Is 'elderspeak' always inappropriate? An empirical investigation of the use of elderspeak in dementia care

According to Alzheimer's Disease International (2019), worldwide there are already over 50 million individuals with a dementia diagnosis, and this is expected to rise to 152 million by 2050. Many of these individuals will at some point require various forms of care, which comes with its own challenges. The importance of communication in healthcare is well known, but this is recognised as challenging in situations involving people living with dementia (PLWD) (Griffiths et al., 2014).
Ryan et al. (1995) suggest that individuals adjust their communication style for older adults, based on potentially erroneous assumptions or stereotypes of incompetence and dependence in these individuals. This leads to communication that may be interpreted as patronising, such as simple or childlike speech with exaggerations (loud speech), and restricted topics. This is also known as elderspeak. Ryan et al. suggest that this speech style can lead to decreased self-esteem, depression and withdrawal in its recipients. Other literature also portrays elderspeak in a decidedly negative light, highlighting consequences and providing information on how to recognise and avoid it (e.g. McLaughlin, 2020; Williams et al., 2017; Williams et al., 2009; La Tourette and Meeks, 2000). Lowery (2013) provides further review on this topic.
Despite the prevalent view of elderspeak as a negative, a preliminary investigation from Torres-Soto (2019) found that older adults in a care facility showed no behavioural or emotional differences when viewing an interaction using elderspeak, compared to a neutral interaction. Interestingly, other evidence (Lombardi et al., 2014; Hummel, 2012) suggests that context may have an influence on the appropriateness of elderspeak. In addition, Grimme et al. (2015) found that elderspeak was often used with good intentions, as some healthcare professionals viewed it as useful and more appropriate for PLWD. Therefore, it seems that further investigation is needed into exactly how elderspeak is received by PLWD in different contexts. This leads to the following research questions.
Research Questions
1) In what contexts is elderspeak used in the care of people living with dementia (PLWD), and by whom?
2) How is elderspeak received and responded to by PLWD?
3) What is the impact of local interactional context on receipt or rejection of elderspeak by PLWD? Does activity type (e.g. medical history taking vs assisting someone with eating) affect receipt?

Methods
Conversation analysis (CA) will be used to examine in detail a pre-existing data set of video-recorded interactions between healthcare professionals and PLWD, in an acute hospital setting. A small number of additional recordings will also be gathered by the student to supplement the data set. NHS ethical approval will be gained for new data collection, using existing approved protocols. The analysis will go beyond individual psychological dispositions by intensively scrutinising and comparing multiple episodes to allow patterns and their consequences to be identified. Data sessions with the supervisory team and other expert CA analysts will be used to enhance the robustness of the findings.
This project will contribute to the empirical literature on best practice communication for PLWD. The findings will also be practically applied, with the aim to develop training resources that can be delivered to healthcare staff. This training will be grounded in the kinds of actual interactions that occur in the hospital setting and will respond to needs that staff themselves identify. Findings will be disseminated via academic journals, conferences and summaries will be sent to key stakeholders (such as dementia charities and healthcare professionals).