Caregiving Coverage Style Guide

Contents

Overview: The Importance of Avoiding Ageism and Ageist Language

Glossary   Alphabetized list of terms, with guidance

Appendix  Links to articles with more background and in-depth discussion

Dedication

This work is dedicated to our late colleague Marilyn Ajavananda, the inaugural engagement editor for the New York & Michigan Solutions Journalism Collaborative. The Stylebook began as her project and includes much of her original research and inspiration.

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Overview: The Importance of Avoiding Ageism and Ageist Language

Sweeping judgments about groups or individuals based on a single salient characteristic – including age  – can result in negative portrayals or reinforce inaccurate stereotypes. That is why journalists should avoid using ageist language, which is wording that depicts older adults in offensive, dismissive, unflattering, or incorrect ways. 

These might be obviously negative and insulting terms such as “frail,” “doddering,” or “over the hill.” But, notably, ageist language also can include terms such as “senior citizen” or “elderly” and even descriptions that seem positive such as “grandfatherly,” or “spry for her age.” Steering clear of ageist depictions and cliches requires some effort.

This stylebook seeks to help writers in that effort.

Everyday Ageism and Elderspeak

An article about ageism from Washington University in St. Louis notes that in a 2019 poll, 82 percent of older adults said they had experienced “everyday ageism.” This manifests itself as assumptions that, because of their age, someone has difficulty hearing, seeing, remembering, or understanding, or needs help using technology or doing everyday tasks. Ageist language reinforces such “everyday ageism.” Dictionary.com has a list of more than two dozen words and euphemisms that it categorizes as ageist. (Many of these are noted in the Glossary below.) 

A related problem is “elderspeak,” which is addressing older adults in patronizing ways. The Oxford University Press calls elderspeak “an example of how communication that is meant to be caring can actually come across as prejudiced to older adults.” The Oxford article notes that it is especially common in healthcare, where even medical professionals can lapse into almost childlike references with those in their care. (Picture a nurse telling someone, “Let me help you with that, sweetie.”) Understanding what constitutes elderspeak is another important tool for writers to avoid using ageist constructions.

Finally, Guidelines for Age Inclusive Communication from the Changing the Narrative project also offers a list of ageist storylines to avoid, including story angles about or stories that use the terms "silver tsunami," "gray wave" or the "demographic cliff/timebomb" or “compassionate ageism” stories, which it calls "a paternalistic approach in which older people are portrayed as vulnerable and requiring protection.” 

Conclusion

A set of guidelines called “Challenging ageism  A guide to talking about ageing and older age” from the UK-based Centre for Ageing Better nicely summarizes the need for avoiding ageist language in favor of more age-positive language:

“Communicating about ageing and older people in the right way can help to tackle ageism and promote positive and inclusive behaviour in all aspects of life, from our communities and workplaces to the media, social media and political platforms.”

The purpose of this stylebook is to help you accomplish that.

Glossary (alphabetized list of terms, with guidance)

able-bodied: Note the hyphen, as per Associated Press style. Some members of the disability community oppose use of this term because it implies that all people with disabilities lack “able bodies” or the ability to use their bodies well. They may prefer “non-disabled” or “enabled” as being more accurate. The term “non-disabled” and the phrases “does not have a disability” or “is not living with a disability” are more neutral choices. Source: Disability Language Style Guide. See also disabled, disability entry.

activities of daily living. Often referred to by the acronym ADLs. Actions a person must do by themselves to engage independently in everyday life, such as bathing, dressing, eating, being mobile, and using the toilet. Source: AARP Caregiver Glossary. See also instrumental activities of daily living (IADLs). 

adult care home, also called an adult family-care home (AFCH) or group home. A small assisted living residence where employees provide for adults who are older or disabled and need help with certain tasks but want to remain as independent as possible. They are an alternative to more restrictive, institutional settings, such as nursing homes, which provide 24-hour nursing care. Source: AARP Caregiver Glossary. 

adult day care. This is assistance that provides companionship and help to older adults who need supervision during the day, thereby offering a break to round-the-clock caregivers. They come in various formats including drop-off centers, in-home care, and residential facilities, and can serve both social needs and health needs. Sources: AARP Caregiver Glossary, federal Administration on Community Living..

aged, aging. “Aged” can have a negative connotation (see elderly) and therefore should be avoided. Aging, however, is acceptable for most general uses; everyone is aging all the time so it is acceptable to describe someone that way.

ageism. According to Guidelines for Age-Inclusive Communication compiled by the Colorado-based Changing the Narrative program, ageism is “stereotyping, prejudice and discrimination based on age." As Changing the Narrative further points out, "As with any identity-based prejudice, it works under the assumption that it is possible to judge someone knowing one thing about them – in this case, their age.” Changing the Narrative says ageist terminology includes terms such as elderly, seniors, senior citizens, the aged, and stereotypes such as grandmotherly, grandfatherly, or "spry for his/her age." "Older" as a modifier is a more acceptable usage than most of these because it is more neutral.

