Dementia Care: Sweetheart—Comforting or Condescending?

In the emotionally complex world of dementia care, communication is more than just what we say - it's how we say it. Terms of endearment like "darling", "my lovely" and "sweetheart" are often used by healthcare staff with the best intentions: to comfort, connect and show warmth. But some people believe that elderspeak may sound patronising.

For my doctoral research , I collaborated with a team of researchers who study real-life acute hospital interactions by examining video recordings of how healthcare professionals communicate with dementia patients . The researchers use these insights to develop training programs for healthcare workers.

In my research, I focused on the use of elderspeak - a style of speech often directed at older adults. It typically involves a higher-pitched tone, simplified grammar and sentence structure and the use of terms of endearment.

Some people compare elderspeak to the way someone might speak to a young child, which is why it's often viewed as patronising. Terms of endearment - like love, sweetheart, or darling - are particularly controversial and frequently debated in healthcare settings.

Yet, despite these concerns - and that healthcare professionals are discouraged from using terms of endearment during training - the data showed that experienced healthcare professionals were using the terms regularly, suggesting that they might actually serve a valuable purpose in communication. When I closely analysed a range of real-life hospital interactions where terms of endearment were used, that's exactly what I found. Three key themes emerged from the data.

1. Mirroring

First, healthcare professionals weren't the only people using these terms. Terms of endearment were used responsively - so both patients with dementia and staff used them, reflecting or mirroring each other's language.

This resulted in positive interactions. For example, a patient saying "OK duck" when a doctor asked them if they could sit the hospital bed up higher, and the doctor responding with "all right mate". These examples shows that terms of endearment can be helpful for building rapport and trust between staff and patients.

2. Signposting

Second, terms of endearment were used at the beginning and end of conversations between staff and patients. In this case, terms of endearment were helpful for signposting and giving information about context to patients. Previous work has shown that people living with dementia can struggle with recognising cues in conversation. So, a term of endearment could help to signal that a conversation is coming to an end, such as a nurse saying: "Alright darling, it's lovely to speak to you."

This is not surprising since people use terms of endearment to signal the end of conversations in many social settings. For example, in a shop, a cashier might say "Thanks very much, love!" to signal the end of the transaction.

Terms of endearment were also used regularly when conversations began, signalling that the healthcare professional who has come to speak to the person with dementia is someone familiar or friendly. Although in this case, the healthcare professional would need to show caution depending on context and whether they're familiar to the patient.

For example, one doctor opened a conversation with: "Hello my dear, you haven't seen me for a while, have you?" The conversation continued with no issue. Another doctor used a very similar opening of: "Hi darling, I'm Ethan I'm the doctor for today." In this case some conversational trouble followed. The difference here is that in the first example the doctor's words demonstrate he has met the patient before. In the second, the words show they are unfamiliar.

3. Mitigation

A third way terms of endearment are used is to mitigate or minimise an imposition on a patient. Examples of this are:

• When a healthcare professional asks a patient to repeat something if their words were hard to interpret or unclear. For example: "What my lovely? Say that again."

• When a healthcare professional is giving an instruction during a healthcare task. For instance: "Just bend this knee my love."

• When a healthcare professional is responding to a patient expressing unease or discomfort - often when an unpleasant but medically necessary medical task is occurring, such as a blood test. For instance: "I won't be a second darling."

In these cases, the terms of endearment work to soften whatever the healthcare professional is doing. This can help to save face - avoid or reduce embarrassment on the part of the patient - particularly in cases where the healthcare professional has to ask them to repeat a comment or question. It can also aid in minimising whatever the professional is doing - similar to if someone said "We're just going to do xyz," rather than "We are going to do xzy." Terms of endearment also acknowledge the sensitivity of the healthcare situation.

While there were many examples of terms of endearment being used successfully in healthcare settings, they are not a magic bullet that can improve every situation. There were a couple of examples in the data of patients rejecting terms of endearment. In both cases, patients were particularly distressed about the healthcare activity at hand - a painful injection, for example.

In these cases, the terms of endearment were not enough to excuse the action that the healthcare professional was trying to do. This is therefore an example of where context and sensitivity to the individual situation are important.

Lauren Bridgstock received funding from an ESRC Midlands Graduate School DTP collaborative PhD studentship between the University of Nottingham and Nottingham University Hospitals NHS Trust (ES/P000711/1). The data discussed in this article were collected as part of the NIHR funded VOICE (13/114/93) and VOICE2 (NIHR134221) research projects. The views expressed in this article are those of the author and not necessarily those of the ESRC, NIHR or the Department of Health and Social Care.