CHAPT

CHAPTE
ER
R5
5
DEQUILLA, EDERLYN
FAITH V.
 Communicating
Older Adultswith
Communication is the process of
exchanging information: sending
messages back and forth between
individuals or groups of people.
Problems between individuals,
families, or groups, as well as
difficulties on the job or in society, are
often the result of poor
communication.
Effective communication does not 01
mean that we will like or agree with
everything that another person says,
 Communicating
Older Adultswith
Effective communication requires the
following:
1. The need or desire to share
information
2. Acceptance that there is value and
merit in what the
other person has to say, demonstrated
by a willingness to treat the other
person with genuine dignity and
respect
02
3. Understanding of factors that may
interfere with or
 INFORMATION
SHARING (FRAMING
Verbal communication involves
THE MESSAGE)
sending and receiving
messages using words. Some verbal
communication is
formal, structured, and precise; some
is informal,
unstructured, and flexible.
Formal or therapeutic
communications have a specific
intent and purpose. Informal or 01
social conversations are less specific
and are used for socialization. When
 INFORMATION
SHARING (FRAMING
A person’sTHE
age,MESSAGE)
marital status,
cultural or ethnic orientation,
educational background, interests, and
the ability to hear and see influence
the communication techniques used
and the words chosen.
We need to be careful to choose
words that the patient can understand;
not so simple that we are “talking
down” to the patient, but also not so 01
technical or “medical” that the
meaning is unclear. Avoid acronyms,
 Communication Dos and
Don’ts When
DO’s
Working with Older Adults
 Identify yourself.
 Address the person using their pre
ferred name (e.g.,Mrs. Smith and
Bill).
 Speak clearly and slowly in a low
tone of voice.
 Get to know the person.
 Listen empathetically
 Pay attention to body language,
yours and theirs. 01
 Use touch appropriately and
frequently
 Communication Dos and
Don’ts When
DONT’s
Working with Older Adults
 Assume that the person knows who
you are.
 Use “baby talk” or patronizing
names such as “sweetie” or “honey.”
 Shout
 Make generalizations about older
people.
 Pay too much attention to tasks and
forget the person. 01
 Consider nonverbal messages as
 FORMAL OR THERAPEUTIC
COMMUNICATION
Therapeutic communication is a
conscious and deliberate process used to
gather information related to a patient’s
overall health status (physical,
psychosocial, spiritual, etc.) and to
respond with verbal and nonverbal
approaches that promote the patient’s
well-being or improve the patient’s
understanding of ongoing care. This type
of communication looks easy and natural
when performed by an experienced health
professional, but it is a skill that requires
time, effort, and practice to develop.
02
Careful use of words and language is an
art. Knowledge of the individual’s
 INFORMAL OR SOCIAL
COMMUNICATION
Small talk; pleasantries; and
con_x0002_versations about the weather,
a favorite television show, or the latest
news can demonstrate that you think of
the patient as a real person, not just a
patient.
Likewise, older patients often like to know
something
about the nurses who care for them; they
may ask
about your family, hobbies, and interests.
Do not be afraid to be “human” when 02
com_x0002_municating with older adults,
but be careful not to overdisclose
 INFORMAL OR SOCIAL
COMMUNICATION
Be honest with your older patients.
When you do not have time to visit,
explain why so that patients do not
personalize and think they have done
something wrong. Do not be afraid to
use humor appropriately, but choose
the right time and place, and make
sure it is culturally sensitive.
It has been said that “laughter is the
best medicine.” Remember that it is
okay to laugh at yourself, but never at 02
the other person. Aging does not
cause people to lose their sense of
 NONVERBAL
COMMUNICATIO
N
it is essential that we examine each aspect
of nonverbal communication to consider its
effect on our interactions with the older
adult
SYMBOLS
 In the health care setting, uniform styles
and colors help patients distinguish the
various caregivers. Many patients,
particularly older adults, were unhappy
when nurses stopped wearing caps. The
white uniform and cap were symbols that
helped older adults distinguish nurses from
other caregivers, and to distinguish the
level of education attained by that nurse.
For this reason, nurses in some long term 03
care facilities continue to wear white
uniforms and caps. In other settings, nurses
 TONE OF
VOICE
 Think of the sound of a whisper, shout, or whine. Try
saying, “I don’t want to do that,” first in a whisper,
shout, and whine, and then in a normal speaking voice.
When a person shouts at us, we normally shout back.
Shouting is often associated with anger or displeasure,
yet many
people shout in an attempt to communicate with
someone who is hard of hearing.

