“I Am Not Your Sweetie!”

Caregivers’ Use of Language Impacts Care Recipients

Guest Article by Carole Mulliken

A series of strokes landed Don in a very nice nursing home. His guardian sister who lived several states away, arranged that I attend and contribute to his care conferences in her place.

One day I arrived to hear a string of obscenities worthy of a sailor. From the farthest wing of the nursing home, the booming voice was familiar, but the filthy language was not. In 35 years, I had never heard a crude word pass my sailor friend’s lips. He was mild, articulate, and respectful. He was the soul of diplomacy in his approach, never displaying anger. Yet here, above the heads of dozens of coiffed, blue-haired 80- and 90-year-old ladies, surged a veritable torrent of four-letter words and variations thereof.

What had set Don off? Post stroke, Don was no longer able to get to the bathroom without help. Yet when he rang for assistance, it often arrived too late, and he lay soiled, sometimes for hours. He began to swear, louder and louder. When an aide did arrive, he would hear,

“Now, Sweetie, there’s no need for all that fuss…”

“I am not your sweetie!” he would roar.

Calling someone a pet name is demeaning.

First, a pet name describes a relationship between two genuinely intimate partners or family members. That relationship does not exist between residents and paid employees in a nursing home setting. It is a fiction, a lie.

Second, pet names contribute to the idea that the person with dementia has become a small child or a pet animal. It is infantilizing an adult. Adults with dementia remain adults throughout the disease process, and they expect adult treatment.

Third, when people with dementia lose language and cognition, they become much more sensitive to the meanings conveyed by body language, facial expression, and voice tone. If a caregiver’s nonverbal expressions reveal that she is rushed, over-extended, impatient, or that she finds caregiving distasteful, that is the message the person with dementia will hear.

Adding a pseudo-endearment like “Sweetie” does nothing to hide the distaste the nonverbal messages convey. Communications studies differ in their findings; however, most agree that nonverbal expressions carry more weight than verbal ones, even across healthy populations.

Finally, as was the case with Don, reliance on pet names robs a person with dementia of the respect and achievements he earned throughout his life. When Don’s sister was “encouraged” to find a more appropriate placement for him, she chose a Veteran’s Administration nursing home. Residents’ military rank and position were included in their names. “Sweetie” became “Captain Radcliff, and sometimes “Captain Radcliff, sir.” Using the rank he achieved as part of his name reminded Don of accomplishments he was entitled to but may have forgotten. The Veterans Home may have had many fewer amenities than the costly nursing home, but Don was much happier there because they treated him with respect. They addressed him in ways that acknowledged his accomplishments, and it didn’t cost the facility a penny.

A diagnosis of dementia deprives many of their greatest life achievements.

One surgeon went from Doctor X to simply Henry.

An attorney went from being “Counselor” to plain old “Jerry.”

Professor Emeritus Cummings became just “Lydia.”

Helping people with memory loss connect with their earlier achievements is invaluable.

Exhausted caregivers keep a person with dementia at home in part because they know they are the sole protectors of the person’s identity and memories.

While caregivers consider appropriate placement for a loved one, they can also listen carefully to how residents are addressed. 

Carole Mulliken serves as host and moderator the Dementia Advocacy and Support Network International (DASNI) message boards, having moderated more than 35,000 posts from caregivers, people with dementia, personal caregivers and professionals. DASNI was the first Internet advocacy organization led for and by people with dementia. She was also a caregiver for several people with dementia. A retired high school teacher, counselor, and suicide crisis interventionist, she also writes as a hobby.