Foreword
Good communication makes for good medicine. Although communication alone will not cure the sick, it can be an important part of the healing process. Patients who feel they’ve been heard and understood are more likely to follow doctors’ orders. They are more likely to adhere to treatment and so to have better outcomes. And, patients who rate their doctors high on communication skills are less inclined to bring malpractice suits. Improving communication skills is worth the investment in time and energy.
Although physicians must rely on basic communication skills to work with patients, these skills are not routinely reinforced in the medical school curriculum. Recent studies indicate that when such skills are taught, students improve dramatically, not only in communicating with patients, but in assessing patients and building relationships with them and in managing time. By learning about effective communication techniques—and by trying them out for yourself—you may improve your relationships with older patients and become more skilled at managing their care.
What are effective ways to interact with older patients, particularly with those facing multiple illnesses, hearing and vision impairments, or cognitive problems? How does one approach sensitive topics such as driving privileges or assisted living? Are there special communication strategies that can help older patients who are experiencing confusion or memory loss? With these questions in mind, the National Institute on Aging (NIA), part of the National Institutes of Health, developed this Handbook.
Facilitating Diagnosis and Promoting Adherence to Treatment
This booklet introduces physicians, physicians-in-training, and other health care professionals to communication skills essential in caring for older patients and their families. Working with Your Older Patient: A Clinician’s Handbook describes and explains issues pertinent to older patients. It offers practical techniques and approaches to help with diagnosis, promote treatment adherence, make more efficient use of clinicians’ time, and increase patient and provider satisfaction.
Three points are important to remember. First, stereotypes about aging and old age lead patients and physicians alike to dismiss or minimize problems as an inevitable part of aging. Just getting old does not cause illness. Being old does not mean having to live with pain and discomfort. Clinicians may, without realizing it, allow stereotypes about aging to creep into everyday medicine. These attitudes do not reflect what research and practice tell us.
Second, many of our suggestions may, at first glance, appear to be time-consuming or impractical, given the time constraints of most clinicians. However, an initial investment of time can lead to long-term gains for physicians and patients. Time-intensive practices need not be inefficient. You may get to know your older patient over the course of several visits, adding to the life history as you go along, rather than trying to get it all in one session.
Third, keep in mind that older patients are diverse and unique, just like younger patients. You may see frail 60-year olds, and you may see relatively healthy 80-year olds. Your patients may represent the cultural diversity that typifies America. We hope that the techniques offered here encourage you to view all older people as individuals who have a wide range of health care needs and questions.
Many physicians, researchers, and other health care professionals were generous in providing information and advice on making this edition of the Handbook useful. The Institute is grateful for their thoughtful contributions.
Richard J. Hodes, MD
Director
National Institute on Aging
National Institutes of Health
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