1. 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.

2. Learning Objectives
State the importance of communication with older adults.
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.

3. 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.

4. 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.

5. Person-Centered Communication

6. 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

7. 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.

8. 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.

9. 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
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.

10. 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

11. 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.

12. 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 )
Vision
Hearing
Cognition
Speech and language impairment

13. 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

14. 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

15. 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

16. 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.