 Shouting is not an appropriate way to deal with hearing

problems, because our tone of voice may lead the 04
hearing_x0002_impaired person to think we are angry.
Speaking in a low tone of voice close to the
 BODY
LANGUAGE
 We communicate many things by how we move, stand,
sit, and position our bodies. In dealing with all patients,
it is important that we be aware of what we
communicate through our body language.
 In situations in which the words and body language are
conveying two different messages, most people respond
to the body language. Standing at the door, hurrying
down the hallway, sitting behind the nurses’ station,
and working in the medication or treatment room all
communicate that you are busy and do not want to be
interrupted. 04
 Many older adults and their families are intimidated by
this body language and may hesitate to interrupt, even
 BODY
LANGUAGE
Going into the rooms to talk with patients, sitting
down at eye level with residents, and spending
time in the lounge with visitors are all ways of
nonverbally communicating that you are truly
interested and concerned.
Another part of nonverbal communication involves
watching for the messages that patients are
communicating to us through their body language.
For example,
patients who slump down or slouch in their chairs
04
may be communicating many things, such as
fatigue or physical weakness, lack of interest,
 SPACE,
DISTANCE, AND
POSITION
Physical space, distance, and position are other ways
we communicate. The study of the use of personal
space in communication is referred to as proxemics.
Personal space refers to how close we allow
someone to get to us before we feel uncomfortable.
The amount of space that separates two individuals
when they communicate is significant. In the
traditional American culture, most people are
comfortable when strangers are 12 feet or more
away. This is considered public space; at this 05
distance, there is no real positive or nega_x0002_tive
connection with the other person. Between 4 and 12
 SPACE,
DISTANCE, AND
POSITION
This is a comfortable distance for a casual
relationship, in which communication is at an
impersonal level. If you stay this far away from your
patients, you are communicating indifference. A
distance of 18 inches to 4 feet is considered personal
space. This is the optimal distance for close
interpersonal communication with another person. A
nurse who communicates from within this
space is usually viewed as concerned and interested.
The space within 18 inches of the body is considered
05
intimate space. Entering the intimate space
without permission is usually perceived as a threat. A
 SPACE,
DISTANCE, AND
POSITION
An older adult who has poor vision or hearing, who
has been sleeping, or who is not totally alert may be
startled by this approach. The person may not be
able to recognize the nurse as a trusted person at
first and may strike out verbally or physically from
fear of physical attack. It is essential to recognize the
importance of personal space and to obtain the older
adult’s attention and
permission before attempting to perform any
physical care.
05

GESTURES
 SPACE,
DISTANCE, AND
POSITION
Some gestures that are accepted today as
commonplace were once considered crude or
insulting. Gestures that have a certain meaning in
one culture may have a different meaning in another.
For example, nodding the head up and down means
yes in most cultures, but to some Eskimo tribes it
means no. Before using gestures, it is wise to
determine that both parties have the same
understanding of just what a particular gesture
means. Gestures are helpful for people who cannot
05
use words. After a stroke, many individuals suffer
from a condition called aphasia. Because of brain
 FACIAL
EXPRESSIONS
Facial expressions are yet another form of
communication. The human face is most expressive,
and facial expressions have been shown to
communicate across
cultural and age barriers. Smiles, frowns, and
grimaces appear to have the same meaning whether
you are in the outback of Australia or in a boardroom
on Wall
Street. Humans respond to facial expressions from
the time they are born.
05

Fear, anger, joy, and a variety of other emotions can

 EYE
CONTACT
“Look me in the eye” is a phrase many white
Americans have heard. Looking someone in the eye
is perceived in our culture and other cultures as a
measure of honesty. Yet in some cultures (e.g.,
African Americans and some groups from Southeast
Asia), averting the eyes communicates respect.
When dealing with older adults, it is important to be
sensitive to the meaning of eye contact for them.
Face-to-face, eye-to-eye contact can be helpful when
communicating with older adults, providing this does
05
not frighten or intimidate them. Eye contact is often
interpreted to be a sign of attentiveness and
 PACE OR SPEED
OF
COMMUNICATIO
The resulting difference in rate
N of speech and
movement can be overwhelming and frustrating to
older adults. Many choose not to respond or interact
with younger nurses because they feel they are
being hurried. Do not become impatient or uneasy
with silence; give the older person enough time to
think and
organize a response. Provide encouragement and
reassurance that they will have all of the time they
need.
05

