Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud. In these podcasts, you get to listen in on my conversations with some pretty amazing people.

Today, I’m talking with Dr. Anna Corwin, who is an Assistant Professor of Anthropology at Saint Mary’s College of California. Trained in linguistic and medical anthropology, her work focuses on how cultural practices and communication shape older individuals’ experiences of their lives, their bodies and aging.

Much of Anna’s research has examined how and why American Catholic nuns age more successfully than their lay counterparts, benefitting not only their physical health, but also mental and emotional wellbeing.

I read Dr. Corwin’s article, “Overcoming Elderspeak: A Qualitative Study of Three Alternatives,” that was published in the journal Gerontologist.

That term, “elderspeak,” was new to me, but it immediately seemed to make sense, and I really wanted to know more. I emailed Anna, as a corresponding author of the article, and happily, she replied. We’ve had some back-and-forth, and being a guest on Health Literacy Out Loudis the wonderful happenstance that followed.

Welcome, Anna.

Anna Corwin: Thank you. I’m happy to be here.

Helen Osborne: I really want to know more. Tell us all. What do you mean by that term “elderspeak”?

Anna Corwin: It’s not a term that I coined. It’s a term that was coined first in 1964.

I think the easiest way to think about elderspeak is to think about baby talk. In America, the way we often talk to children includes simplified speech, using a slower speech rate, exaggerated intonation, elevated pitch and volume, a really simple vocabulary.

It also involves usually using the collective pronouns, so the “we” pronoun rather than “you” or “I.”

Helen Osborne: “Are ‘we’ hungry right now?”

Anna Corwin: Yes, exactly.

Helen Osborne: That’s why I think that your article resonated with me. I could just hear it in my head. “How are ‘we’ doing?” That’s elderspeak?

Anna Corwin: Exactly, with that exaggerated intonation, the “would we like to put on our sweater today?” It’s not always quite that pronounced, but sometimes it can go to that extent.

Helen Osborne: It grates on my nerves even to read about it and think about it. Why do people talk that way? What are the implications when they do?

Anna Corwin: I think your first question, why do people talk that way, is a complicated question. It’s a cultural question, and it has to do with the way that Americans, and Europeans too, often think about children, babies and also older people.

It has to do often with a stigma around older people, a sense that they’re not fully adults who should be addressed in the same way as other adults. I think stigma is a big part of why people are doing it.

Then your second question is, “What are the implications?” Not only is it grating, as you say, a lot of people who receive elderspeak, it’s really annoying to them and also insulting, but there’s also a lot of research.

Again, this is research that has been done by gerontologists, not by myself. But research that has found that not only is the experience problematic, of feeling disrespected or patronized, but it also can trigger negative self-assessment. People feel really bad about themselves if they’re continually spoken to in this way.

Helen Osborne: Of course.

Anna Corwin: Also, even worse, if older adults are only exposed to elderspeak, it can be associated with cognitive decline, social isolation and also some negative behaviors, such as being resistive to care.

Helen Osborne: I think if someone said to me, “Are wehungry right now?” I’d have a lot of behavioral problems with that one.

Anna Corwin: Yes, absolutely. It makes sense.

Helen Osborne: Tell us more about the cognitive decline. If someone speaks to you in that way, what would happen?

Anna Corwin: I don’t think that anyone has done enough research to precisely identify exactly what’s going on, but I think the mechanism is more or less that language and cognition are kind of use-it-or-lose-it mechanisms.

Think about speaking a second language. If you want to keep up your French or your Spanish, you really need to be exposed to it and practice it.

The same goes for cognition, for thinking and for speaking your own first language, like English, if that’s your first language. If you have no exposure to complex vocabulary, complex ideas, rich interaction, it’s a use-it-or-lose-it mechanism. I think the evidence is pointing toward that being why it’s linked to cognitive decline.

Helen Osborne: That’s fascinating. Tell me about your research. I was really wowed by your article. It’s not all that many corresponding authors or authors I go to, but yours was written in such an accessible way. You have real dialogue in there, and you came up with some really interesting points.

Please tell our listeners and explain a little bit more about the work that you have been doing on elderspeak.

Anna Corwin: Sure. Thanks. I appreciate you as someone who works on health literacy appreciating the way it’s written. I feel like I’ve worked so hard. I really want all the work that I do to be accessible and to be readable.

Helen Osborne: Thank you.

Anna Corwin: It’s something that I also care very much about, so I appreciate that you experienced that when you were reading it. My work, I’m an anthropologist, as you said, a linguistic anthropologist, and I attend to medical issues, too. I spent a year living in a Catholic convent in the Midwestern United States.

Helen Osborne: That’s where the nuns live, in the convent.