Alzheimer's disease. Note the apostrophe. A type of progressive mental deterioration, affecting memory and the ability to process thoughts, that is one form of dementia. However, do not use Alzheimer’s and dementia interchangeably because other sources of dementia also exist. The broader term is dementia; use Alzheimer’s disease only for that specific circumstance. Source: AARP Caregiver Glossary. See also dementia. The Alzheimer's Association offers further guidance on the progressive stages of the condition and early signs or symptoms of it. 

assisted living facility (ALF). Housing for those who may need help living independently but do not need skilled nursing care. The level of assistance varies among residences and may include help with bathing, dressing, meals and housekeeping. Source: AARP Caregiver Glossary.

caregiver. One word. It is capitalized only when it starts a sentence. See care partner. Caretaker, however, is a term to avoid. The AP Stylebook makes the following distinction: “A caregiver is a person who takes care of someone requiring close attention, such as a person with serious illnesses or age-related concerns. Generally use that term, rather than caretaker, in situations involving people receiving care. The term caretaker generally refers to a person who takes care of something, such as a house, when the owner isn’t present.”

care partner. While “caregiver” is acceptable in all uses, the term “care partner” is starting to gain popularity because it depicts the relationship as a two-way street and reduces the emphasis on a care recipient’s dependence. Source: Alzheimer’s Association San Diego. The American Geriatric Society has some reservations about this term, however, because it may not distinguish family caregivers from paid care providers. 

care recipient. Preferred term for someone who receives assistance from a caregiver.

certified nursing assistant (CNA). These members of the care team in a hospital or nursing home perform tasks under the supervision of licensed nursing staff. Duties may include helping patients with their daily needs, such as eating, bathing, dressing, and toileting; helping patients move from a bed to a chair or wheelchair and back; and ensuring patient comfort by changing bedding, positioning items so they are in reach, etc. Source: Premier Nursing Academy. See also home health aide (HHA).

Consumer-Directed Personal Assistance Program. A Medicaid program available in several states that permits chronically ill and physically disabled people to choose, train and supervise workers who help them with activities of daily living such as bathing, light housework and meal preparation so they can remain in their homes. Some relatives and friends of participants can qualify to be paid through this program. Source: AARP Caregiver Glossary.

cripple, crippled: Avoid using these terms, which are offensive when used to describe a person who is unable to walk or has difficulty walking. Source: AP Stylebook

dementia. A general term for a decline in cognitive ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's disease is the most common cause of dementia, but not all dementia comes from Alzheimer's. Source: AARP Caregiver Glossary. See also Alzheimer's disease.

dinosaur.  A disparaging term if used to describe an older person, according to Dictionary.com's Glossary of Ageism Terms.

disabled, disability. In general, do not describe someone as “disabled”  unless it is clearly relevant to the story. Do not use “handicapped.” If a description must be used, try to be specific. For example, "An ad featuring Michael J. Fox swaying noticeably from the effects of Parkinson’s disease drew national attention." Also avoid descriptions that connote pity, such as “afflicted with,” or “suffers from.” Use instead, “has.”  Source: AP Stylebook See further, detailed discussion at the Disability Language Style Guide published by the National Center on Disability and Journalism. See also able-bodied.

elder. This word may be used appropriately as a noun, e.g., "Children should respect their elders," or "She is an elder in her church." It also can appear as an adjective, e.g. "an elder statesman." These usages show a level of respect for age, unlike the word elderly. See also entries for elderly, and older/senior/elderly.

elderly. Do not use the word elderly to describe a person or  population of people. To many people, the word “elderly” connotes a person who is both old and frail. The preferred term is “an older person” or better still report the age. “A 68-year-old …”  See also Older/senior/elderly.

family caregiver, informal caregiver. This term is used to describe any relative, partner, friend or neighbor who has a significant personal relationship with and provides a broad range of assistance for an adult with a chronic or disabling condition. Source: AARP Caregiver Glossary. Note, however, that the American Geriatric Society has reservations about informal caregiver because the term “informal” suggests care that is “casual, unstructured, unofficial" -- and therefore not essential.

