Listening to Those Who Call Out
When you walk into a space that houses older adults, what do you hear? What is the soundscape of a facility dedicated to those who, having raised children and grandchildren, now find themselves in need of care? Because these are places of life, the most likely thing a newcomer — visitor, staff member, or new resident — will encounter is voices.
Perhaps the voice of a woman who calls out to anyone who passes: “Come here, dear, I need to tell you something!” Or another who says “Where are you going, don’t leave,” even when the other person has been right there beside her for some time. Another who cries out with dramatic urgency: “Help, they’re bothering me,” no matter how much the staff try to reassure her. The repeated “Nurse, are you there? Nurse!” of an anxious resident who cannot settle. The weaker voice of a man, asking over and over: “Where are you, are you coming?” Or the resident who calls out: “Hello, is anyone there?” And another who announces emphatically: “I have to go to my mother, she’s waiting for me!”
The creatures most naturally given to this kind of expression are infants. Whose silence, if prolonged, becomes a cause for concern. Through their cries, babies may be expressing physical needs — hunger, thirst, discomfort, fear. The cry always resembles a response to something urgent, something pressing, in the absence of words.
An older adult who calls out is an older adult who is gradually losing their words. When neurodegenerative disease has already progressed to the point where words no longer suffice to articulate a clear request, how else is one to express anything? In all the cases above, we can assume that the people sending out these anxious calls are facing a personal emergency: a state of intense anxiety and confusion, alongside an attempt at relief, a search for some feeling of safety. The calls are the solution they have invented. An awkward and ungainly solution perhaps, but a personal one, which manages with great economy of language to ask for something.
These persistent calls, however vague they may sound, are not empty cries. They are always addressed to someone else, from whom they ask to be heard, perhaps even interpreted. That someone may be physically present in the space, or may not be there at all. Usually, though, the other to whom the calls are directed is the staff of the facility, the people who share their daily life. Those we call caregivers, present in the role of companion — listening, reassuring, responding to the anxious requests.
What older adults who call out are often asking for so urgently is human contact, the saving intervention of another person. If you ask them why they are calling out, you may not get a clear answer. The person who listens to their calls is also the one who will give those calls an interpretation. That endless “Hello, is anyone there?” for example, we are sometimes called to hear as: “I don’t want to be alone, could someone from the staff stay close to me?”
The difficulty is that the continuous calling out of older adults, which is essentially a plea for help, can become exhausting for the professionals in a care setting. More than that, it can make them feel helpless and inadequate. Because when the calls continue despite daily efforts to respond, every attempt at an answer begins to feel futile. At the same time, this atmosphere can be difficult for other residents. Gradually, the person who calls out becomes the one most at risk of isolation: through their calls they end up pushing away the very people they were hoping to draw close.
In the face of this risk of isolation, how does the caregiver respond? There are no easy solutions, but what matters is not to stop thinking, observing and asking questions. What role might an unexplained behaviour be playing? What need does it serve for this person? What place might these anguished calls hold in their daily life?
By asking questions, we restore to the confused little cries the meaning they seem to lack. The disoriented older adult calls out, asks for something, and we give their muddled call the value of a message. Like the woman who cries out desperately every afternoon — “Come here, dear, I need to tell you something!” — and you go to listen, thinking in the end she had nothing particular to say. And yet, with surprise, you discover one day that there is one caregiver, someone with whom she has developed a particular bond, who can “translate” every request. Because no voice is ever without reason.
All of this resembles a work of decoding. It is a process of assigning meaning and content to something that would otherwise be flatly recorded as “a behavioural disturbance.” Where others see the undefined, the shapeless, the inexplicable, the caregiver knows exactly what is at stake each time.
This is the purpose that care facilities ultimately serve, and this is their great mission: to not give up, not in the face of the “difficult case,” not in the face of the “heavy situation.”
