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Certified nursing assistants are more likely to use “elderspeak,” a form of patronizing speech used with seniors, if they are familiar with the resident, if the resident has dementia, or others are not around, a study finds.

Minnesota State University and Oklahoma State University researchers surveyed 134 CNAs who worked at nine nursing homes or assisted living facilities in the Midwest. The CNAs were asked to rank the appropriateness of elderspeak in 36 different scenarios. The speech was defined as simplified vocabulary or sentence structure, exaggerated intonation and vocal pitch; slowed rate of speech, use of personal terms of endearment (i.e. “honey”) and collective pronoun usage.

The CNAs were least likely to use elderspeak if the resident’s family members were around, other residents were present, or if they had not interacted with a particularly resident before. They were most likely to use it if they were familiar with the resident and interacted with him or her on a regular basis.

Researchers wrote that “the use of elderspeak may increase resistance to care, threaten self-esteem and well-being, and increase dependency among residents.” They recommended training programs to improve communication.

Results were published in the Journal of Gerontological Nursing this month.