Chapter 4: Therapeutic

Communication with Older Adults, Families and

Caregivers

Learning Objectives• State the importance of communication with older

adults.

http://www.jointcommission.org/multimedia/improving-patient-provider-communication---part-1-of-4/

• Identify effective and ineffective communication strategies.

• Understand how normal and pathological changes of aging affect communication.

• Describe communication strategies for older adults with common normal and pathological changes of aging.

• Describe person-centered communication.

Communication Basics• How we provide and receive information from others• Conveys a message between a sender and a receiver• Dynamic: ongoing exchange of information with

feedback • Relies on intact senses, physical and cognitive

processes needed to send and receive messages, and a conducive environment.

• Verbal: relies on knowledge of a common language as well as the ability to produce words.

• Nonverbal: includes tone of voice and physical behaviors such as body language and eye contact.

Person-Centered Communication

• Key characteristics of quality health care.

• Focus on the patient and their unique perceptions and experiences with health and illness

• Nursing interventions include providing information to promote health and healing and to engage patients in self-care

• Confirms uniqueness of the patient and allows the patient to participate in his or her own care.

Person-Centered Communication

Communication Obstacles Facing Older Adults

• Lack of opportunity for communication and declining social networks– Retirement– Spouses and friends die– Children move away

• Physical or mental impairments interfere with ability to communicate

Strategies for Communication with Persons with Dementia that Support

Personhood (Table 4-1, page 100)

• Recognition: acknowledge uniqueness• Negotiation: consult the person about

preferences, desires, and needs.• Validation: acknowledge the person’s

emotions/ feelings and respond.• Facilitation/Collaboration: work together,

involve the person.

Intergenerational Communication

• Elderspeak– Similar to babytalk– Simplification: measurable reductions in

complexity of grammar and vocabulary– Clarification strategies: adding repetitions and

stressing and altering the pitch of one’s speech, resulting in speech that is overly caring and controlling and less respectful than normal adult-to-adult speech. figure 4-1, p. 101

Cultural Competence and Health Literacy

• Teach-back method– patients repeat back the information they have

received– easy and effective method to assess comprehension

of health teachinghttp://www.nchealthliteracy.org/teachingaids.html

• Communication in end-of-life care– may be complicated by emotional distress and prior

relationships with family and significant others– may be especially difficult when the news is bad or

when patient's or families' listening skills are poor.

Changes Throughout the Typical Aging Process

• There are numerous age-related factors that affect communication.– Vision changes: presbyopia - “aging-eye”– Hearing changes: presbycusis – “old man’s

hearing”– Dual sensory impairment: loss in both vision

and hearing– Cognition changes

• Short-term memory • Long-term memory

Pathological Changes Affecting Cognition, Speech, Language

• Dementia– Memory loss accompanied by speech and language

impairments and/or decline in executive functioning– Alzheimer’s most common form of dementia

• Speech and Language– rate of speech slows with declining cognition and/or

lost teeth or ill-fitting dentures– comprehension may decline with hearing, vision, or

sensory loss, cognitive changes, and emotional factors– Aphasia is an acquired language impairment and

occurs when there is damage to language center in the brain.

Strategies to Aid Individuals with Communication Impairments

• Compensatory strategies: technological devices- using hearing aids, eye glasses…

• Rehabilitative strategies: practice repeatedly – speech therapist…

• Effective communication strategies (Table 4-2, P. 114-115)

– Vision– Hearing– Cognition– Speech and language impairment

Communicating with Others• Families and significant others:

– Nurses can support family members, assist them to overcome communication barriers

– Nurses must be aware of the need to include older adult in communication regarding health matters as much as possible.

– Permission to communicate about health issues with others is a key privacy issue complicated by impairments

• Professional and Nonprofessional Caregivers– Treat others with respect and be good role model for

paraprofessionals

Summary

• Many older adults may have significant sensory or cognitive impairments that affect their ability to communicate.

• Nurses can use techniques to facilitate appropriate communication.

• Health literacy should be considered when planning teaching or educational materials.