The Iowa Coding Scheme for Elderspeak: Development and Validation

Background and Objectives: Elderspeak is communication that sounds like babytalk and is a common form of communication often used in dementia care. The purpose of this research was to develop and validate the Iowa Coding for Elderspeak (ICodE) scheme, as a means of standardizing the coding of elderspeak across studies. Research Design and Methods: The ICodE categorizes communicative interactions by nursing staff into 5 states that encompass who is speaking, who is being addressed, and in what manner. ICodE also captures different attributes of elderspeak, such as vocabulary usage and prosodic modifications. Intra-rater and inter-rater reliability were evaluated for each communication state. Convergent validity was evaluated by comparing the use of elderspeak to ratings of emotional tone by 31 community-dwelling older adults and to the occurrence of rejection of care during 88 observations of hospital dementia care. Results: Inter-rater and intra-rater reliability were excellent for each communication state with confidence intervals ranging from moderate to excellent. Convergent validity with the emotional tone ratings was established for 10 of the 11 elderspeak attributes, indicating that older adults perceive these attributes as more patronizing and/or less respectful than neutral speech. Convergent validity with rejection of care was established for 8 of the attributes, suggesting that these aspects of elderspeak were also negatively perceived by individuals living with dementia. Discussion and Implications: The ICodE is an evidence-based coding scheme that can reliably and validly document the use of elderspeak by nursing staff and that will facilitate uniformity in elderspeak research going forward.