Chapter 3 - Communicating With Older Persons

Saint Mary’s University
SCHOOL OF HEALTH and NATURALSCIENCES

Nursing Department
Bayombong, Nueva Vizcaya
NURSING DEPARTMENT
Course No.: NCM 114 Lecture
Subject: Care of Older Adult
Yr. Level: BSN 3
Contact Hours/ Credit Units: 2
Prepared by: Anne Margaret Callang Botor, RN, MSN (c)
Chapter 3
Communicating with Older Persons
I. Introduction:
Communication is a core skill in the health care professions. Nurses rely on their
ability to communicate effectively to gather and share information as well as to build
relationships with patients and families. Learning and practicing the art of
communication is one key to success as clinicians.
II. Learning Objectives:
1. Identify physiological and psychosocial barriers to communication among older
adults.
1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
Nursing Department
2. Acknowledge the nurse’s role and responsibility in the process of communication.
3. Utilize basic principles when communicating with older adults.
4. Discuss strategies to overcome communication barriers.
5. Communicate effectively, respectfully and compassionately with older adults and
their family.
6. Ensure a working relationship with the older adult based on trust, respect and
shared decision making.
III. Core Content of the Chapter:
A. Communication
Communication is the process or means by which an individual relates
experiences, ideas, knowledge, and feelings to another. Communication is a
reciprocal process involving minimally two people, a sender and a receiver.

pano ba naten masasabing effective ang communication?
Effective communication depends on the ability of both to engage in the process
of sharing not merely words, but also concepts, emotions, and thoughts. Language
hindi lang salita, kung hindi may laman or idea yung sinasabi mo
is the use of symbols or gestures that are common to groups and serve as a means
of sharing thoughts, ideas, and emotions.
Communication with older adults can be quite rewarding, though at times it is
fraught with challenges for both the sender and the receiver. Physiological

Nursing Department
changes associated with aging or secondary to chronic illness and disease can
pose a barrier to communication.
The Basic Principles of Communication:
1. Inviting- care providers can make several gestures that show respect and
interest in the patient as person.
we can initiate a conversation by: Use open- ended questions for starting a conversation:
a. Ask questions about the past
b. Ask personal questions
c. Inquire about what is new and different
d. Ask about their hopes and dreams
e. Talk about facts or mutually shared events
f. Ask how and why questions
g. Reference current events that are meaningful to most people
2. Arranging the Environment- the second basic principle is to arrange an
environment conductive to communication. The environment should be

so of course naman, hindi naman
maganda if mag uusap kayo sa isang
lugar
na maingay, tandaan ninyo na having a comfortable, provide privacy, and minimize distractions that could be
noisy or chaotic environment is
one of the barriers of having good
communitcation
barriers to communication, such as noise or poor lighting.

Nursing Department
we have to understand na hindi lahat

3. Maximizing Communication- the third principle is to use communication
nakakaintindi ng medical terms, use of
layman terms
so kapag sinabi nating TID, ano ang TID?

strategies that maximize the individual’s ability to understand the
message. Communication is critical in health care, yet many consumers
have difficulty understanding the language of health care due to language
barriers, illiteracy, or limited literacy.
4. Maximizing Understanding- the next principle is to maximize
understanding. The most important skill to help maximize understanding
is to learn to listen. Learning to listen is essential to good communications.
It is much easier to hear than it is to listen. Listening requires not only
hearing the words spoken, but also understanding their meaning and the
context in which they are spoken.

When someone feels listened to, they feel loved and understood. Their feelings are validated and they are often able to gain a deeper understanding of who they are.
5. Follow Through- the final principle is to follow up and follow through.
Words backed by actions help develop trust. A relationship built on trust
and concern for the welfare of others is critical to optimal health
outcomes.
The follow-ups - It’s the ultimate signifier that you don’t take your patients for granted.

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B. Formal Communication Group
Coalition of Services of the Elderly, Inc. (COSE) Formal groups are defined by their expression, dependability, and goals.
Non Government Organization
working with and for older persons,
especially the most disadvantaged
ones, in urban and rural areas in the
The intensity of interpersonal exchange varies in accordance with the members’
Philippines to
address issues of poverty, exclusion,
and invisibility so they may live in and group’s goals. Development and maintenance of aged peer groups are
dignity.
particularly important when friends are no longer available. The advantage of
group affiliations for the aged is in the diffusion of relationship intensity and the
constancy over time. A reliable group maintains its function despite the loss or
addition of members.
C. Informal Communication Group
Informal groups are those that naturally occur and have few restrictions,
expectations, or goals.
The following are examples of such groups:
1. Groups of the aged that spontaneously arise at nutrition sites.
2. Gatherings of old people in city parks.
3. Participants in senior citizen activities.
4. Groups that cluster together in long term care or residential settings.
5. Any group that occurs sporadically for the purpose of socialization,
discussion, or participation in an activity.

