Background

Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care.

Objectives

The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia.

Design

A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia.

Setting

Three hospital units in one Midwestern university hospital in the United States.

Participants

A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020.

Methods

Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia.

Results

Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: − 0.02, − 0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035).

Conclusions

Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed.

Tweetable abstract

This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.

中文翻译：

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医院痴呆症护理中长者言语沟通的特征：护士谈话观察研究的结果

背景

老年人的语言交流通常被老年人视为居高临下和婴儿化，并可能导致痴呆症患者的抵抗行为。人们对美国医院中长者语交流的存在知之甚少。为了改善医院痴呆症护理，需要了解医院环境中的这种现象。

目标

护士谈话研究的目的是（1）描述医院痴呆症护理中使用长者语的属性，以及（2）确定哪些特征与护理人员使用长者语与住院痴呆症患者进行交流相关。

设计

采用横断面观察研究设计来收集和分析护理人员在护理住院痴呆患者期间的录音。

环境

美国中西部一所大学医院的三个医院单位。

参加者

2019 年 10 月至 2020 年 3 月中旬招募的 53 名护士和护理助理的便利样本，为 16 名轻度或更重度痴呆症患者提供直接护理。

方法

使用爱荷华州长者语编码方案对 88 次护理经历进行录音和编码，以确定长者语交流的频率和特征。使用线性混合效应模型来确定哪些特征与长老语相关，以及护理人员对住院痴呆症患者使用长老语的频率。

结果

超过四分之一 (28.7%) 的护理人员针对痴呆症患者的言语构成了长者言语，几乎所有 (96.6%) 的护理遭遇都包含一些长者言语。长辈语的特别常见的特征是尽量减少单词和减轻表达方式、幼稚的术语和短语以及集体代词替换。在预测老年语使用频率方面，工作人员角色和年龄之间存在显着的交互作用（95% CI：−  0.02，−  0.00，p  = .008），这表明老年护士更常使用老年语，而年龄更大的护士更常使用老年语。在使用长辈语期间，护理助理的比例保持不变。还证明了对谵妄和住院时间的静态显着影响。谵妄患者的 Elderspeak 使用率增加 12.5%（95% CI：0.02, 0.23，p  = .025），痴呆患者住院时间每增加一天，使用 Elderspeak 的比例增加 1.5%（95% CI：0.00, 0.03，p  = .025）。 035）。

结论

长者之言在急症护理环境中普遍存在。需要针对老年护士和护理谵妄患者和住院时间较长的医院单位的护理人员采取干预措施。

推文摘要

这项研究发现，护理人员经常对住院的痴呆症患者使用长辈语（婴儿化语言）。@claireshaw_phd @IowaNursing。