Words matter

At the Erickson School, our mission is to educate a community of leaders who will improve society by enhancing the lives of older adults. Our society and every service and institution in it is about to be strained, possibly to the breaking point, by the 78 million Baby Boomers who will begin to turn 65 next year. To solve the complex problems of this age wave, faculty and students at Erickson School teach and study from an interdisciplinary perspective that looks through the lenses of aging, policy, and management. We teach our students how to influence policy; how managers of services and organizations designed to help older people must be flexible, authentic, and creative; and what it is like to grow old and to care for somebody old. At the same time, and perhaps more importantly, we expose the bias against and negative attitude toward older people that we have adopted as a culture in this country. Until many more of us shine a light on this and turn it around, and until we remove the distaste with which aging is regarded, we will continue to have difficulty changing the way people are treated as they grow older.

Our philosophy is that old age is another stage of life, and one in which people are still developing. By focusing on their retained strengths, and honoring their contributions and wisdom, we in the aging services field can improve the way individuals experience aging instead of marginalizing them and interacting with them only when we have a task to execute that will remind them of what they may have lost.

One of the most tangible examples of how we may sometimes convey a negative cultural attitude toward aging, even when we mean to be caring, is the language we use to talk to and about older people, especially in long­-term care settings. Organizational culture in long-term care settings mirrors and reinforces society’s view of elders and the social roles they are expected to play. A central feature in these cultures is the words used to communicate with and about elders who are care recipients. Degrading language, such as referring to an elder who needs help when eating as a “feeder,” or calling every elder “honey,” “sweetie,” or other infantilizing names, seems to persist out of habit or training. In many care settings, the medical model of care prevails, and historically the attitude toward aging in this model considers aging as failed adulthood that defies medical solutions. This places a low social value on both older individuals and their caregivers.

In a study conducted by John Bargh of Yale University, college students were shown groups of scrambled words and asked to rearrange them to form sentences. One group was given words that reflected a conventional view of the elderly, such as “lonely” and “wrinkle.” A second group was given words that had nothing to do with this stereotype, such as “thirsty” and “clean.” When the students had finished the sentence-constructing task, they were observed and timed (without knowing it) as they walked down the corridor to leave the building. Observers found that the students who had the words from the aging stereotype list walked much more slowly than those who had the neutral words. Even just working with the words caused these young people to behave in a way that they associated with being old. Later, participants were asked whether any of the words they had seen might have affected their behavior, and they answered no. That is how powerful words can be-they influence us outside of our conscious thinking. In this case, the study also highlights how negative our associations with aging can be, as reflected in the words chosen to portray aging to the young people.

So the way we talk to and about older people matters a great deal in our quest to make aging a more positive experience. Words shape understanding, perception, and relationships. They give cues about how to think of a person and how people think of themselves. When we say we will “let” a resident do something, it says that we are in charge, that they are powerless and need permission. Over time, this type of language can contribute to a lowered sense of well-being, a lack of motivation, and further loss of ability.

Although we have been charged with helping people in long-term care with the tasks they can no longer manage on their own, they are still people first. Because in many settings the focus is on making sure that a number of tasks are completed in a certain time frame, we sometimes find ourselves referring to people by room number, disease, or task, instead of by name. For example, when we discuss treatment plans or talk with each other about a resident’s care, we may say “room 5 is a walker.” We are not intentionally dehumanizing the woman who lives in room 5 and uses a walker. We believe (if we think about it at all) that it is simply harmless shorthand employed in our busy days. But residents hear this language and they begin to wonder what happened to their names and the other features of their personality and interests that make them uniquely themselves. Over time, hearing themselves talked about in this way undermines their sense of self, a process that has already begun simply by being old and overlooked in our culture.

An easy way out of this is to remember at all times that we are talking about other people-people whose changing abilities have placed them in a situation where we are being called upon to help them. Each of them is still a unique individual and it is that which we can help them remember by our language. Keeping this is mind, it becomes easy to put their personhood first and call them by name. Instead of being identified by the shorthand “a walker,” she becomes Mrs. Smith, who lives in room 5 and uses a walker. Many people have also begun to dislike being called “diabetic,” “blind,” and other such terms. The same consideration applies here and she becomes Mrs. Jones who has diabetes or cannot see. These are only facets of the whole person. Being conscious of using names first will ensure that the person does not become her disease or the task with which she needs help.

[B]eing aware of the messages that words can convey is the first step in choosing different words and changing the message to one of respect and equality.

None of us means to convey a dehumanizing attitude. We would not be in this field if we felt that way about older people. We are simply using the language and terms we are accustomed to using, and that have become the norm in these work cultures. But being aware of the messages that words can convey is the first step in choosing different words and changing the message to one of respect and equality. In this way, through words, we can honor those we are helping to grow old with dignity and those who facilitate this journey. LTL

Judah L. Ronch, PhD, is the Dean of and a professor at the Erickson School, University of Maryland Baltimore County, which offers undergraduate and Master’s degrees in Management of Aging Services as well as online and live Executive Education programs and customized industry training. He can be reached at

JudahRonch@UMBC.edu. Long-Term Living 2011 January;60(1):16-17