Nurses have too often been observed completing

 TIME AND
TIMING
Timing is related to the pace of
communication, but it has other distinct
implications as well. The amount of time a
person must wait after seeking attention is
important. Delays in response to a call light
or direct request from a person may be
interpreted as a lack of concern, even if
this is not intended. The person’s response
05
may manifest in anger, displeasure,
anxiety,
 TOUCH

Touch is a form of communication. No

words are required, and there is no need
for high-level sensory or cognitive
functioning. When all else fails, touch is
left. Caring touch is a basic need for all
humans, and many older adults suffer from
touch deprivation. Many older people have
no one to meet this need. Research shows
05
that psychotic patients and older adults are
 TOUCH
Use of touch as a method of communication is often
difficult and uncomfortable, particularly for young or
inexperienced nurses. Touching is a very personal
form of communication. Affection, understanding,
trust, hope, and concern can be communicated by a
hand placed on a shoulder, a stroke of the forehead,
or a frail hand held by another stronger one. Touch is
a common method of expressing concern and caring.
People who are emotionally close hold hands and
touch and hug one another. High on the list of things
05
lonely older people say they miss are hugs and
touching. Empathetic use of touch is a much-needed
 SILENCE
Saying nothing is also saying something. Being
with another person and remaining silent is
difficult for many people, including nurses. At
times, words can be intrusive; they can interfere
with true communication. Many times, older
adults require more time to compose their
thoughts. Silence permits them to focus on the
point of discussion, while continuous talking is
distracting. At times, no words are necessary;
05
silence is therapeutic. During intense grief, pain,
or anxiety, simply being there without saying or
 ACCEPTANCE, DIGNITY,
AND RESPECT
IN COMMUNICATION
Empathy is defined as the willingness to
attempt to understand the unique world of
another person. It is the ability to put oneself in
another person’s place and to understand what
he or she is feeling and thinking
in that situation. Empathetic listening involves
actively trying to truly understand the other
person.Effective communication starts with
proper intro_x0002_ductions. Determine how
each older adult wishes to be addressed. It is 05
presumptuous to become too famil_x0002_iar
 ACCEPTANCE, DIGNITY,
AND RESPECT
People who areIN COMMUNICATION
unskilled at working with older
adults may use a sing-song voice, use inflection
to make statements sound like questions, or
refer to older adults by “baby talk” names such
as “sweetie”
or “honey,” thinking that this conveys affection
and caring.
Elderspeak, is a form of ageism. Elderspeak
also includes incorrect use of the pronoun we.
Elderspeak should always be avoided, because it 05
has a subtle way of diminishing an older
 BARRIERS TO
COMMUNICATION
Communication makes use of all of the senses.
Hearing and vision are the senses used most often
in communication, but touch, smell, and even taste
also play a part in the relay of messages. It is
important to remember this when communicating
with older adults, because their perceptions may be
altered by normal physiologic changes that occur
with aging. Pain or extreme fatigue may make
communication difficult. It is best to limit
conversation to essential topics during these times.05
A variety of disease processes, such as strokes and
 BARRIERS TO
COMMUNICATION
HEARING IMPAIRMENT
If the person wears a hearing aid, make sure that it
is clean, that the batteries are working, and that the
device is in the correct ear. Try to minimize
background noise because this can distort sounds
and make hearing
more difficult. Many people who are hearing
impaired spontaneously begin to read lips. In
addition to the basic strategies, the following
actions are likely to be beneficial: 05
1. Stand in front of the person, at eye level.
 BARRIERS TO
COMMUNICATION
APHASIA
Individuals who have had a stroke or other head
inju_x0002_ries may experience aphasia, which is a
partial or total loss of the ability to use or
understand words. It affects the ability to
understand and express oneself through
words, gestures, and writing but does not
necessarily affect intellectual function. Consultation
with a speech therapist can help the nurse devise
approaches that will optimize function. In addition 05
to the basic strategies, some commonly
 BARRIERS TO
COMMUNICATION
1. Keep messages simple but adult.
2. Use nonverbal modes of communication, such as
picture boards, gestures, yes/no responses, and
facial expressions.
3. Use visual aids to support.
4. Try increasingly specific guesses or questions to
determine concerns (e.g., Is something wrong with
your meal? The coffee? It’s too hot? You want
milk?).
5. Praise attempts to speak, and avoid correcting or05
criticizing errors.
 BARRIERS TO
COMMUNICATION
6. Reassure the person that it is okay to be
frustrated, but avoid empty platitudes such as
“You’ll be fine.”One intervention worth trying when
working with an aphasic patient: singing.