Anna Corwin: That’s where these nuns live, who I worked with. The reason that I was there is that American Catholic nuns have been found to have really positive health outcomes at the end of life. They are living longer, they’re happier, they’re healthier and they have fewer chronic conditions, less depression than their lay counterparts toward the end of life.

Helen Osborne: How interesting.

Anna Corwin: There are a lot of factors that contribute to that. I write about that elsewhere.

One of the things that I noticed, when I was at the convent, was that the sisters do a lot of the care for each other. When they’re speaking to each other, to other older sisters, the caregiving sisters don’t use elderspeak. The thing that is so prevalent in so many other spaces in the U.S. happened almost never in the convent.

Helen Osborne: Do you think that’s because they’ve lived with each other and known each other for decades?

Anna Corwin: I think that absolutely has something to do with it, yes, but that isn’t the whole picture. Often, people will speak to their own parents using elderspeak, and they’ve known each other their whole lives, but I do think that’s part of it.

I think another part of it is cultural and the way we think about older adults. The nuns themselves, their value of a person is not only someone who is productive and is active in the world, but they see a person’s value as sort of more inherent, in the soul, as continuing before birth and then after death, because they have a sense of heaven.

I think that there’s something about the way they’re thinking of persons. They’re valuing these older adults, even when they’re old enough or have chronic conditions that lead to them not being able to interact in the ways that they might have when they were younger.

Helen Osborne: That’s really interesting, and it leads me to other questions about cultures around the world. That might be a factor, too, but let’s focus on this group.

I’m just letting you know we have listeners who can be from all over the world, so I’m glad that you’re generalizing some of this too.

All of us in this health literacy world want to communicate in ways others can understand, and we want to do it in ways that are respectful and help promote good health outcomes. We have many different jobs, but that’s what we all care about a lot. What did you learn from your study that we might apply in our work?

Anna Corwin: I was very curious about exactly what linguistic tools these sisters were using when they were speaking to the older adults.

I think there are two reasons that people use elderspeak. One is just they have this idea that an older person should be spoken to in this way. I think that if the older adult is fully cognitively able and physically able, then there’s no reason to be using elderspeak. If somebody can return your conversation, there’s no reason to speak to them in any way that’s other than you would to any other adult.

If you are speaking to somebody who does have some chronic condition, such as aphasia, dementia or Alzheimer’s, so that you ask them a question, “How are you today?” and they’re not responding in a way that’s typical or coherent, then that can become a problem. You can have communicative breakdown.

That’s a second reason that people often use elderspeak. There’s this sort of communicative breakdown, because someone’s not responding to them.

Helen Osborne: It’s more one-way communication.

Anna Corwin: More one-way communication and when they’re saying, “Can we put on our sweater?” maybe it’s because if they say, “Would you like to put on your sweater?” they’re not getting a response that’s coherent or related to the question.

Helen Osborne: Oh, okay. Thanks for that example. Probably most of us can think of many instances with loved ones, with people we’re caring for or caring about, we’ve been in similar situations. What can we do?

Anna Corwin: What the nuns do that’s really wonderful is that they . . . I broke it down basically into three genres of speech. I was noticing that they would go into these caregiving interactions. Sometimes they’d massage the older sister’s feet to get blood flow going, or bring water, or just sit down to visit with them.

For these sisters who weren’t communicatively competent, or weren’t able to communicate in typical ways, they would sit down and start telling a story.

A narrative is an interesting genre. When you sit down and you start telling a story, there’s the opportunity for somebody else to contribute and say, “Yes, I remember that,” or, “That’s interesting,” or, “I have another story that I’d like to share,” but you’re not required to. If you sit down and tell a story, I am not required to respond.

If I just sit and listen, then it’s a way of allowing the older person to be exposed to this rich language, to hear complex language, a rich story, without the requirement of responding in a particular way.

They also told jokes, which I found interesting. Can I tell you one of the jokes that I heard in there?

Helen Osborne: I wish you would. Never having lived in a convent or even being part of my everyday experience, I have no idea how nuns joke around with each other. Please, clue us all in.

Anna Corwin: I recorded a bunch of jokes, but there’s one that I liked. The sister is in there and she’s massaging this other sister’s feet to get the blood flowing. She says, “The donkey that carried Jesus into Jerusalem on Palm Sunday, he thought it was all about him, because he saw the people starting to clap and sing and yell Hosanna. The donkey said, ‘I didn’t know my name was Hosanna.’”

You’re laughing, which is wonderful.

Helen Osborne: I am. I don’t even quite get all the nuances, but I get it enough to find it funny.

Anna Corwin: Donkeys are not worshipped even in Jerusalem, so you get the joke.

Sister Julette, a sister who had really pronounced dementia, wasn’t able to remember anything. She was often very anxious about her dementia. But she laughed. She was able to hear that complex interaction and share in this laughter with the sister.

