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.
• 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
• Integral part of person-centered 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.
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
• 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
• Rehabilitative strategies: practice repeatedly
• Effective communication strategies
–
–
–
–
Vision
Hearing
Cognition
Speech and language impairment
Table 4-2, P. 114-115
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.
Question
Younger people often modify and simplify their
speech when talking to older adult patients,
resulting in communication that is similar to
baby talk, featuring terms of endearment and tag
questions that prompt for a response. The term
for this type of speech is ________.
a)oldstertalk
b)agespeak
c)elderspeak
d)eldertalk