Strategies for Communicating with the Elderly
by Lee Guion, MA, RRT
Communication is the key. This adage is emphasized from the halls of Congress to the campaign trail. In our healthcare facilities, from the O.R. to C.C.U., to the medical surgical units, we strive to assure medication orders, treatment plans and surgical sites are identified, double checked and communicated to all unit team members responsible for the health and safety of our patients.
Communication is the key to understanding the purpose of physician-prescribed medication, proper delivery techniques and possible side effects. As respiratory therapists, we have the opportunity each time we administer an aerosolized medication or demonstrate chest expansion and coughing techniques to give our patients the skills they need to manage their respiratory disease. We know that hospital admissions for exacerbation of chronic pulmonary disease present a “teachable moment” in which we may emphasize the need for smoking cessation, use of controller medication, or airway trigger avoidance.
But what is communication beyond the interchange of thoughts and information? There is intention, certainly, but the best of these can be lost in the actual delivery. To this end, I will share with you tips for communicating with the elderly and those with sensory losses.
The Rule, Not the Exception
Most older adults experience decline in eyesight and hearing. By age 40 our vision begins to decline and by 70 poor vision is commonplace. This is due to the loss of elasticity in the lens of the eye which results in increased density and rigidity, a flattening of the convexity of the cornea. Presbyopia, “old eye,” is the reason our patients cannot read prescription labels, medication instructions, and, frequently, the handouts we have so carefully developed and distributed prior to hospital discharge. In our attempts to present colorful and appealing educational materials, we often print them on pastel or soothing green, blue or violet paper. Sadly, the yellowed lens of the aging eye makes distinguishing colors at the blue end of the light spectrum difficult. Dark brown, black and blue may appear to run together.
Loss of elasticity in the iris, decrease in size of the pupil, and increased opacity in the lens combine to both reduce the amount of light into the eye and increase the sensitivity to glare from sunlight and bright artificial light. Bright light from one source such as a bedside light, window, or light above a bedside sink with mirror, may make vision more difficult. Lens rigidity diminishes visual acuity, so words may appear blurred and images muted.
Hearing impairment, too, is a normal part of the aging process due to thinning and fibrosis of the tympanic membrane. Presbycusis, or age-related hearing loss, results in the inability to distinguish high-pitched frequencies. Degenerative changes in the eighth cranial nerve, cochlea, auditory nerve pathways, and cilia result in the decreased ability to distinguish between consonants. Aging ears may not be able to distinguish between consonants composed of high frequency tones such as f, s, g, z, and t, and combined consonants ch and sh.
Elderly patients without cognitive deficits require directions be given slowly and distinctly to facilitate recall. By doing so, you can expect an 80-year-old to retain the same information as a 21-year-old.
Communication is a two-way street. We need to meet one another half way. Our education about managing respiratory symptoms will be to no avail if our patients have a different perception of the cause and treatment of their disease. We may be lulled into a false sense of accomplishment as our patients nod their heads in seeming agreement to our instructions. We may be dismayed to find them in our emergency department a month later. Some people may label them “non-compliant” with treatment and write them off.
The LEARN mnemonic developed by Elois Ann Berlin, RN, MPH, PhD, for the Stanford University Division of Family Medicine and the South Bay Area Health Education Center through a Department of Health and Human Services grant* is a guideline for health practitioners who desire effective communication with their patients. Its use fosters dialogue and respect for cultural and individual differences in the experience of illness and disease.
L Listen with sympathy and understanding to the patient’s perceptions
E Explain your perception of the problem
A Acknowledge and discuss differences and similarities
R Recommend treatment
N Negotiate agreement
*DHHS Grant 5-U01-PE-00053-04
Strategies for Communicating with People with Vision and Hearing Loss
Face patient directly within easy view. To enhance lip reading and
Make sure you have patient’s attention nonverbal communication such as facial expressions and gestures.
Do not hide mouth with hand or chew People with hearing loss rely
food or gum while talking on multiple clues to word meaning, including context, body language and lip reading
Do not stand in front of window or If speaker is back lit, lip
bright light reading will be difficult and facial expressions harder to distinguish
Avoid noisy backgrounds. Turn TV Background noise makes
or radio off sounds difficult to differentiate
Don’t shout Shouting makes hearing more difficult
If you are not understood, restate Consonants with high
question or sentence more slowly frequency tones may be difficult to differentiate
Lower the pitch of your voice Loss of ability to hear high-pitched sounds occurs in early stages of normal, age-related hearing loss
Use a combination of methods Combine text, pictures,
to communicate and demonstrations with verbal explanations to utilize as many senses as possible
Use good contrast between background Contrasting background and
and lettering of printed materials.
Use lettering will allow text to “pop
dull finish out.” Shiny paper will produce glare.
Use large print for educational materials Improve deficits to the degree possible
Assure room is well lit and light Avoid glare and assure patient
evenly distributed is able to see clearly
If patient uses a hearing aid, make sure Use assistive devices to
it is turned on, positioned correctly, and enhance communication and
has a functioning battery; identify need increase patient independence
for other assistive devices (glasses Vision loss may contribute to
and/or magnifying glass) a sense of isolation, which may lead to withdrawal and depression
Minimize noise, distractions and Older adults require directions
stimuli during questions or instruction be given slowly to enhance recall.
State instructions slowly and clearly. Verify information has been
Ask patient to repeat instructions in heard and understood
their own words. Allow time for
questions and clarification
Lastly, ask if there is anything else Open-ended questions allow
the patient would like to discuss patients to address issues or concerns not previously covered
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Aging Process. J.B. Lippincott Company. 1996.
Hogstel, M O Gerontology: Nursing Care of the Older Adult. Delmar Publishing. 2001.
Purtilo, R Health Professionals and Patient Interaction. W.B. Saunders. 1990.
An Aging Society: Implications for Health Care Needs and Impacts on Allied Health
Practice and Education. A Report of the National Task Force on Gerontology and
Geriatric Care Education in Allied Health. Journal of Allied Health. 1987: 16(4); 301 -