This joke, which also has a narrative in it, was a way that the sisters were able to have this complex language and interact with each other, but not have this sort of heavy requirement of saying, “Where is this?” or, “Do you remember when your sister came?” or, “Do you know what’s going on later?” which could, for someone who has dementia, be very stressful.

Helen Osborne: With someone who has aphasia or dementia, are they able to engage in laughter? Would you acknowledge smiling as a part of a response to that, too?

Anna Corwin: Absolutely. Sometimes there was smiling and not laughter. Sometimes the person who was receiving these narratives, the recipient of the narrative, was not able to respond at all. Maybe they’re in bed, or they’re potentially even comatose. But you never know what somebody might be hearing. They may not be responding, but you don’t know what they’re hearing.

The nuns would tell these narratives or these stories. They’d pray also. That’s another way that they would engage communicatively, even with people who weren’t responding.

The beauty of this genre is that when you’re telling a story, even if someone’s laying there and not responding, you can still tell your story. It doesn’t ruin the back-and-forth of the story, because there’s no interactive requirement.

Most people did respond, either with a smile or a laugh, but there were even people in the convent who didn’t respond, who were maybe locked in or whatever else, and they would still treat them the same way, which was really quite interesting.

Helen Osborne: As you’re telling these stories, and it’s not your area of study, I don’t think, but I’m thinking of music or music together. I know that in nursing homes they sometimes bring in pets, like little bunnies and little puppies and things.

To me, I’m getting this sense of this shared experience. People can participate in whatever ways they are able at that time.

Anna Corwin: Exactly. That, just what you said, is exactly the key. It’s finding genres or bases where people can interact in whatever way is possible for them, so they have these opportunities to interact that they’re not excluded from. One idea that I think about a lot is how to scaffold activities.

Helen Osborne: What does that mean?

Anna Corwin: It’s a word that’s often used in literature on child psychology. If you actually think of a scaffold, something that’s holding up a building. It’s that metaphor of using a scaffold. I’ll give you an example, because sometimes that’s helpful.

In the convent, people would play cards. At the end of the day, there would be these card games. There was a sister who had a neurological deteriorative disorder, so she couldn’t use her hands in the same way that she used to be able to, so she couldn’t hold the cards.

She also couldn’t speak. She had aphasia, so she couldn’t play cards in the same way. She couldn’t pick them up and put them down and say, “I want to,” whatever. She couldn’t use her speech in that way.

They scaffolded the activities by creating a little wooden holder, so her cards could go in there in front of her so she could see them even though she couldn’t hold them. Then she would point to a card with her knuckle. One of the sisters would pick up that card and put it down for her.

She was able to participate in the activity to the maximum of her ability. Then the rest of the movement or the activity was scaffolded, so they would help with those things so that she could participate.

Helen Osborne: I know you also talked about prayer too, which is part of their culture and their world, more specifically, than maybe other laypeople. But telling stories, telling jokes, having that shared experience and building on a scaffolding, those sound like lessons that we might apply in our speech that we do when we explain about health. Can you see that overlap in there, too?

Anna Corwin: Absolutely. I think there are many of these tools that any of us can use when we’re interacting with older adults.

The thing that I want to say first, and I believe I said this again, but I think it’s worth repeating, is if you’re interacting with an older adult who is communicatively competent, just interact with them like any adult. You don’t need to use these activities necessarily.

If you’re dealing with somebody who does need scaffolding, maybe they have dementia or other chronic conditions, so they’re not able to interact in a typical way, or there is communicative breakdown, instead of using elderspeak and simplifying your speech or reducing it, what you can do is use these. I think telling a story is a wonderful way to engage with somebody.

Helen Osborne: That’s beautiful. I want to try that. We have someone we see a fair amount who is certainly in her decline cognitively, pretty seriously, and I’m going to try that.

Anna, I learned so much from you. Listening to you and you telling us stories helps make these lessons even more clear.

I want to just repeat for our listeners, and we will have it on your website, the article which wowed me of yours, “Overcoming Elderspeak: A Qualitative Study of Three Alternatives,” in the journal Gerontologist. We’ll have that on a link on your Health Literacy Out Loudweb page.

I just want to thank you so much for doing all that you do and bringing a new perspective to it, and then sharing it with us on this podcast. Thank you, Anna.

Anna Corwin: Thank you, Helen. It’s a pleasure to get to speak with you.

Helen Osborne: As we just heard from Dr. Anna Corwin, it is so important to think about how we speak, as well as how we write, to people of all ages and abilities, in ways that not only are understandable, but also respectful. But communicating clearly is not always easy.

For help clearly communicating your health message, please visit my Health Literacy Consulting website at www.HealthLiteracy.com. While you are there, sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.

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