A PhD student’s experience of working with VOICE

Background

When I first applied to undertake a PhD, I had no idea where my journey would take me. I had completed a BSc and an MSc in Forensic Psychology at the University of Lancashire, and after witnessing my grandmother’s difficult journey with Dementia, I aspired to focus my research in this area. I was lucky enough to be awarded an ESRC DTP Collaborative PhD studentship, working with professors Alison Pilnick, Sarah Goldberg and Rowan Harwood at the University of Nottingham on a project entitled “Is ‘elderspeak’ always inappropriate? An empirical investigation of the use of elderspeak in dementia care in the acute hospital context.”

Elderspeak is a style of talk often used towards older adults. It involves many features such as high pitch, simplified sentences and grammar, terms of endearment and ‘excess’ praise. Often, people compare this style of talk to how you might speak to a young child. Past research has tended to assume that elderspeak is always patronising or infantilising, but this was not typically based on investigations of what happens in real life.

As a part of my studentship, I was granted access to some of the original VOICE data, and I joined the VOICE2 team on the wards to collect new data. Working with the VOICE2 team provided me with valuable experience and allowed me to develop my research skills and knowledge of data collection on the hospital wards. During this time, I met many lovely healthcare professionals and patients and observed many of the ups and downs of acute hospital care. (Check out this blog by Dr Isabel Windeatt-Harrison for an in depth look at data collection).

The chance to analyse the combined VOICE and VOICE2 data using conversation analysis allowed me the unique opportunity to examine how healthcare professionals actually use features of talk that could be classified as ‘elderspeak’ in practice and to see how people living with dementia actually responded in real life hospital interactions.

Findings

Overall, my findings showed that in hospital interactions, use and response to elderspeak-style talk depended a lot on the context of the situation. Features of elderspeak fulfilled a variety of functions which were often beneficial in healthcare interactions. For example:

Terms of endearment (discussed here and here) can be helpful when beginning and ending conversations. Terms of endearment can also be useful to address (mitigate or soften) the discomfort of a sensitive or uncomfortable activity like inserting a needle or doing intimate care.
Praise can work as a supportive action - aiding orientation to tasks by providing encouragement and/or celebration on an ongoing basis or when a task has been completed.
Finally, prosody (pitch, tone, duration and volume of the voice) draws attention to greetings, conveys key messages and adds additional layers of meaning when people take turns at talking.

All of this led to the writing of my thesis.

Looking ahead – the work continues!

My work with VOICE has contributed substantially to my research journey. Following my PhD, I have undertaken wider work on healthcare interaction at Manchester Metropolitan University, working with Professor Alison Pilnick on a project which has examined interactional authenticity of simulation in communication skills training for nursing students, adding to my experience of healthcare communication research.

I am delighted to have been awarded a FSHI Mildred Blaxter Post-doctoral Fellowship (beginning October 2025). This award will allow me to further expand upon, develop and disseminate my elderspeak work. This award will give me time to share my research findings more widely, with people like healthcare workers and other caregivers, as well as with academic audiences. In particular I am going to develop some new training resources for this VOICE website, to help people understand how to apply my findings on elderspeak and improve their communication skills. I also hope to do some more digging into the VOICE data to discover new insights.