Breaking the real language barrier in care for older people.

Abstract

In nursing, when we say “language barrier,” we mean that our patients and we do not share the same language. An obstacle to effective communication results. Or so we believe. Nevertheless, many surmount this obstacle with careful gestures, expressive non-verbal behaviours and judicious use of technologies. Empathy, compassion and reflection shrink the distance between our patients and us, regardless of fluency and literacy. Listen carefully to how we communicate with patients, and a far more profound and elusive linguistic problem becomes apparent. The language of ageing common today divides and isolates. Consider the words we choose to describe being old or prototypical approaches to communicating with older people. Education, culture, community and family shape our language. Our word choices represent values, preferences and beliefs although those underlying ideas may be largely unacknowledged or unexplored. Education from primary school on generally offers little exposure to build an understanding of ageing and what it means to grow old. Cultures vary in how they attend to ageing and later life. Many cultures tout respect for elders, often tied to ancient philosophies and theologies central to the culture itself. Ageing today, with unprecedented longevity, often challenges interpretation of ideas anchoring a culture. Thus, late life remains a topic held distant or framed as duty to protect and revere. Our words spoken to older people and our language of ageing reflect detachment and obligation. Importantly, the science of ageing and long, well-lived lives contradicts popular interpretations of growing old. Being older is not a precipitous decent into incapacity, a place of extreme susceptibility to harm or a state of disengagement with daily life. On the contrary, ever more evidence points to accumulating manifold advantages and strengths as we age. Specific evidence outlines critical influences of education, mental and physical activity and social engagement on living long and well. Further, emerging clinical data underscore the importance of prehabilitation—doing rehab before surgery or other events—as well as rehabilitation in preserving and restoring function and capacity. Our current language of ageing tends not to reflect such realities, instead reinforcing outdated understandings and myths about what it is to grow old. Much language used today, despite being beneficent and protective, is nonetheless unintentionally ageist. Getting older is described with humorous trepidation or outright resistance. Consider the familiar phrase “anti-ageing” or birthday cards that lampoon a “certain age” in a manner cutting perilously close to self and personhood. Individuals perceived to be older receive idealistic treatment of protective exclusion or respectful separation as in “Oh no, please let me get that for you while you remain seated.” Distance grows greater as we talk about older people. “The elderly” is a label that always excludes the speaker. We never say “the elderly” to include ourselves and rather draw the fundamental “us–them” divide of this ambivalent ageism possible. In nursing, our language of ageing mirrors society, interpreting values through our professional lens in the context of health care. The language of ambivalent ageism pervades nursing just as it does health care and society more broadly (Cary, Chasteen, & Remedios, 2017). Distinguishing us—nurses—from them—patients—holds a certain pragmatism. Knowing who is who in clinical settings is key to assuring ability to meet needs and deliver care. Nonetheless, the social roles of nurse and patient work only when empathy establishes our shared humanity. That empathy is fundamental to compassion necessary to our care. Regardless of age, the greater the distance between our patients and us, the bigger the obstructions to empathy and compassion. Ageing is universal. The diversity worth celebrating in our care lies in individual expressions of identity from the attributes accrued through decades of life to the many other facets of our personhood which makes us each unique. Nursing holds the power to lead positive change in health care for our ageing societies. In recognising the real language barrier in our ageing societies, we begin the transformation. Let us take important first steps by eliminating pejorative words such as “elderly” from our vocabularies, and choosing instead to speak truthfully of ageing and being older.