Treating People Who Have Cognitive Impairment With Dignity

For many older people, revealing a diagnosis of mild cognitive impairment or Alzheimer’s disease almost always triggers a change in how friends and loved ones behave toward them. Often — sometimes without even realizing it — people may adopt a soothing, higher-pitched tone when talking to them or jump in to finish their sentences, even when it’s not necessary.

Those changes may be well meaning, but they can be harmful to a person with cognitive decline.

In fact, verbally infantilizing someone — speaking to them as if they’re a child — can not only be demeaning but also interfere with a person’s care, as they may balk at receiving the help they need. So it’s important for friends, loved ones, and caregivers to be aware of their tone of voice and choice of words when talking to someone with mild cognitive impairment or Alzheimer’s.

The Language of Elderspeak

Verbal infantilization has a name: elderspeak. The term is used to refer to a form of language and way of talking that many people lapse into when communicating with someone who’s older and showing signs of cognitive slips. Similar to baby talk, elderspeak is characterized by cloying terms of endearment delivered in a high-pitched tone and singsongy style.

It’s especially common for people living with Alzheimer’s disease or MCI to be spoken to in this way, according to Monica Moreno, senior director of dementia care and support at the Alzheimer’s Association. There’s also evidence it can be more harmful than helpful.

“Every caregiver wants to provide care to the person living with dementia with dignity and respect,” says Moreno. Problem is, caregivers may employ elderspeak because they’re trying to reassure people who may be anxious, confused, or depressed.

“It’s an issue for caregivers, because it can be very hard to know how much awareness a person [with cognitive impairment] has,” says Victoria Leavitt, PhD, a clinical neuropsychologist at Columbia University in New York City.

How to Talk to Someone Living With Cognitive Decline

• Ditch the diminutives. Eliminate cloying terms (such as “sweetie” and “honey”) and phrases (such as “good boy” or “good girl”). It’s fine to refer to the person by their first name or, if they aren’t a close family member or friend, Mr./Mrs./Ms., followed by either a first name (Miss Katie) or last name (Mr. Jones). You might also simply ask what they’d like you to call them.
• Cut back on the collective pronouns. The royal we — “Have we finished our dinner?” — can sound patronizing.
• Don’t exclude the person from a conversation. In conversations with more than the two of you, speak directly to the loved one or person in your care, maintaining eye contact so they don’t feel they’re being talked over or about.
• Slow down — a little. Try to speak slowly and clearly, but not to the extent that the decrease in speed sounds forced or stilted.
• Don’t minimize their concerns. Using phrases such as, “It’s okay,” or, “It’s just a little poke” downplays their feelings.
• Temper your tone. Don’t raise the pitch of your voice, as you would when speaking to a baby or toddler.
• Ask closed-ended questions. For example, “Instead of, ‘What would you like to drink?’ it may be easier for the person to respond to a choice: ‘Would you prefer coffee or soda?’” says Moreno.
• But don’t ask questions that restrict their choices. For example, avoid saying, “You’re ready for a bath now, right?”
• Don’t interrupt or finish sentences. The person “may know what they want to say,” says Moreno. “[It may just take them] a little bit longer to … verbalize.” Let them ask for help if they need it.
• Don’t make assumptions. “People who are living with the disease want to stay as independent for as long as possible,” says Moreno. “But care partners … aren’t always sure when to let the person lead.”

Remember, too, to give yourself grace. You’re up against a conundrum: You want to support the independence of the person in your care, but you can’t always know their capabilities. So it’s hard to know when to step in and when to let them take charge, says Moreno.

With that in mind, be prepared for missteps. “There will probably be times when you’re going to hurt their feelings,” says Dr. Leavitt. But if you have their best intentions at heart and are prioritizing their safety above everything else, forgive yourself and move forward, she says.

“It can be so hard to maintain your resolve [as a caregiver],” she says. “But you’re doing it for the good of the person, even though it’s hard.”