by Craig Klugman, Ph.D.

During the season premiere of the HBO comedy, Getting On, I noticed the excessive use of toddler-speak toward patients portrayed as being elderly. The show takes place in a senior rehab/hospice unit in a community hospital. Whenever one of the health care providers (physician or nurse) was speaking to one of the patients, they tended to use baby talk—higher pitch, lilting tone, longer spaces between words, elongated space around vowels, and using simple, shortened words. When speaking to a baby or a toddler, such tones may help them to learn language, provide amusement, and get their attention. What struck me is that the characters were people who had lived a long time. In one instance, one physician talked to a patient who had also been a physician like she was an infant.

Some of the patients had dementia, but others were perfectly capacitated. These people had lived full lives and continued to have meaningful lives—having raised families, had careers, taken care of themselves and others, and made contributions to society, they were being spoken to as if they were 2 years old.

I wondered whether this blatant disrespect was just a television invention or something real. As it turns out, it is real. A New York Times piece in 2008 discussed how not just in medicine, but in all areas of life, society tends to talk to seniors in a different ways using terms like “”sweetie” and “dear.” In a 2010 study and a 2009 study , researcher Kristine Williams found that seniors who are spoken to in elderspeak tend to be more resistant to care. Such speech sends a message to the person that he or she is incompetent, increasing their downward spiral and feelings of dependency.

A physician at a large community hospital told me that it was common to talk to senior patients as “sweetie” and “dear.” The physician said that he never used those terms normally, but found that he just does it. He credited such tendencies to his training where all his mentors used elder speak. “It’s just part of the culture.”

Another friend who comes from a family of physicians and attorneys was explaining how a loved one recently was in the hospital for surgery. Despite their expertise and years of medical and legal practice, the nurse on duty after surgery told the patient and family, “the boo boo will hurt for a while,” and that she would have pain from the “ouchie.” Another friend who is a young senior had visited her doctor’s office and told me that she is always referred to as “baby.”

In medical school, students learn how to talk to patients in regards to giving bad news, introductions, and putting the patient at ease. But, I do not recall any curricula about how to speak with seniors. Given the massive shortage of gerontologists, it’s important for all health care providers, especially those in primary care, to learn not to use elderspeak. Such language has been documented to be demeaning and to decrease patient well-being. People who have lived a full life deserve to be spoken to with respect, understanding, and dignity. Infantilizing them through elderspeak is detrimental to the goals of medicine and to basic human kindness. Rather than seeing these patients as vulnerable and frail, we should temper that vision of them with thinking about the full life that they have lived. Given the prevalence of this phenomenon, it is something we all have to become aware of and avoid.