 |
|
|
  
Overcoming Communication Barriers
|
Certain attitudes about growing
older and physical changes associated with aging can hinder communication
between physicians and older patients. Many of these barriers can
be reduced. |
Alleviating Discomfort
|
A patient's physical or emotional
discomfort can interfere with communication. Here are some suggestions
to minimize common sources of such discomfort.
 Make
the environment welcoming from the start. Be sure that the office
is physically accessible. Also be sure that receptionists and other
staff members treat the patient with warmth, consideration, and
respect, both in person and over the telephone.
Address
the patient by his or her last name, using the title the patient
prefers (for example, Mrs., Miss, Ms., Mr., Dr., Father, or Professor).
Avoid forms of address such as "dear" or "hon," which tend to be
impersonal and condescending. Address the patient by his or her
first name only if the patient tells you to. Using the patient's
last name conveys deference and promotes an atmosphere of equality.
As one older patient quipped to her young physician, "Don't call
me Edna, and I won't call you Sonny.".
Introduce
yourself clearly. Show from the outset that you accept the patient
and want to hear his or her concerns. You might mention looking
forward to working together and encourage the patient to ask questions
as they arise. If you are a consultant in a hospital setting, remember
to explain your role or refresh the patient's memory of it.
Keep
the examining room warm enough, and check that the patient is otherwise
physically comfortable.
Avoid
background noise and interruptions. They are especially disruptive
if the patient has poor hearing or impaired cognition.
Address
the patient at eye level. For example, sit in a chair the same height
as the patient's. This helps establish a comfortable atmosphere,
and it allows the patient to pick up visual cues.
Consider
gently touching the patient on the hand, arm, or shoulder to help
set him or her at ease. Some older people expect physicians to be
"hands on," but be aware that this expectation may vary among cultures.
Maintain
an unhurried pace. Because many older people function well only
if unrushed, trying to hurry communication can prove counterproductive.
Some patients may need additional time to formulate their thoughts,
so try not to put words in their mouths. To permit sufficient time,
consider scheduling a longer visit or multiple visits.
|
Reducing Language Barriers
|
Language barriers can exist,
whether or not a patient's native language is English. It can help
to keep the following in mind.
In
addition to being unfamiliar with medical language (e.g., hypertension
for high blood pressure, or gastric carcinoma for stomach cancer),
older people may be unacquainted with recently coined words, new
expressions, or new uses of old words. For example, an older patient
may not know what it means to contact a support group or helpline,
or to network with others. On the other hand, older patients may
use expressions unfamiliar to younger clinicians. Use simple, common
language and be willing to ask for clarification if needed..
Educational
levels of older people are generally lower than those of their children,
and even some very intelligent older people may not be functionally
literate. Keep this in mind when deciding whether to give written
instructions. If an older person whose native language is not English
lacks literacy in his or her native language, merely translating
written materials will not suffice. Alternatives include using diagrams
and giving written materials to relatives who read.
Rapid-fire
questioning and fast delivery of information may intimidate some
older people. A gentle, more empathic style generally proves more
comfortable and productive.
|
Compensating for Hearing Deficits
|
Hearing very often diminishes
with age, and by age 79 an estimated 50 percent of people have significant
hearing impairment. To compensate for hearing deficits you can use
the following techniques.
Early
in the visit, remember to ask the patient whether he or she can
hear you clearly. If possible, have an amplification device available
in the office.
If
a patient without a known hearing disorder has trouble hearing you,
examine the auditory canals for the presence of excess earwax.
If
the patient has a hearing aid, make sure that it works, that the
patient knows how to use it, and that he or she is using it.
Speak
clearly. Face the patient, so he or she can lipread and pick up
visual cues, and so you can see whether you are being understood.
Be careful not to cover your mouth with your hand. Remember, if
you have a mustache, the patient may not be able to read your lips.
Speak
in low tones as presbycusis diminishes hearing mainly in the higher
range.
Avoid
shouting. Shouting distorts language sounds, is uncomfortable to
the listener, and may inadvertently convey an impression of anger.
In some medical settings very loud voices can be overheard by people
other than the patient..
Reinforce
your speech through other channels such as gestures, simple diagrams,
and written materials.
Alert
the patient when you change the subject. For example, pause briefly,
speak a little more loudly, gesture toward what will be discussed,
gently touch the patient, or ask a question.
Check
comprehension of what you have said. It's a good idea to ask the
patient to repeat your main point in his or her own words.
|
Compensating for Visual Deficits
|
Visual disorders become more
common with age. Difficulties presented by vision problems can be
managed in several ways.
Make
sure the setting is adequately lighted and that there is sufficient
light on your face. Try to minimize glare.
Check
that the patient has brought and is wearing his or her eyeglasses.
Be
aware that some older people can't bring objects into focus at close
range. They may pull away so that they can see more clearly.
Make
sure that handwritten instructions are clear.
When
using printed materials for reinforcement, make sure the type is
large enough and the typeface is easy to read. Printing such as
the following tends to be widely suitable:
This size is readable.
If
the patient has trouble reading, consider alternatives such as tape-recording
instructions, providing large pictures or diagrams, or using aids
such as specially configured pillboxes.
|
Compensating for Cognitive Impairment
|
|