fogey, old fogey. Considered a disparaging term, according to Dictionary.com's Glossary of Ageism Terms. Do not use.

fossil.  A disparaging term if used to describe an older person, according to Dictionary.com's Glossary of Ageism Terms.

geezer. Generally considered a disparaging term, according to Dictionary.com's Glossary of Ageism Terms.

grandpa/grandma, granny, gramps. Mentioning that someone is a grandparent will, of course, be relevant to some stories. Terms such as "granny" or "gramps" might appear in quoted matter, such as a grandchild using their nickname for a grandparent. But these words also should be used carefully because in some contexts they may have unflattering connotations, according to Dictionary.com's Glossary of Ageism Terms.

handicapped. Do not use in describing a disability or a person.  Also, avoid uses such as handicapped parking; instead, accessible parking. Source: AP Stylebook. See disabled, disability entry.

home health agency. A for-profit company or nonprofit agency, often certified by Medicare, that provides health-related services such as nursing, personal care, social work, or occupational, physical or speech therapy in a client's home. Source: AARP Caregiver Glossary.

home health aide (HHA). A trained and certified health care worker who assists a patient in the home. Duties typically include help with hygiene and exercise, light household work such as meal preparation, and monitoring the patient's condition. Source: AARP Caregiver Glossary.

identify-first language. See people/person-first language entry.

informal caregiver. See family caregiver, informal caregiver entry.

instrumental activities of daily living. Often referred to by the acronym IADLs, these are those activities that allow an individual to live independently, including being able to cook and clean, manage finances and provide transportation. IADLs should not be confused with basic activities of daily living (ADLs), such as feeding, dressing, bathing, and walking. Source: National Institutes of Health National Library of Medicine. See also activities of daily living.

invalid.  This may be the oldest term for someone with physical conditions that are considered seriously limiting. However, this term should not be used; it is now widely viewed as offensive because it implies that a person lacks abilities. Source: Disability Language Style Guide of the National Center on Disability and Journalism.

Medicare, Medicaid. Do not confuse these federal programs. Medicare provides assistance to US residents ages 65 and older, and serves primarily that demographic, although disabled people and minor survivors of deceased parents may be eligible. Medicaid provides services for individuals of all ages who meet the proper lower-income threshold. Many older individuals do receive Medicaid (as well as Medicare) but Medicaid is not exclusive to older people. Both programs are overseen by the federal Centers for Medicare & Medicaid Services. See also Consumer-Directed Personal Assistance Program entry in this glossary, and more detailed discussion in the AARP Caregiver Glossary.

Medicare Advantage, Medigap. Both of these are private-insurance programs that work in conjunction with traditional Medicare, but they are not the same and should not be used interchangeably. Medicare Advantage plans are private health insurance plans that work as a replacement plan for standard Medicare (although participants must join, and pay premiums to, the traditional program). They offer the benefits covered by traditional Medicare (parts A and B) but may also provide additional benefits such as prescription drug, dental, and vision coverage. Often they have an additional premium, and many programs have been found to have cost and care problems. MA coverage from some insurers has narrow access to providers and prior-authorization requirement sometimes with high denial levels.. Medigap insurance, on the other hand, covers co-pays, deductibles  and certain other expenses for those enrolled in traditional Medicare but does not offer benefits beyond the standard coverage. 

memory care communities. Separate facilities or specialized units of an assisted living center that focus on helping people with Alzheimer's disease and other forms of dementia, where the staff is specifically trained to manage behavioral problems and other impairments. Source: AARP Caregiver Glossary.

mental illness This is an umbrella term for many different conditions that affect how individuals act, think, feel or perceive the world. The most common forms of mental illness are anxiety disorders, mood disorders and schizophrenia disorders. Severity and symptoms vary widely. Because of perceived stigma, the term “mental illness” is becoming less used in favor of constructions such as “a person diagnosed with a psychiatric disorder” or “a person with a mental health history.” However, the term “mental illness” still is widely used within the medical and psychiatric professions. Source: Disability Language Style Guide  For more information, see the National Institute for Mental Health.

nursing home. A public or private residential facility providing a high level of long-term personal or medical care for chronically ill, disabled and older people who are unable to care for themselves properly. Source: AARP Caregiver Glossary.

