January/February 2011 Issue

What’s in a Name?
By Ira Rosofsky, PhD
Social Work Today
Vol. 11 No. 1 P. 5

As a graduate student, I was with a group interviewing elder psychiatric patients at a state hospital when our advisor admonished us not to address any of them familiarly by their first names. “These people are old enough to be your grandparents or even your great-grandparents. So it’s Mrs. Smith. Never Sally,” he said.

We may have been the first people in ages to call a patient Mrs. Smith, not Sally, and that message of personal respect has stuck with me in the decades of professional practice since my student days.

In my work in eldercare settings, I have tried to stay true to my professor’s simple call for respect, even as I remain one of the few people in the life of a present-day Sally to address her as Mrs. Smith. I try to do this when I speak to the staff. “Where can I find Mrs. Smith? She’s not in her room,” even as the staff may respond, “Oh Sally, she’s in the rec room.”

If Mrs. Smith asks me to call her Sally, I’ll respect that request. For similar reasons, I speak only of residents, never patients. Hospitals have patients; nursing homes have residents.

More generally, respect means we should not slip into “elderspeak,” the old-age analog of baby talk. A resident is not a “sweetie,” “honey,” or “dear.”

Kristine Williams, RN, PhD, a gerontologist at the University of Kansas, and her colleagues looked at taped interactions in a skilled nursing facility between staff and residents with moderate dementia. Using a scale measuring resistance to care, Williams found greater resistance among residents when they were addressed with elderspeak and more compliance and cooperation when they were addressed with normal adult conversation.

Although the caregivers may think they are showing affection and nurturance, the residents hear condescension and infantilization. This is not a difficult problem to manage. Williams found that a brief education session—simply increasing staff awareness—reduces elderspeak and increases compliance and cooperation.

Williams’ work is just one example of the power of language and, specifically, naming in contexts other than nursing homes. In one study by Harari and colleagues, teachers read and graded essays by fictionally named students. For the same essay, if the essay’s author had a popular name (like David or Jennifer), it received higher grades than when it was supposedly written by an author with an unpopular name (like Boris or Bertha). Other studies have concluded that attractive names are associated with academic achievement and even perceptions of personal attractiveness.

Patronizing, condescending, and infantilizing language is only one of the many factors affecting the personal dignity of nursing home residents. It’s important to keep elders’ dignity in the forefront of our thoughts.

Most of us have at least one door we can close to the world. Older adults in nursing homes have lost that door. They live their lives in public. When a resident closes his or her door, it’s often viewed with some suspicion. Sometimes it’s even a cause for a referral to me. “Mr. Jones is isolating himself. He closes his door and just sits there all day.”

So I go and have a chat with Mr. Jones. “It’s kind of noisy with the PA system going off all the time. It makes it difficult for me to catch up on my reading,” he says. If Mr. Jones were still independent, some might not approve of him sitting in his house all day reading, but I doubt it would prompt a psychiatric referral.

We must remember that a skilled nursing facility may be our place of employment but for the residents, it’s their home and we are their personal staff. If you put that spin on it, then we could think of them as rich folk who are complaining about how hard it is to find good help.

I joked to my wife that if I wind up in a nursing home, I too would finally be able to catch up on all my reading with nobody telling me to walk the dog or take out the garbage, to which she replied, “Since when did you walk the dog or take out the garbage?”

— Ira Rosofsky, PhD, is a psychologist who works in nursing homes and assisted living centers. He is the author of Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare, a narrative of his professional life and the personal caregiving he provided for his own elder parents.