A different part of the brain is used for singing than

is used for speaking. You may find that while speech
is hesitant and difficult for an aphasic patient to
produce, singing an old familiar song with the
patient may lead to a surprisingly fluid verbal 05
output. Researchers are studying the use of singing
 BARRIERS TO
COMMUNICATION
DEMENTIA
Dementia causes both cognitive and language
deficits. The older person suffering from dementia
has no control over these changes, so the
responsibility for effective communication rests with
the nurse. Depend_x0002_ing on the severity of the
dementia, the individual may demonstrate different
levels of function. The abilities and limitations of
each individual suffering from 05
dementia must be evaluated, so that the most
 BARRIERS TO
COMMUNICATION
Some characteristics of dementia include a
limited attention span, inability to focus on more
than one thought at a time, confusion of fact and
fantasy, and the inability to follow complex
instruction.

According to the Alzheimer’s Association, “For

persons with dementia, behavior is frequently a
form of communication.” Problems with
communication can result in agitation, restlessness,05
abusive language, or combativeness. Repetitive
1. Talk about one thing or ask only one question at
a time.
2. Limit choices; too many options are confusing.
3. Keep the conversation in the here and now. 03
4. Ask simple yes/no questions.
5. Try “filling in” or “repairing” thoughts. Rather
than letting a person get upset trying to find the
right words, you may offer some likely choices.
However, be careful not to get in the habit of
finishing the thoughts and sentences of patients
06
who are not cognitively impaired.
6. Avoid asking questions that require information or
recall, such as “How was your day?”
7. Use gestures or demonstrate an action so that the
person can mimic your behavior. 03
8. Avoid the use of an intercom, which may confuse
the person.
9. Avoid arguing if the person does not accept your
reality.
10. Redirect the person who is acting out to a more
appropriate activity. 06
11. Share activities such as looking at a
magazine,
viewing family photos, or listening to music.
03
12. Avoid trying too hard to communicate. If
words
do not work, try gentle touch.
13. Watch your tone of voice because patients
with
dementia are often very sensitive to nonverbal06
cues and may sense your frustration and
 CULTURAL
DIFFERENCES
A Chinese guide in Beijing asked his tour group (in
very clear English), “What do you call a person who
speaks more than one language?” The group replied,
“Multilingual.” He then asked, “What do you call a
person who speaks only one language?” The group
was not sure how to reply, so he provided the
answer:
“Americans.” Although this is rather a strong
general_x0002_ization, the majority of Americans
still speak only one language: English. We tend to
expect everyone else, no matter where we are in the07
world, to understand us.
 SKILLS ANG
TECHNIQUES
INFORMING
Informing uses direct statements regarding facts.
A good information statement is clear, concise,
and expressed in words the patient can
understand. When the nurse is informing, the
nurse is active and the patient is passive.
Informing is the least effective form of
communication because the patient is not actively
involved. When giving information, ask the
07
patients to restate what they understand using
their own words. A message may need to be
 SKILLS ANG
TECHNIQUES
DIRECT QUESTIONING
It is best to keep communication conversational
and not too aggressive. Too many direct questions
can overwhelm an older person and may block
rather than expand communication. Direct
questioning is helpful when nurses need to obtain
specific information or in emergency situations
when time is precious. Direct questions tend to
include the words who, what, when, where, do
07
you, and don’t you. Direct questioning is
appropriate when information must be obtained
 SKILLS ANG
TECHNIQUES
USING OPEN-ENDED TECHNIQUES
Open-ended communication techniques include
open_x0002_ended questions, reflective
statements, clarifying state_x0002_ments, and
paraphrasing. These techniques allow the patient
more leeway to respond, thus establishing a
more empathetic climate. The patient is more
likely to feel that you are interested in him or her
personally and not just trying to fill out a stack of
forms. Examples of open-ended techniques include
07
the following: “And
after you moved to the nursing home, what
 SKILLS ANG
TECHNIQUES
CONFRONTING
Confronting is used when there are inconsistencies
in information or when verbal and nonverbal
messages appear contradictory. Confrontation is
one of the most difficult communication
techniques to use and should
be used only after good rapport has been
established. It is never advisable to confront a
highly agitated or confused person, because
07
conflict and a breakdown in communication will
result. Confrontation should be
 SKILLS ANG
TECHNIQUES
COMMUNICATING WITH VISITORS
AND FAMILIES
Be prepared to interact with the friends, family
members, and visitors of your patient. These people
make up the older adult’s social network and support
system. Families and friends are interested and
concerned about what is happening to their loved ones.
Not only do they turn to nurses for information and
reassurance, but they can also be a good source of
information. These significant others, as they are often
called, can help in many ways if nurses are responsive07
to them. Many of the older adult’s significant others are
 SKILLS ANG
TECHNIQUES
DELIVERING BAD NEWS

