Communicating with seniors

Helping the hard-of-hearing

Doctor talking to older patient
Communicating with older patients is a challenge for professionals, demanding a more personal, holistic approach.

JERRY Stoddard, an active 72-year-old. recently walked out of his urologist's office believing that he was facing major surgery for his enlarged prostate. As a matter of fact, the doctor had recommended a procedure much less invasive. Jerry was not relieved of his error until his next visit, when a nurse offered him a pamphlet explaining the procedure the doctor had actually recommended.

Luckily, this simple misunderstanding had no adverse consequences. In many other cases, however, such a misunderstanding can have serious and even fatal results.

Communication barriers

It has long been known that the elderly have difficulty reading, mainly because of the loss of short-term memory. For this reason, language experts recommend that medical information for the elderly be written at the 5th-grade level. They also recommend that medical procedures and disclosures be carefully explained to the elderly in two-way conversations that can determine if the patient clearly understands the material.

Studies have also shown that speech may be more difficult for the elderly to understand than printed text. Not only do they suffer from loss of short-term memory, but also of high-frequency hearing and sometimes impairment of the mental ability to process speech.

Some studies show that high-frequency hearing loss accounts for two-thirds of difficulty in speech perception among the elderly. General cognitive decline accounts for the other third. Other studies show that many seniors have difficulty understanding fast or muffled speech, the speech of children, reverberation, and speech in a noisy environment.

Patricia Kricos, in Trends in Amplification, writes:

At least 1 out of 5 adults over 60 years have difficulties not only with their ears being able to hear sounds, but also with being able to actually process sounds that the ear delivers to the brain. As a result, these adults may have additional difficulties that other hard-of-hearing people do not have. For example, in everyday situations, they may have greater problems with:

  1. Understanding someone who talks very quickly or with an accent
  2. Knowing where sound is coming from
  3. Identifying who is talking in a group conversation
  4. Understanding quickly what a person is saying
  5. Figuring out what people are saying when listening conditions are poor, such as in noisy rooms
  6. Making sense of what people are saying when conversing with several people at the same time
  7. Keeping up with quick changes in conversational topics
  8. Becoming very tired during conversations because of the extra effort needed to understand what the talker is saying

Remedies for the hard-of-hearing

According to other studies, because the loss of high-frequency hearing can impair the mental ability to process speech, using a hearing aid can help prevent such decline.

Other technologies to help the elderly understand speech include:

Many health-care professionals use the REALM Health Literacy Test to determine their patient's ability to read instructions. There is now a similar test for assessing hearing difficulties, the Hearing Handicap Inventory for the Elderly (HHIE).

Kricos (above) also writes:

As researchers have pointed out, people with hearing impairment live in an acoustically hostile world. A number of authors have described group support programs for adults with hearing loss that focus not only on orientation to hearing aids but also on the psychosocial aspects of living with hearing loss, collaborative problem solving, and use of facilitative and repair strategies to overcome communication difficulties.

Following directions for drugs

Old lady with hearing aid
Wearing a hearing aid can help prevent a decline in the mental ability to process speech.

Half the U.S. population takes at least one prescription drug. Sixty percent of seniors take five or more medications. Yet, about half of patients prescribed a drug do not folllow directions.

The Better Health Blog has an interesting graphic explaining how poor communication contributes to the failure to follow instructions for prescription drugs. Physicians spend only about 49 seconds during an office visit explaining a new prescription to patients. Half of the patents leaving the office do not understand what they were told to do. Moreover, doctors underestimate the information patients need while overestimating the amount of information conveyed.

Bridging the communications gap

There is often a social distance between doctor and patient. Doctors often dominate the course of the conversation and speak from a distant technical perspective.

Many studies show the mismatch of the frameworks in which the doctor and the patient are working. Doctors view health as a set of observable facts and view symptoms as a pathology. Their patients, however, regard health and disease as intimately personal, often with threatening implications for themselves, their relationships, and other aspects of their lives.

In the best circumstances, doctor-patient communication can be a difficult exercise. With older patients, however, the situation is even more complex.

Language difficulties and multiple health problems require a much more holistic approach. Personal issues of self-worth, relationships, autonomous living, financial stress, and travel arrangements become more central to the diagnosis and treatment. For the elderly, social relationships are crucial medical concerns.

Overcoming language difficulties

Hearing loop sign in airport
The hearing-loop icon indicates installation in the Grand Rapids airport.

Many medical and nursing schools now teach patient communications as a central element of medical practice. While communication is primarily speech and written materials, it can also employ visual aids and non-verbal elements. For example, body language and tone play significant roles and can have a greater impact than words.

While speech and conversation provide immediate feedback, printed materials witten in appropriate language can be a very important aid for communication. The best way to determine if the patient has understood instructions, however, is by collaborative problem-solving in conversation with the patient.

Here are more communication tips, not only good for doctors, nurses, and social workers, but also for anyone else dealing with the elderly:

Patients also are learning to communicate more effectively in the doctor's office:

  1. This means first of all being pro-active and speaking up in the doctor's office. Be as straight-forward as you can in describing symptoms.
  2. Don't be afraid to questions if there is something you don't understand. That is what the doctor is there for. If the doctor prescribes a medication or a new procedure, be sure you understand its purpose and how it is supposed to work.
  3. If the doctor or nurse gives you something to read describing your condition, take it home and read it carefully. Ask questions later if there is something you don't understand.
  4. Make every visit a test of your communications skills. In the doctor's office, better communications can save your life.

The above article in Family Practice Management states:

By the year 2030, a projected 71 million Americans will be age 65 or older, an increase of more than 200 percent from the year 2000, according to the U.S. Census Bureau.

Itís estimated that some 6,000 people turn age 65 every day and, by 2012, 10,000 people will turn age 65 every day.

Aging health care consumers will increase the demand for physiciansí services. In the United States, people over the age of 65 visit their doctor an average of eight times per year, compared to the general populationís average of five visits per year.

Physicians should prepare for an increasing number of older patients by developing a greater understanding of this population and how to enhance communication with them.

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