Gerontologists outline how doctors can bridge communication gap with older patients

With the elderly population expected to increase substantially in the next two decades, physicians need to be prepared for the unique challenges they will face treating these patients, says a new report from the Gerontological Society of America.

Nearly one in five Americans will be 65 or older by 2030, according to the U.S. Administration on Aging. People in this age group make nearly twice as many physician office visits per year than adults 45 to 65. Yet the Centers for Disease Control and Prevention estimates that two-thirds of older people are unable to understand the information given to them about their prescription medications.

The society’s report offers recommendations for physicians and other health professionals on how best to communicate with this growing patient population. It is intended to help dispel some of the myths and stereotypes physicians may have about older patients and give concrete suggestions for good communication strategies, said Jake Harwood, a professor in the Dept. of Communication at the University of Arizona in Tucson, who chaired the advisory board that oversaw the report’s development.

Assuming that all elderly patients are frail, dependent, hard of hearing or cognitively impaired can lead to a patronizing communication style that many older people find disrespectful, he said.

“The consequence would be medical encounters in which the patient is annoyed or dissatisfied,” Harwood said. “That is not an optimal environment for the patient to gather the information he or she needs, or for the patient to trust the physician and follow through on his or her recommendations.”

The report offers 29 recommendations for avoiding poor communication, such as recognizing one’s stereotypes, minimizing background noise, and monitoring and controlling arm movements and other nonverbal behavior when talking with patients. Clear physician-patient communication is essential, yet many health professionals don’t get enough training on interacting with elderly patients, Harwood said.

Other experts in patient communication say physicians need to be aware if a patient has any cognitive impairments, poor health literacy or sensory limitations such as poor hearing and eyesight.

Poor communication can be detrimental to a patients’ health, said Cynthia Boyd, MD, MPH, associate professor of medicine with the Dept. of Medicine Division of Geriatric Medicine and Gerontology at Johns Hopkins University School of Medicine in Baltimore. If there is bad communication, patients are more likely to miss appointments or fail to follow medical advice, such as properly taking medications, said Pam Mason, director of Audiology Professional Practices with the American Speech-Language-Hearing Assn.

Knowing a patient’s literacy

Physicians and other health professionals need to be aware of a patient’s health literacy — their capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions, said Andrea Moxley, associate director of multicultural resources with the American Speech-Language-Hearing Assn. Patients who don’t understand what their physician tells them are more likely to have poorer health outcomes, be dissatisfied with their care and be less likely to get appropriate follow-up care, Moxley said.

“Hospital readmissions are higher in those populations that indicate poor patient-provider communication,” she said.

To help prevent such problems, physicians should take time in talking with patients and their families, use pictures to emphasize key points, repeat important information, encourage questions and use plain language with limited terminology and jargon, Moxley said. Verbal directions should be reinforced with clear and easy-to-read written materials.

An estimated 36 million American adults have hearing loss, Mason said. Thirty percent of adults 65 to 74 have hearing loss, and 47% age 75 and older have hearing loss.

Physicians should speak slowly and face patients when speaking to them so patients can see their lips. There needs to be good lighting in the room, and pictures and diagrams can help support the conversation, said Janet Schreck, PhD, a speech-language pathologist and executive director of the Loyola Clinical Centers at Loyola University in Maryland.

“The consequences of untreated hearing loss can be isolation, depression or dementia, so physicians should learn to recognize the signs of hearing loss and make appropriate referrals,” she said.

Physicians and other health professionals need to do all they can to make sure older patients understand what they are saying and can make informed decisions about their care, Harwood said. Good communication during patient encounters is critical.

“A patient emerging with full information and with a sense of trust in their physician could make the difference between life or death,” he said.