Download Chapter 4: Aging Changes that Affect Communication

Chapter 4:
Therapeutic
Communication with Older
Adults, Families and
Caregivers
Learning Objectives
• State the importance of communication with older
adults.
http://www.jointcommission.org/multimedia/improvi
ng-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
– 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. figure 4-1, p. 101
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
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.