"It's been a long road," Luanne Baron says of caring for her 77-year-old mother, Phyllis.
Baron, of Revere, Mass., took on the role of caregiver nearly three years ago, beginning at home and now during daily trips to visit her mother at a nursing home.
Phyllis has Alzheimer's disease, which has dramatically worsened over the past year, Baron says. "The conversations were becoming more difficult in terms of making sense of things."
And even though her mother continues to ask about Baron's grandparents, who died about 30 years ago, Baron says that her own end of the conversation hasn't changed, in spite of her mother's disease.
"I try to speak to her and any other patient in the nursing home as the human beings that they are," Baron says. "Whether or not it's even comprehended, it doesn't matter. What matters is that you're providing an answer that you would give to any other person who asked the question."
But not all caregivers communicate the same way as Baron does.
"Our society has these negative attitudes about aging, and because of that most people have negative stereotypes about older adults being less competent in communication," says Kristine Williams, associate professor at the University of Kansas School of Nursing.
Williams, who has more than 20 years of experience as a nurse working with older adults, says that based on this assumption, many hospital and nursing-home caregivers communicate in "elderspeak."
This includes using basic vocabulary and grammar, speaking in a high-pitched or loud voice, sounding overly caring or controlling, and using terms of endearment such as "honey" and "sweetie," Williams says.
"Elderspeak is a kind of talk or communication that is common between younger adults and older adults in a variety of settings," she says, adding that it's not too far from "baby talk."
"As health-care professionals, we talk like this to older adults all the time, and we think that in doing this we're giving them a message that we care about them," she says.
But her latest study, presented Monday at the 2008 Alzheimer's Association International Conference on Alzheimer's Disease, shows that this language might have the opposite effect.
Williams and her colleagues analyzed videos of nursing-home encounters between staff and residents who had dementia. They noted whether the staff communicated normally, used elderspeak or remained silent.
The residents' behavior was rated as cooperative, resistive to care or neutral during activities such as bathing, dressing and brushing their teeth. When residents resisted care, their reactions included saying no, grabbing a person, pulling away or clenching their teeth.
When staff members spoke in elderspeak, the residents' resistance to care nearly doubled compared with when staff spoke normally.
Even in silence, dementia patients were more cooperative than when hearing elderspeak.
Dr. Claudia Kawas, professor of neurology, neurobiology and behavior at the University of California, Irvine, says that it might be difficult to determine the direction of the effect.
"When you use elderspeak with someone, does it make them behave badly, or does the care provider start using elderspeak when someone [begins behaving badly]?" Kawas asks.
But Williams says that the researchers looked at residents' behavior seven seconds before the nurses began using elderspeak, and did not find that the residents were resistant to care at that time.