Nurses encounter many older people in the course of their careers. This makes sense, because as a person ages they may require more frequent care. Communicating with patients is a skill that you need to practice. Addressing older patients can be different to talking to other adults; older people may be scared, may not want to bother you, or may not fully understand what you are talking about. Memory and cognitive disturbances can also make talking to this population challenging. Of course, it goes without saying that you should respect the intellectual capacity of the person you’re speaking to regardless of their age.
“Wrinkles should merely indicate where the smiles have been.” – Mark Twain
Give Them Time
One of the most important considerations when talking with older people is time. If you show the slightest amount of impatience or stress, you’re likely to shut them down. It is hard to dedicate the time necessary to talk properly to an older person, but this is the way to open the communication channel. Some elders are afraid to speak out because they don’t want to bother you or be seen as someone who is a complainer. Some don’t have the mental capacity to talk to you or to fully express themselves immediately. It is only over time that you get the whole story.
Another challenge you may encounter when communicating with older people is that they don’t feel comfortable “talking back” to the medical professionals. This is especially true of doctors, but they may feel the same reticence when talking to nurses. If you are there and available for their concerns, they may be more willing to talk to you than to the doctor who might only spend five minutes in the room. You may find out something that is vital to the care and comfort of that patient just by spending an extra few minutes with them. Yes, nurses are busy, but older people need time to express their pain, fear, and questions, and you need to allow for that in your schedule.
Explain Things Simply
As with children, it is best to avoid medical jargon when speaking with older people. Medical jargon isn’t really a good way to talk to any patient, but it is particularly detrimental when speaking with the elderly. However, you don’t want to come across as condescending, either. It is a fine line to walk, and you need to base your language on the questions and cognitive ability of the patient you are speaking with.
Try to use language that is simple, clear, and non-threatening. You should also strive to be as honest as possible. Some older patients need to write down what you are telling them so that they will remember it. Be prepared to repeat yourself and express concepts in different ways so that your patient can grasp what you are trying to say. One of the most important parts of helping your elderly patients is acting as a kind of interpreter for the doctor. Try to be on hand when the doctor talks to the patient so you can explain later what they said. Older people will often be overwhelmed by a doctor and won’t ask questions at the time. They will wait and ask you later to get a better understanding.
Carolyn is a 75-year-old female patient with a history of mild to moderate Alzheimer’s disease. Although she is forgetful, she is still able to live a relatively independent life. She experienced an episode of fainting that was witnessed by several people at church, and she was taken to her primary care physician. It took a great deal of talking to her to help her understand that the fainting spell was, in fact, a major problem that needed to be investigated.
In addition to restricting her driving privileges, Carolyn needed several tests to rule out different probable causes of her fainting spell. Each test needed to be carefully explained to Carolyn and the information repeated so that she could grasp what each one required. She wrote down all the key information in a system that she had developed to keep herself from forgetting important points. In the end she had her tests, although she didn’t understand many of them, and doctors are still trying to determine the cause of her fainting spells. It takes careful reminding to keep her from driving her car or performing other actions that may put her in danger.
Include Family in the Conversation
Finally, including family is a big part of communicating with older people. When the patient doesn’t understand, often a family member will step in and take the reins. Again, you shouldn’t begin ignoring the patient to talk to the family member. You should always try to keep your older patient in the conversation, although not much of it may be understood. Often children, spouses and family friends can help the older person understand what is needed from them. Communicating with a patient’s family and friends is always beneficial and should be encouraged.
Family and friends can help you to communicate with an older patient because they know how that person thinks. It may help to have a three-way conversation between the patient, their caregiver, and yourself. When everyone works together to help the patient understand, you stand a much better chance of putting him or her at ease with all that is happening around them.
- National Institute on Aging; Talking With Your Older Patient: A Clinician’s Handbook
- Family Practice Management; Improving Communication With Older Patients: Tips From the Literature
- Gerontological Society of America; Communicating with Older Adults
- Communication Tips for Nurses
What works for you? Share your tips for communication with older patients.