Communication Habits of the Elderly
Solie identifies some verbal behaviors that are common in older people. In many cases these behaviors may reveal something between the lines.
- Lack of urgency. Older people need more time to decide things. Accept that slower pace as normal. Don’t take it personally. Adjust your schedule to allow time to deliver news or ask for choices and then allow time for them to discuss with their families or contemplate on their own; return to them at a later time. Become expert at spontaneous facilitation. Use your access code to get their attention and gain their trust.
- Nonlinear conversations. Although older patients may appear to wander off topic, they may do so in the urge to ground themselves in what their priorities are, what their feelings are, what their choices will be. Signal you’re willing to listen and that you’re tuned in to the content, even if you don’t know where it is leading. (Obviously, someone who is demented or delirious presents a different scenario altogether, and depression is common and frequently overlooked.) Listen for patterns and themes. Nonlinear conversations can lead to spontaneous revelations and great insights for your patients and for yourself and can help patients revisit life dramas that test and clarify values. This, too, is a part of healthcare.
- Repetition and attention to details. In situations when dementia is ruled out, a patient’s repetition may indicate a means to emphasize an important point or value. Keep in mind, too, that as we age, we all repeat stories to some degree. Details in stories may be the means by which older adults connect to their pasts and may also serve as clues to what is important to these people. Don’t assume details demand any action on your part. You are only being asked to listen as the older person sorts things out.
- Uncoupling. Solie describes uncoupling as any time an older person appears to disconnect from you in the course of a conversation. For a professional, this can feel as if you are dismissed or ignored just when you think you’ve hit the mark with a comment or question. Go back and assess the information you’ve gathered by doing some verification. Rethink the objective: Any action that works against their maintaining control and discovering a legacy will produce uncoupling.
“I try to be aware of when I’m losing people,” says Dr. Chittenden of this phenomenon. “I would say, ‘I seem to be losing you and I’m wondering what you’re thinking right now.’ I would try to find out where they’re at and if it was something I said that didn’t gel with them, didn’t make sense to them, or wasn’t their priority.” This is something, she emphasizes, that a hospitalist needs to watch for with patients of all ages. “Whether you’re older or younger,” she says, the communication can be complicated because “you’re … in the hospital culture and the priorities of doctors are so often different from the priorities of patients.”
Older and especially old-old individuals in some ways live in an era other than the one traversed by the young and middle-aged.6 Their purposes, agendas, and mission are different and the slowing down of their functioning can facilitate their attempts to put their lives into perspective and manage what control they can still exercise or are still allowed. Viewing older patients with the utmost respect and acknowledging the challenges they face at these last phases of their lives can better help you to partner with them and their families in their care. TH