Chapter 4: Therapeutic Communication with Older Adults, Families and Caregivers Communication is an integral part of quality healthcare. Assisting older adults to maintain their connection to others through communication is an important focus for nursing. Communication is a critical part of the nursing process. A number of physical and psychological changes occur with aging that influence both communication abilities and opportunities. Effective communication and common normal and pathological changes of aging that challenge communication for older adults will be discussed. Environmental influences on communication for older adults and strategies to improve nursing communication with older adults, their families, and caregivers will be explored.

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 (figure 4-1, p. 101) 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.

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 teaching http://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

Effective Communication Strategies Use person-first language Do not shout & speak clearly Make use of the person’s other unimpaired senses by touching or using visual cue, and wait Lip reading. Try to be eye level with the pt. Ensure hearing aid turned on Limit background noise Avoid demeaning terms like “sweetie, honey, or dearie” Start with important topic

Include the patient Speak slower and pause between phrases Simplify vocabulary and avoid jargon Use short, direct, clear phrases Use touch to communicate Speak in the direction of the person Position yourself in the person’s direct line of vision Use gestures to aid in communication Prepare magnifier Low pitch sounds

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.