Chapter 4: Therapeutic Communication with Older Adults, Families and Caregivers

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Chapter 4 Therapeutic Communication with Older
Adults, Families and Caregivers
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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.

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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.

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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.

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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

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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 persons emotions/
  feelings and respond.
• Facilitation/Collaboration work together,
  involve the person.

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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 ones speech,
  resulting in speech that is overly caring and
  controlling and less respectful than normal
  adult-to-adult speech. figure 4-1, p. 101

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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.

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Changes Throughout the Typical Aging Process

• There are numerous age-related factors that
  affect communication.
• Vision changes presbyopia - aging-eye
• Hearing changes presbycusis old mans
  hearing
• Dual sensory impairment loss in both vision and
  hearing
• Cognition changes
• Short-term memory
• Long-term memory

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Pathological Changes Affecting Cognition, Speech,
Language

• Dementia
• Memory loss accompanied by speech and language
  impairments and/or decline in executive
  functioning
• Alzheimers 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.

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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

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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

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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.

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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 ________.
• oldstertalk
• agespeak
• elderspeak
• eldertalk