Address Patients Directly

“Sometimes, the physician will address questions to a family member or caregiver who might have accompanied the patient to the appointment, or the family member might interject an answer to a question that has been directed to the patient,” he said.


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At that point, “It is really the doctor’s responsibility to reorient the conversation back to the patient and say, ‘I would like Mom or Dad to answer, if they can.’”

Addressing the patient is appropriate even if he or she has dementia, Dr Harwood added. In that situation, “it is certainly okay for the accompanying person to provide clarifications and contribute to the conversation, but it should be a conversation in which the patient is involved, so it is not a constant back and forth only between the doctor and the caregiver.”

The role of family members is heavily influenced by culture, since aging is “a meaning-making process” in which people “internalize cultural values.”12

“In any age group it is important to pay attention to culture, but especially with older people,” Dr Harwood noted.

For example, in Asian cultures, it is “very normative for multiple family members to be involved with decision making and participating,” Dr Harwood pointed out. By contrast, “in people from Northern European cultures, it is much less common for the whole family to be involved with the conversation.”  Being aware of “how aging takes place in other cultures” will inform patient-physician encounters and enhance effective communication.

Educational resources regarding aging and culture can be found in Table 1.

Beyond the Mechanics.

“As a society, we tend to talk about “older adults” as if it is one group, but there is a vast difference between a person of 65 and a person of 90,” Dr Harwood observed.

For example, people over age 80 probably have some hearing loss and short-term memory deficits, and a possibility of mild dementia. But for those in their sixties, the probability is fairly low, except perhaps for some low-grade hearing loss.

Several studies have shown that individuals integrate both positive and negative stereotypes of aging and that activation of negative stereotypes can have broad and deleterious effects on older individuals’ self-evaluation and functioning.13,14

“Whatever the age of the patient, aging is either something you are terrified of or something you celebrate, and this will change what aging will be like,” Dr Harwood said.

Communication with patients transcends the specifics of language and style and includes the provider’s own attitudes toward aging, which can be conveyed in subtle ways and will, in turn, impact the patient’s attitudes to the process.

Additional communication tips can be found in Table 2.

References

1.    Knickman JR, Snell EK. The 2030 Problem: Caring for Aging Baby Boomers. Health Serv Res. 2002;37(4):849-884.

2.    Population Reference Bureau. Aging in the United States. (2016) Available at: https://www.prb.org/aging-unitedstates-fact-sheet/. Accessed: April 10, 2018.

3.    Robinson TE, White GL, Houchins JC. Improving Communication With Older Patients: Tips From the Literature. Fam Pract Manag. 2006 Sep;13(8):73-78.

4.    University of Michigan. National Poll on Healthy Aging. Available at: http://www.healthyagingpoll.org/sites/default/files/2017-11/NPHA_Drug-Interactions-Report_111417.pdf. Accessed: April 5, 2018.

5.    University of Michigan, National Poll on Healthy Again. Available at: https://www.healthyagingpoll.org/report/march-2018-report-too-much-good-thing-overuse-health-care. Accessed: April 7, 2018.

6.    US Department of Health and Human Services. National Institutes of Health. National Institute on Deafness and Other Communication Disorders (NIDCD). Hearing Loss and Older Adults. Available at: https://www.nidcd.nih.gov/health/hearing-loss-older-adults. Accessed April 7, 2018.

7.    Gerontological Society of America. Communicating with older adults. Available at: https://changeagents365.org/resources/ways-to-stay-engaged/the-gerontological-society-of-america/Communicating%20with%20Older%20Adults%20Low_GSA.pdf. Accessed: April 10, 2018.

8.    Kemper S, Lacal JC. Addressing the communication needs of an aging society. In: National Research Council (US) Steering Committee for the Workshop on Technology for Adaptive Aging; Pew RW, Van Hemel SB, editors.

9.    Washington (DC): National Academies Press (US); 2004. Available at: https://www.ncbi.nlm.nih.gov/books/NBK97337/. Accessed: April 10, 2018.

10. Williams KN, Herman R, Gajweski B, Wilson K. Elderspeak Communication: Impact on Dementia Care. Am J Alzheimers Dis Other Demen. 2009;24(1):11-20.

11. Busacco D. Normal communication changes in older adults. American Speech-Language Hearing Association. Let’s Talk. Available at: https://www.asha.org/uploadedFiles/0499ashamag.pdf. Accessed: April 10, 2018.

12. Fung HH. Aging in culture. The Gerontologist. 2013;53(1):369-377.

13. Kotter-Grühn S, Hess TM. The Impact of Age Stereotypes on Self-perceptions of Aging Across the Adult Lifespan. The Journals of Gerontology: Series B. 2012;5(1): 563–571.

14. Coudin G, Alexopoulos T. ‘Help me! I’m old!’ How negative aging stereotypes create dependency among older adults. Aging Ment Health. 2010 Jul;14(5):516-23.

This article originally appeared on MPR