Elderspeak, hearing loss, and dementia

We’ve all heard adults speak to toddlers and young children in a sing-songy, oversimplified way. Maybe we’ve been the adults employing this method of communication with our own progeny. For many, it seems like the right thing to do. We might think: How can a baby, toddler, or young child understand the complexities of life without some amount of dumbing down? Interestingly, in more recent years, studies have been conducted about this same technique being used to talk to people as they age. The moniker given to this type of speech is “grayspeak” or “elderspeak."

This phenomenon first came to our attention after reading a 2023 New York Times article by author Richard Morgan. In it, he mentions how, when his now-93-year-old grandmother began losing her hearing about 10 years ago, their telephone conversations became more stilted. He also noted that people started talking to her – and he noted this in regards to other older people as well – not as a sage, but more like a toddler, or even a pet. When he started visiting her more in person, he discovered that she was still a wealth of information and provided wise advice when she could understand what he was saying.

Elderspeak study

Diving deep into this topic, in an article in the NIH National Library of Medicine titled “Understand Elderspeak: An Evolutionary Concept Analysis,” authors Clarissa Shaw, Jean Gordon, and Kristine Williams define elderspeak as “an inappropriate simplified speech register that sounds like baby talk and is commonly used with older adults, especially in health care settings.” After reviewing 83 articles, they categorized elderspeak characteristics by semantic, syntactic, pragmatic, paralinguistic, and nonverbal qualities. In their research, they discovered that the primary precursor to elderspeak is “ageism in which old age cues and signs of functional or cognitive impairment lead to simplified communication from a younger caregiver.”

Their research indicates that, overall, a key feature of elderspeak—exaggerated prosody, or patterns of stress, rhythms and sounds (think baby talk)—is found to reduce comprehension. Those that employ elderspeak are generally considered condescending by older adults, as well as being less respectful.

Further, the Shaw, Gordon, and Williams study revealed that for people living with dementia, elderspeak increases the probability of resistiveness (unease) to care, which is consistent with the behavioral and psychological symptoms of dementia. This important study recommends that when working with elders, methods that help to enhance comprehension should be considered.

The importance of hearing aids

Let’s circle back to the importance of elders hearing properly. After researching studies that indicate a relationship between hearing loss and dementia in older adults, Frank Lin of Johns Hopkins University and his team conducted a revealing three-year study, published in The Lancet in 2023. In it, they tracked and compared the rate of cognitive decline between two groups of people: those who received hearing aids and those who didn’t.

Lin and his researchers recruited nearly 1,000 people ranging in age from 70 to 84. All of the participants had substantial hearing loss. The participants were randomly assigned to one of two interventions. Half of the recruits participated in a health education program which focused on promoting healthy aging. The other half received hearing aids and instructions on how to use them. To reinforce training, follow-up visits were conducted every six months with both groups.

Prior to the study, and every year for three years, the participants took a battery of tests to measure their cognitive functioning. People in the health-education group did not experience improvement in hearing and communication. This was expected by the researchers. However, people who received hearing aids reported considerable improvement in both hearing and communication abilities over the course of the three years.

According to Lin, “Hearing loss is very treatable in later life, which makes it an important public health target to reduce risk of cognitive decline and dementia.”

Lin and his team continue to track the participants, monitoring changes in cognition development over time. They are also studying brain scans and social engagement data. Their goal is to gain a better understanding about how protecting hearing as we age may prevent cognitive decline in some older adults.

What we can do for elders and ourselves

Here’s a short list of things that may help us or the elders in our lives maintain or slow the loss of cognition:

• Be aware. No matter our age, let’s be aware of how we speak to older people, especially those with hearing loss. Don’t dumb down what you’re trying to convey. (We wouldn’t speak to Albert Einstein as if he was a toddler.)
• Be respectful. We all want to be respected; elders are no different.
• Encourage hearing aid use. If we or someone we know would benefit from wearing a hearing aid, let's wear one or encourage another to do so; it might make the difference between holding dementia and cognitive decline at bay, or succumbing to it.
• Engage in social activities. Being unable to hear can cause some people to isolate. By wearing a hearing aid and participating in social activities we can keep our cognitive and language skills sharper.

Let’s remember that Richard Morgan discovered his nonagenarian grandmother was a veritable sage when he started spending more time with her and she could understand what he was saying.

Note: This article originally appeared in Psychology Today and is reprinted here with permission of the authors.

^{Additional Sources}

^{Mehta, J.M. (2020). How Elders Make Us Human. New York, NY: Anthropology Magazine/Sapiens.org.
Reynolds, S. (2023). Hearing aids slow cognitive decline in people at high risk. Bethesda, MD: NIH/Research Matters.}