prairie Village.

"There's this assumption when you're older that you're less than (a full person), an assumption of weakness," Niedens said. Too often, she said, the life experiences and relationships of these people aren't valued. They are viewed simply as people with an illness.

Niedens recalled making visits to a nursing home resident with Alzheimer's disease, a retired country doctor. "It was clear talking to him that was his identity," she said. "I never called him by his first name. We always called him 'Doc.' It was affirming to him."

Nursing home staff members are often very caring people, Niedens said. But the work is demanding and turnover is extremely high. Workers may not have the time to get to know patients as individuals. When people talk in elderspeak, they may use inappropriate terms of endearment, simplify their vocabulary and grammar, repeat things or use a high-pitched voice.

Collective nouns are often used, as in: "Are we ready for our bath?"

When elderspeak isn't sugarcoated, it can be bossy and abrupt.

The language is virtually the same that parents might use to coax or order a small child to do something.

When researchers played audio recordings of what staff members at day-care centers and nursing homes said, people couldn't tell whether they were talking to children or to elderly people.

For a previous study, Williams recorded a nurse's aide using elderspeak while trying to persuade a nursing home resident to make friends with another resident. The two elderly people are sitting next to each other in the hallway in wheelchairs. The nurse's aide, who speaks in a high-pitched voice, does all the talking.

For her new study, Williams videotaped staff members at three Kansas nursing homes as they cared for 20 residents. The residents ranged in age from 69 to 97. They all had a moderate level of dementia. Most of the staff in the study were certified nursing assistants, but the participants also included nurses, therapists and social workers. They helped residents with such activities as getting out of bed in the morning, taking their medications, brushing their teeth and going to meals.

After analyzing the videos, Williams calculated that there was a 26 percent chance that residents would resist care when the staff used normal adult speech. But when the staff used elderspeak, the likelihood that residents would resist jumped to 55 percent.

"It could really facilitate care if staff used normal speech," Williams said. "Resistance to care takes a lot of time and is stressful to staff."

Williams has tried brief training sessions with nursing home staffs to help them avoid using elderspeak, and it makes a difference, at least at first.

But two months later, she found that staff speech was taking on the less respectful tone of elderspeak again. "It's the language of the nursing home," Williams said. "Any kind of habit is difficult to overcome."

"People with dementia realize they're losing their cognitive abilities. One of their challenges is to maintain their sense of identity. If they're talked to like an infant, it can be very disturbing," said KU researcher Williams. "They recognize they're being talked down to, and they find it patronizing and demeaning."

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