CUTE AS A BUTTON

It happened again!   A psychiatric nurse, well experienced, well trained, and well meaning, described the newest admission to our service, a ninety-year-old, very frail looking woman with severe dementia, as “cute as a button”. Hearing this, I cringed. Not only because this nurse said it, but also because it’s commonplace in so many healthcare settings, including specialized geriatric programs, where staff members ought to know better. They don’t!

I know this nurse well. She really cares about the older patients on our geriatric psychiatric service. She’ll go out of her way to ensure their needs are met. I’m sure she means to treat them with the dignity and respect they deserve. So why does she not understand that describing geriatric patients as “cute as a button” is not a good way to do this? Why do so many other equally well-meaning healthcare professionals describe frail elders as cute? And is there anything truly cute about advanced, old age?

Toddlers, puppies, and kittens are cute, little old ladies and men not so much. I doubt that you know anyone hoping to be cute in old age? Quite the opposite, they want to avoid that fate, maintaining their dignity and independence. Think about what old-age “cuteness” signifies. It signifies that formerly robust, capable, independent adults have turned into shrunken, frail, feeble, confused waifs with elfin or gnomish qualities. Not an attractive picture.

My guess is that seeing such elders as cute is a defense mechanism for healthcare workers, a way they can ward off their own fears of decrepitude triggered by close proximity to frail patients nearing death. Emotional contact precautions, that’s what it is. It says, “You’re infected with old age, and I don’t want to catch it”. Contact precautions work by providing a barrier, blocking infection. “Cuteness precautions” provide a barrier too, blocking the emotional reality check staff members need to empathize with older adults and help them maintain their dignity. When you’re ninety years old, there’s nothing dignified about being cute.

We teach cultural competence to healthcare professionals to help them be more sensitive to the personal needs of all kinds of patients. Isn’t it about time we added elderly patients to the list?

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