No one likes to get bad news, and no one

likes to be the one who has to tell someone
else bad news. Most people try to avoid this
daunting task. Ideally, this task should be
performed by the most experienced and
knowledgeable person, such as the
07
physician, but, occasionally, the nurse must
be the one to break bad news to an older
 SKILLS ANG
TECHNIQUES
HAVING DIFFICULT CONVERSATIONS
Emotionally loaded topics are likely to generate
strong emotions and often lead to conflict. Conflict
is a normal and routine part of human interaction;
it can occur between older adults and adult
children, nurses and
older adults, nurses and patients’ families, nurses
and other nurses, or nurses and physicians.
Difficult conversations may occur in clinical areas
07
or in home settings involving friends and family
members.Some people prefer to avoid conflict
 SKILLS ANG
TECHNIQUES
IMPROVING COMMUNICATION BETWEEN
OLDER ADULT AND PHYSICIAN
Clear communication between the older adult
and their physician is essential. Most physicians
are aware of effective communication protocols,
but, because of time constraints or other factors,
they may not always use these techniques.
Ineffective communication can result in frustration
for both parties and can contribute to a lack of
adherence by the patient. 07
Also, it is not uncommon for an older adult to
become passive, evasive, or tentative when
 SKILLS ANG
TECHNIQUES
The nurse can often help minimize these problems
by (1) suggesting that the patient keep a written
list of concerns and questions so nothing is
forgotten; (2) asking the physician to repeat and
summarize direc_x0002_tions to the patient; (3)
identifying printed materials that support the
physician recommendation; (4) sug_x0002_gesting
that a trusted friend or family member be present
to take notes and help the older adult express
07
concerns; or (5) acting as a patient advocate by
asking
 SKILLS ANG
TECHNIQUES
COMMUNICATING WITH PHYSICIANS
The quality of communication between nurses and
physicians can have a significant impact on the quality
of care older patients receive. Communication
problems between nurses and physicians can lead to
job
frustration, blame, and distrust, all of which diminish
the level of care provided and increase the risk for
problems or errors. Conversely, good communications
tend to improve job satisfaction, decrease errors, and
promote quality care of the older adult patients. 07

Physicians and nurses are busy. No one has time to

 SKILLS ANG
TECHNIQUES
PATIENT TEACHING
Education plays an important role in
promoting and
maintaining the health of older adults.
Teaching may be a one-on-one session or a
group experience. The ability to teach,
explain, and motivate is increasingly part of
the role of today’s nurse. To perform this role
07
successfully, you need to know basic
principles and techniques of adult education
 Prioritize teaching by starting with
the area that the patient perceives to
be most important, then linking that
information to the other things the
nurse thinks are necessary or
important. Work in small, discrete blocks
of information, proceeding from simple,
more familiar concepts to more complex or
difficult ones. Success breeds success: 08

when older adults realize that they have

THAN
K YOU