The interactional environment of institutionalized elders has been described as communication-impaired due to the lack of opportunities for ordinary adult-to-adult conversation. Patronizing speech from caregivers is one form of constraining communication that may frustrate elders within institutions. In this study, 256 adults (randomly assigned to one of 16 experimental conditions) evaluated either a patronizing conversation between a nurse and an elderly woman in a nursing home or a more neutral version of the same conversation. In a complex between-subjects design based on Communication Accommodation Theory, we examined the possible influences on the evaluation of patronizing speech of three manipulations: resident alertness, personal situational topic, and privacy of setting for the conversation. Across all contexts, the nurse using a patronizing speech style was viewed as less respectful and less nurturant than the nurse using the neutral style. The resident was considered less satisfied with the patronizing conversation. The situational topic manipulation yielded main effects for these same variables, with the nurse criticizing a resident about a personal issue being viewed as less respectful and nurturant than the nurse raising a safety issue. Moreover, the resident addressed about a personal issue was rated as less competent than the resident addressed about a safety issue. Situational topic interacted with speech style on only one measure, while resident alertness and privacy had no impact on the negative connotations of patronizing speech.