Shouting should be avoided, he warned.

“Shouting is ineffective because it raises the pitch of your voice, and the hearing loss of older adults is usually associated with higher frequency ranges, so the higher the pitch, the less likely the person will hear you.”

It is also important to consider hearing loss as a factor in the patient’s responses if the patient appears to be answering in non-sequiturs. “If the patient’s responses to your questions are incongruous, don’t assume the patient has dementia,” he emphasized.


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Underaccommodation and Overaccommodation

Practitioners sometimes engage in 5 patterns that contribute to older adults’ communication problems—underaccommodation and overaccommodation.8

Overaccommodations “occur when the speaker or writer is over-reliant on negative stereotypes of aging.”8

Several studies have shown that stereotypes can lead to infantilizing communication (sometimes called “elderspeak”), which includes excessively simplistic vocabulary and grammar, shortened sentences, slowed speech, elevated pitch and volume, and inappropriately intimate terms of endearment (eg, “honey” or “sweetheart”).9,10  These can lead to a communication breakdown with cognitively intact elders as well as those with dementia.9  

“One communication style we often see younger people use when addressing older people is patronizing baby talk, which older people universally dislike,” Dr Harwood observed.

Elderspeak “derives from stereotypical views of older adults as less competent than younger adults.”9 This conveys an implicit message of incompetence that can initiate a negative downward spiral for older persons, who react with decreased self-esteem, depression, withdrawal, and the assumption of dependent behaviors.9

“Younger people need to be aware that even in talking to a patient with dementia, this style is not appropriate,” Dr Harwood said.

On the other hand, underaccommodations “occur when the speaker or writer fails to consider how aging affects speaking and listening.”8 Underaccommodations “put older adults at risk for social isolation and neglect because they lead to comprehension failure and hence to the possibility of misunderstanding, deception, and exploitation.”8 

Generally speaking, older adults tend to use shorter sentences than do younger individuals.11 They also tend to use sentences that are less grammatically complex and it is harder for them to follow more grammatically complex sentences, which put more strain on their often declining processing resources.7

“How you structure your sentences is really important,” Dr Harwood commented. 

Sentences should be kept short, although not patronizing or infantilizing, and information should be presented at the beginning of the sentence.

“Long sentences tax the short-term memory, and short-term memory tends to decline with age,” he said.

He advised physicians to “practice how to present key information in at the beginning of a short sentence.”

This article originally appeared on MPR