older/senior/elderly. All three of these terms are commonly used to refer to people of higher age groups. The words elderly and senior have begun to fall out of favor, however, and the term older has become the preferred word. The most common objection to the words senior and elderly is that both terms are thought to imply that a person is frail, and neither term accounts for the wide range of lifestyles or abilities of the people they refer to. However, the word older is typically seen as the most neutral, the most factually accurate (everybody is older than someone), and has the least implications about lifestyle. Source: The Language of Ageism at dictionary.com. Note that being specific about a person's age eliminates the need for any sort of adjective. The following additional guidance is offered by the Associated Press Stylebook: “Older adult is preferred over senior citizens, seniors or elderly as a general term when appropriate and relevant. It is best used in general phrases that do not refer to specific individuals, such as ‘concern for older people’ or ‘a home for older adults.’ Aim for specificity when possible, such as ‘new housing for people 65 and over’ or ‘an exercise program for women over 70.’ The term elderly is acceptable in headlines when relevant and necessary because of space constraints. But aim for specificity when space allows: ‘Couple in their 90s die in fire’ rather than ‘Elderly couple die in fire.’ Terms like senior citizen and elderly are acceptable in reference to an individual if that person prefers them. Do not use ‘the elderly’ in reference to a group.”

patient, resident. Those who live in assisted living or skilled nursing facilities should be referred to as residents of the facility, not patients there.

people/person-first language (in contrast with identity first language): According to the Disability Cultural Center at Syracuse University, “ ‘People-first’ or ‘person-first’ language is a way of describing disability that involves putting the word ‘person’ or ‘people’ before the name of a disability, rather than placing the disability first and using it as an adjective.” An example would be “person with bipolar disorder” rather than “bipolar person.” While this is especially significant with discussion of persons with disabilities, it is relevant also for many situations involving older adults, especially those with conditions that produce some sort of disability or limitation. For example, “person with dementia” would be preferred over other constructions. This is especially true because using “dementia” as an adjective could lead to using a noun with negative connotations such as “dementia sufferer” or “dementia patient” (see patient, resident entry).

respite care. Short-term or temporary care of a sick, disabled or older person for a few hours, days or weeks, designed to provide relief to the regular caregiver. Source: AARP Caregiver Glossary.

senile. Dictionary.com defines this as "showing a decline or deterioration of physical strength or mental functioning, especially short-term memory and alertness, as a result of old age or disease." Avoid using this term in favor of a neutral description of an older person's specific situation or limitations.

senior, senior citizen. See Older/senior/elderly.

silver tsunami. Avoid this term, which is sometimes used to describe demographic trends that show older people comprising an increasing proportion of the population. A tsunami is a natural disaster in which a massive ocean wave strikes land, causing widespread destruction. Using the term as a reference to the aging population therefore also implies a catastrophe. For the same reason, avoid terms such as demographic time bomb or demographic cliff to describe the situation. Source: Changing the Narrative.

Veterans Affairs, Department of. Not Veterans Administration, and note the lack of an apostrophe. It formerly was the  Veterans Administration but changed to the Department of Veterans Affairs when it became a cabinet level department in 1989. VA (no periods) acceptable on second reference. Source: AP Stylebook.

wheelchair user: People use wheelchairs for independent mobility. Do not use “confined to a wheelchair,” or “wheelchair-bound.” A wheelchair can actually liberate. Mention wheelchair use when relevant.

Source: AP Stylebook.

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Appendix 

Links to articles with more background and in-depth discussion

Ageism – The Unnoticed -ism. (2021). Washington University in St. Louis Institute for Public Health.

Challenging Ageism  A Guide to Talking About Ageing and Older Age. (2021) Downloadable PDF (17 pages) from the UK-based Centre for Ageing Better.

Disability Language Style Guide (2021). Published by the National Center on Disability and Journalism. Also available as PDF 

Elderspeak: The Language of Ageism in Healthcare. (2021). Oxford University Press blog.

Six Tips for Improving News Coverage of Older People. (2022) Journalist’s Resource (Harvard University).

The Language Of Ageism: Understanding How We Talk About Older People. (2021). Discussion of using terms such older vs. senior vs. elderly, as published at dictionary.com

Using Person Centered Language. (2017). Alzheimer Society of Canada. PDF download.

Words Matter: The Language of Family Caregiving (2019). Editorial in the Journal of the American Geriatric Society.

Resources for age-positive images

Changing the Narrative’s Guidelines for Age Inclusive Communication and AARP both discuss the importance of using age-positive images, and offer the following ideas for sources of those photos:

• Changing the Narrative & NextFifty Initiative photo collection

• Unsplash collection, compiled by Changing the Narrative

• AARP “Disrupt Aging” collection via Getty Images

• Ageing Better collection (UK)

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