Language matters: The power of words

By Alekhya Johnson, Mary-Lynn Peters, Wendy Zeh, and Barbara Liu

What images come to mind when you see the word “aggressive” in a patient’s chart? What about “wandering” or “violent”?

An 85-year-old man with dementia is admitted to hospital. While being showered, he grabs the care provider. The following note is added to his chart: “patient is aggressive”. Weeks later, his application to long-term care is declined and his discharge is deferred. An assessment by a behavioural care specialist reveals no other documented behavioural incidents; and that the patient had grabbed the provider because he was startled by the shower.

An 82-year-old woman at a reactivation care centre walks around the unit for something to do. Her behaviour is documented as “wandering” and this word is carried over into her long-term care application. Her application is declined due to concern she would require a secure unit, delaying

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That’s her discharge. She did not require a secure unit.

A 75-year-old man with dementia is on an orthopedic surgery unit.

When being turned, he raises his fist and strikes his care provider. The word “violent” is added to his chart. He is referred to the geriatric team for recommendations to manage his behaviours. The team determines that he has poorly controlled pain. When this is addressed, his physical behaviours stop. These examples reveal how language can influence an older adult’s care, length of stay, and journey within the health system. Patients with dementia are especially vulnerable as behaviours may be one of the ways in which they communicate unmet need. When care providers use vague words and phrases without context it can provoke fears, negative stereotypes, implicit biases, and reactive decision-making for other care providers. In contrast, person-centred language, which is specif-