Chapter 2: Listening to Older Patients

"Tell me more about how you spend your days..."

Although she complains of her loneliness and long days in front of the TV, Mrs. Klein refuses to participate in activities at the community senior center. “I’m not playing bingo with a bunch of old ladies,” she tells her doctor when he suggests she get out more. “You’ve mentioned how much you love to garden,” her doctor says. “The center has a garden club with a master gardener. One of my other patients says she loves it.” “I don’t want to hang around old people who have nothing better to do than compare health problems,” she says. “Why not give it a try?” her doctor asks. “You might find the members are pretty active gardeners.” Six months later, when she sees the doctor again, Mrs. Klein thanks him. She has joined the garden club and reports that the members all have green thumbs as well as being quite lively conversationalists. Better still, Mrs. Klein’s depressive symptoms seem improved.

Good communication is good medicine—clear communication between patients and physicians is more than a social nicety; it is a health care necessity. Effective communication:

• helps prevent medical errors,
• strengthens the patient-physician relationship,
• makes the most of limited interaction time, and
• may lead to improved health outcomes.

This chapter provides tips on how to communicate with older patients in ways that are respectful and informative.

Don’t Call Me Edna and I Won’t Call You Sonny
Establish respect right away by using formal language: Mr., Mrs., Ms., and so on. You might ask your patient about preferred forms of address and how she or he would like to address you. Avoid using familiar terms, like “dear” and “hon,” which tend to sound patronizing. Be sure to talk to your staff about the importance of being respectful to all of your patients, especially those who are older and perhaps used to more formal terms of address.

With new patients, try a few conventional icebreakers to promote rapport. “Are you from this area?”, “What did you do for a living?”, “Do you have family nearby?”, or “Are you active in community programs?” are good ways to start a conversation and to learn more about a person. Friendly questions can relieve stress.

Introduce yourself clearly. Show from the start that you accept the patient and want to hear his or her concerns. If you are a consultant in a hospital setting, remember to explain your role or refresh the patient’s memory of it.

Don’t Rush
Avoid hurrying older patients. Try to give them a few extra minutes to talk about their concerns. Time spent this way will allow you to gather important information and may lead to improved cooperation and treatment adherence.

Feeling rushed leads people to believe that they are not being heard or understood. Beware of the patient’s own tendency to minimize complaints, “not wanting to be a bother,” or a concern that he or she is taking too much of your time.

Try not to interrupt a patient early in your interview. One study found that doctors, on average, interrupt patients within the first 23 seconds of the initial interview. Once interrupted, patients are less likely to reveal all of their concerns, a situation that often ends up taking even more time.

Older people may have trouble following rapid-fire questioning or torrents of information. In our fast-paced society, slowing down may be difficult, but by speaking more slowly you will give older patients time to process what is being said. If you tend to speak quickly, especially if you have an accent, try to slow down and give older patients time to hear what you are saying and process it.

Avoid Jargon
Older patients may not be as “health literate” as younger adults. Try not to assume patients know medical terminology or a lot about their disease. Introduce necessary information by first asking patients what they know about their illness and building on that. Although some terms seem commonplace—MRIs, CAT scans, stress tests, and so on—some older patients may be unfamiliar with what each test really is. Check often to be sure that your patient understands what you are saying.

Be Careful About Language
Some words may have different connotations to older patients than to you or your peers. For example, the word “cancer” was once unmentionable. The “C” word always meant death. Although you cannot anticipate every generational difference in language use, being aware of the possibility may help you to communicate more clearly. Use simple, common language and be willing to ask if clarification is needed.

Reduce Barriers to Communication
Older adults often have sensory impairments that can affect communication. Vision and hearing problems need to be treated and accounted for in communication. Literacy also may be a problem.