Communication may be challenging, with gaps between what providers say and what patients hear or understand. Communication may be more difficult with older patients due to sensory issues (e.g., vision, hearing), cognitive impairment, and the inherently complex, multifactorial nature of their health history and presentations. Clear, caring communication may be considered a procedure and, like any procedure, is improved with training and repetition.
This procedure of communication is assessed, in part, through the Center for Medicare and Medicaid Sevices measurements of quality of care. Patient satisfaction surveys ask patients and/or families and caregivers to rate provider communication. Providers may experience this increased administrative focus on patient satisfaction and communication as additional pressure beyond that of ongoing productivity and throughput requirements. Simple, concrete communication strategies aim to efficiently improve communication and care for older adults while augmenting both quality and patient and provider goal-concordance.
10 Ways to Improve Communication with Older Patients:
- Provide hearing and visual assistive devices as needed, as deficits in these areas decreases understanding.
- Be seated during conversations, if possible. This increased attention towards the patient, increases satisfaction and the perception of increased time spent by providers.
- Seek to understand the patient’s level of cognition and understanding of medical information. Does the patient have dementia? Is the power of attorney for health care document activated?
- Identify chronic or acute cognitive impairment (dementia/delirium) which effect communication. Contact a surrogate decision maker and/or ancillary historian/caregiver when needed.
- Fully understand the reason for the patient’s visit. This often involves asking about cognition, function, and the social situation. Consider asking the patient and caregiver: “What changed today?”, “What are you most worried about?” and “Can you tell me more?”
- Elicit the patient and caregiver’s goals of care through gentle probing questions. Helpful phrases may include: “Tell me what you understand.”, “What matters most to you?”, and “What are you most worried about?”.
- Identify the patient’s emergent self-care needs. Older adults may present for medical care because they are no longer able to function in their current environment. Inquire about specific self-care activities such as toileting, walking, and taking medications.
- Seek to understand the caregiving environment. Who helps the patient? Is that person still able and willing to help given the acute change in patient or caregiver status? Ask about caregiver stress.
- Develop a patient-centered care plan. This requires understanding acute illness in the full context of the patient (e.g., physical, cognitive, functional, and social domains). Review the medical record and consult with other providers to more fully understand the patient’s prognosis and health trajectory.
- Carefully work with other care team members to coordinate subsequent care and “hand-offs” to help ensure seamless transitions in care.