WhitepaperModerate evidence
Dignity-First Activity Design: Adult Materials and Respectful Communication
What the research on elderspeak and person-centered care means for activity materials
Written for: Activity directors, Nursing leaders, Compliance officers
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Key takeaways
- In recorded nursing home care, elderspeak, such as terms of endearment like “honey”, a sing-song tone and simplified speech, made resistance to care more likely in people with dementia.1
- In a cluster randomized trial, a three-session staff course (CHAT) reduced both elderspeak and residents’ resistance to care.2
- Person-centered care puts the person’s identity and perspective first: Kitwood’s personhood and Brooker’s VIPS framework.34
- Federal rules require facilities to treat each resident with respect and dignity, recognizing each resident’s individuality (F550).5
- Cognicopia applies this to print: adult subjects and art, prompts that invite rather than test, and no cartoon or preschool imagery.
At a glance
Why tone matters1 min
In brief: Elderspeak makes resistance to care more likely; training staff out of it reduces it.
Person-centered care1 min
In brief: Care built around the person’s identity, values and perspective.
Tom Kitwood’s Dementia Reconsidered put the personhood of people living with dementia at the center of care practice.3 Dawn Brooker summed up person-centered care as VIPS: Valuing people, an Individualized approach, seeing the world from the Perspective of the person, and a supportive Social environment.4
From speech to print1 min
In brief: Childish materials send the same message as elderspeak.
No trial has compared childish with adult activity materials. The case for adult materials is reasoned from the communication evidence and from person-centered care: a cartoon worksheet or a preschool coloring page tells an adult what elderspeak tells them, that they are being treated as a child.
A reasoned principle, not a trial result
The elderspeak studies measured spoken communication. Applying them to print is a reasonable extension, and it is labeled as one here.
Cognicopia’s dignity rules1 min
In brief: Adult subjects, invitations instead of quizzes, and automated checks on every page.
- Adult subjects and art: gardens, kitchens, tools, cars, workplaces and local places, drawn with care.
- Invitations, not quizzes: “Tell me about…” rather than “Do you remember…?”.
- No cartoon mascots, no childish fonts, and no preschool language such as “circle time”.
- No labels that reduce a person to a condition: “a person living with dementia”, never “a dementia patient”.
- Automated checks on the tools’ text and the Academy’s lessons flag labeling, baby talk and preschool words before anything ships.
What this means for your community
- Review your activity materials for childish art, fonts and language, and replace them.
- Train staff in person-centered communication. The Academy masterclass Person-Centered Communication in Dementia covers it.
- Build activities from each resident’s own history, preferences and adult roles.
- Describe residents by who they are, never by their diagnosis.
What this evidence does not show
- No study has directly compared adult with childish activity materials.
- The elderspeak research concerns spoken communication in care, not printed activities.
- Dignity also depends on how materials are offered, not only on what they look like.
References
- Williams KN, Herman R, Gajewski B, Wilson K. Elderspeak communication: impact on dementia care. American Journal of Alzheimer’s Disease & Other Dementias. 2009;24(1):11–20.
- Williams KN, Perkhounkova Y, Herman R, Bossen A. A communication intervention to reduce resistiveness in dementia care: a cluster randomized controlled trial. The Gerontologist. 2017;57(4):707–718.
- Kitwood T. Dementia Reconsidered: The Person Comes First. Open University Press; 1997.
- Brooker D. What is person-centred care in dementia?. Reviews in Clinical Gerontology. 2004;13:215–222.
- 42 CFR § 483.10: Resident rights. Electronic Code of Federal Regulations. Accessed September 30, 2026. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.10 View source (opens in a new tab)
How to cite this page
Cognicopia. Dignity-First Activity Design: Adult Materials and Respectful Communication. Cognicopia Clinical Science & Research Center. Updated September 30, 2026. Accessed [date]. https://cognicopia.org/resources/research/dignity-first-design/
An educational summary for professionals, not medical advice. It reports each source’s findings as the source states them, and was reviewed against its sources on September 30, 2026. Cognicopia makes the tools this page mentions. Found an error? Tell us.