When did you get interested in how we communicate with older people?  

During my interdisciplinary gerontology doctoral program, I learned about theories explaining intergenerational communication and the impact of communication on older adults.  With a background in nursing care for older persons, I realized how nurses may not always realize how powerful their communication is and that by using communication methods such as elderspeak that nurses use to show caring, actually provides negative messages of incompetence to older adults.

Can you give us some examples of elderspeak?

Elderspeak can sound like babytalk, including not just the words, but the pitch, tone and volume of speech. Using inappropriately intimate terms of endearment or diminutives when talking to older people, such as honey, dearie and sweetie, is a major component of elderspeak, as is using simplified grammar and vocabulary.

Why do you think we often speak to seniors like they are children?

The Communication Predicament of Aging explains how our negative stereotypes of older adults as being less competent communicators lead younger people to oversimplify and modify communication with older persons. People who use elderspeak usually mean well and think they are using it to convey caring and improve communication success.  Unfortunately, few are aware of the underlying message of incompetence provided by elderspeak.

Where did you come up with the idea of the CHATO program?

As a doctoral student, I learned about the negative aspects of elderspeak and recognized right away that nurses and other health care providers frequently use elderspeak. My goal was to develop a concise and simple education program to make nursing staff aware of elderspeak and its negative messages, with the hope they would stop using elderspeak. So the program was designed to specifically educate nursing home staff to reduce elderspeak and use more affirming communication.

Can you explain how the program works

The CHATO program includes three, one-hour online education modules that nursing home staff complete individually. The modules include videos of actual nursing home communication that provide opportunities to step back and take the older adult’s perspective and ultimately to use more affirming communication. We also ask participants to fill out an evaluation of the program for us.

How difficult is to change the way caregivers and others communicate with older people?

It is hard to change communication like elderspeak because it is based on subconscious stereotypes and becomes a habit. However, by taking the perspective of an older adult, most staff will work to self-monitor their communication to reduce elderspeak and its negative messages. Our research has shown significant reductions in elderspeak use as well as negative responses from older adults.

What has the response been to the program so far?

We have recently completed work with over 200 nursing homes that participated in our CHATO National Trial funded by the National Institute on Aging.  This study included over 3,500 staff in over 200 nursing homes across the nation.  We are currently analyzing the results.

How do you measure the success of CHATO?

We look at a number of indicators to evaluate CHATO. This includes how staff knowledge and confidence improve after participating in the modules and their reported intention to use new communication skills in practice.  We also look at participation rates for staff in each nursing home.

What would you like the ultimate goal of CHATO to be?

Our primary objective is to improve quality of care and the experience of nursing home residents.  We are using archived data from the Center for Medicare and Medicaid Services about nursing home resident behavioral responses and need for psychoactive medication before and after CHATO.  Our hypothesis is that improved communication can improve the experience of older adults living in nursing homes as reflected in their behavior.

Are there plans to expand the scope and reach of the CHATO project?

We recently began a new NIH-funded study to streamline CHATO and make it more inclusive and feasible for under resourced nursing homes who haven’t come forward to participate in the CHATO program. We are adapting CHATO with input from experts and nursing home staff and will then test the adapted version in additional nursing homes.