DON’T CALL MY PATIENTS CUTE
I was sitting in the nursing station at the rehabilitation hospital recently when a new admission arrived. She was a very old looking woman who came for rehabilitation after a surgical repair of a broken hip. She was sitting up on the gurney, amiably chattering at the ambulance drivers who had transporter her. She was gushing about how safe she felt in the hands of such big and strong, and handsome young men. A number of nurses were present in the nursing station as she arrived. On seeing them, she assured her “boys” that they could leave her off and, in a loud, indiscrete voice, encouraged them to “go make time” with the nurses. The nurses were immediately enchanted with her and praised her for being so “cute”. Each hoped to have her as part of their assignment for the shift.
What was it about her that made her cute? Given the setting and circumstances, her incongruous lightheartedness, and cheerful disposition stood out. She also was mildly socially indiscreet and inappropriate, but without being aware of it. According to Dictionary.com, the definition of cute involves a dainty attractiveness, affected cleverness, and being precious, endearing, or adorable. Older patients with these qualities often have mild dementia. This causes them to behave in ways that would not have been part of their personalities when they were mentally healthier.
Finding such older people to be cute, in my experience, is a common reaction among people in general and healthcare workers in particular. What troubles me is that there’s a patronizing quality to their praising her cuteness. Albeit unintentional, it undermines proper respect for the dignity older people deserve. Geriatric workers and healthcare providers owe a special duty to respect frail, dependent elders’ dignity.
Feeling that an older person is cute represents a failure of empathy. It is a failure to be mindful of the self-image most people would want to maintain were they capable. Healthcare professionals and caregivers have an obligation help frail elders maintain their dignity. An aspect of this is recognizing and respecting the self-image a person maintained, and would have liked to continue to maintain, were they capable. Old people do not consider old age cute. I doubt very many firefighters, construction workers, high school principals, librarians, or corporate CEOs ever aspire to an old age of cuteness. Most would find it mortifying rather than amusing or endearing.
I suspect that seeing cuteness in a frail elder probably reflects a defense against empathically experiencing this mortification for the older person. It also holds off anxiety of becoming, frail, decrepit, unaware of oneself, and helpless oneself, some day.
You may think that I am making too big a deal of this, but the problem is that staff who refer to frail, older patients as cute, in my experience, are highly prone to use elderspeak more generally in their interactions with patients. Elderspeak refers to a style of patronizing, infantilizing communication with elders that often includes elements of baby talk. For further discussion of elderspeak and its real impact on the lives of geriatric patients, see the July issue of the Moak Aging & Mental Health Report. Use of elderspeak represents an inadvertent failure to provide professional care consistent with goals of maximizing the treatment and wellbeing and patient satisfaction of older patients.