During my first job as a nurse’s aide in a nursing home, I found out a few surprising things. I had the usual, lowly job of cleaning up after patients, feeding them, walking them and bathing them. I had learned in my first year of nursing school to treat people respectfully, and call them by their real names. I quickly saw that on the job, things were different. The other aides, all more experienced than I was, and even the nurses in charge called the nursing home residents, “dear”, “honey”, and “sweetie” regularly. I felt puzzled by this. I noticed that some of the residents didn’t seem to care what they were called, but others did seem to be bothered by these so-called terms of endearment. The constant use of “dearie”, rather than the resident’s name was annoying, even to my 19 year old ears. Though it was part of my nursing instruction to avoid talking down to a patient, I never saw a study which demonstrated any health related reason for avoiding use of “honey” or “dear”. A recent article describes the effect of this kind of talk to elders on their perceptions of aging, and on their longevity.
In October, 2008, the New York Times reported on a study of how some elders are insulted by these names, and how the perceived insults contribute to adverse health affects. Dr. Becca Levy, the article reports, a professor of epidemiology and psychology at Yale University, studied the effects of negative attitudes toward aging communicated by other through their comments. Health care workers, in particular treat elders in a way some elders perceive as belittling. When health care workers use terms like “dear” or “sweetie”, some elders perceive this as a message that they are incompetent, or that they are being treated like a child. The 660 person survey Dr. Levy conducted over a long term, found that those who had more positive perceptions of aging lived longer. Continued messages that the elder is incompetent can lead to a negative perception of aging, and a downward spiral in self esteem, particularly with Alzheimer’s patients. These persons are struggling to maintain a sense of their personhood. The wrong message about their competence can be very upsetting. The findings held up, even when variables in health conditions were factored in. Negative perceptions of aging were equated with shorter life spans.
Healthcare workers who spend the most time with elderly residents in care facilities are the aides, not the registered nurses. Aides have less training, and sometimes no training, in how to address their aging care recipients. Although some aging persons do not object to being called “honey”, rather than being addressed by name, many object and feel insulted and talked down to. Some even consider these terms a form of bullying. Some aging persons may, on the other hand, like these terms and consider them friendly.
If you are a caregiver, what does this mean for you? If you know the person you’re caring for, have genuine affection for him or her, and you believe your resident likes a term of affection, using “dear” may be fine. However, if you aren’t sure, the best way to find out if calling someone “dear” is bothersome to him or her is to ask. “Does it bother you if I call you ‘dear’?”
If it really upsets the individual, he or she may honestly tell you. If your resident has difficulty speaking, or is perhaps shy about being open concerning feelings, take the more conservative approach. Call him or her by name. Few people are so formal as to want to be called by “Mr. Jones” or “Mrs. Smith”, but there are older persons who feel that it is disrespectful to do otherwise. “Sir” or “ma’am” are what others may be accustomed to hearing, and it could be offensive for them to be called “honey”. It is no trouble for the caregiver to simply say, “May I call you Mary?” The elder is likely to feel respected by this effort. It says you think enough of the elder to give him or her a choice about how he or she wants to be called. The caregiver can use this courtesy to establish trust right away, and build the foundation of a caring relationship.
© 2008 Carolyn L. Rosenblatt, R. N., Attorney at Law, Aging Parents.com