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D. Skills and Techniques for Barriers and Challenges to Communication
The basic principles of communication need to be modified to overcome barriers
associated with individual’s disability.
1. Memory or Cognitive Deficits
Cognitive damage may occur secondary to metabolic damage, stroke, or
hormonal or degenerative disease. Early in the disease process, conversation and
the opportunity to share memories with others can be rewarding and energizing
for the person. Regular conversation helps orient the individual to daily activities
and creates a structure that promotes independence. Conversation that encourages
thought and reflection can help keep the mind active. Just as exercise is important
to the maintenance of physical function and mobility, mental exercise is equally
important.
Nursing Considerations in Communicating with Individuals with Memory or
Cognitive Deficits
a. Approach persons in a nonthreatening manner within their visual field
b. Sit quietly with the person and gently touch her or his hand
c. Ask permission before moving objects
d. Show concern

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e. Post a few pictures, a calendar, or a daily schedule in the patient’s room
and use it to enhance conversation or promote recall
f. Sit so you are facing the person when speaking
g. Avoid a setting with a lot of sensory stimulation
h. Maintain eye contact
i. Be respectful of space Speak in normal tones
j. Use age-appropriate language
k. Start with a familiar topic
l. Talk about people or events known to the person
m. Orientation questions can be confusing and frustrating for the person
n. Ask one question at a time
o. If the individual becomes upset or agitated, ease up and use distraction to
change the topic or provide a period of quiet to allow a cool-down period.
Show interest in the person
p. If it is difficult to hear the person, gently ask him or her to speak louder
q. Provide time for conversation
r. Don’t laugh at responses
s. Acknowledge your inability to understand and your frustration.

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2. Speech Deficits or Impairments (Aphasia)
Aphasia is an acquired loss of impairment of language that occurs as a result
of damage to the speech centers in the dominant hemisphere of the brain.
Following are the several types of aphasia that the nurse may encounter with
elderly persons:
Broca's area is responsible for speech production Broca’s Aphasia is a non-fluent, agrammatic expressive aphasia.
Individuals with Broca’s Aphasia typically have good auditory
comprehension. They can understand what is said to them; however, they

how clearly a person speaks so that his or her speech is comprehensible to a listener
have difficulty producing intelligible speech.

they can speak fluently BUT they can’t
comprehend what u just said
Wernicke’s Aphasia is a fluent aphasia. The individual can speak and
produce language, although the speech may contain many odd words and
sounds. Wernicke’s Aphasia is characterized by impaired auditory
comprehension, so in this case the individual has great difficulty
understanding what is said. Often, he or she must rely on nonverbal gestures
to understand directions or questions.
Global Aphasia typically have problems understanding language as
well as producing speech.
Nursing Considerations in Communicating with Individuals with Aphasia
a. Include the individual in conversations

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b. Look at the person as well as others during conversation
c. Treat the person as an adult
d. Provide time for the individual to speak
e. Getting the message across is more important than perfection
f. If you don’t understand the person, politely say so
g. Remember, frustration works both ways
h. Position yourself across from the person so they can see your face and you
can see theirs
i. Speak naturally
j. Speak slowly using simple words and sentences
k. Use simple gestures to supplement your message
l. Tell the patent one thing at a time
m. Announce topic changes and allow a few minutes before proceeding
n. Provide time for the individual to speak
o. Look at the person and listen as they speak
p. If you don’t understand, ask them to describe the word, use another word,
say, or write the first letter, point to the item, or describe the context for
use
q. If the individual can write, ask them to write the word or use a word board

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3. Speech Impairments (Dysarthria)
Dysarthria can occur secondary to several cases. Even the loss of dentition
that occurs with aging may predispose the individual to dysarthria. Individuals
with dysarthria may be difficult to understand when they are speaking.
example: stroke patient (slurred speech)
Nursing Considerations in Communicating with Individuals with Dysarthria
a. Remember, speech impairment is not related to intelligence
b. Make a note in the medical record
c. A quiet environment with minimal distractions can help facilitate
understanding
d. Face the person as they are speaking for facial cues and gestures that can
enhance understanding
e. Remember, the individual has no problem hearing you
f. Encourage the person to speak slowly and use simple sentences or single
words
g. Allow time for the patient to respond
h. Don’t try to complete their words or sentences

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4. Visual Impairments
Individuals with visual impairments have no difficulty hearing or speaking;
however, they will miss nonverbal communications. These individuals will have
difficulty reading signs or relying on visual Choose for orientation or education
for purposes. Printed materials may need to be large or translated into Braille to
maximize understanding.
Nursing Considerations in Communicating with Individuals with Visual
Impairments
a. Gently call out to the individual when entering the room and identify
yourself and anyone with you in the room.
b. If the individual can see shapes or outlines, stand where he or she can see
you.
c. Minimize distractions
d. Explain what you are doing, especially when you are moving and creating
sounds in the room
e. Make certain not to move frequently used objects
f. Alert the person when you will be touching them
g. Oral communication with touch is more important than nonverbal gestures
that they cannot see; use an appropriate tone of voice

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5. Hearing Impairments
Individuals with hearing loss fall into one of two groups, the hearing impaired
and those who are deaf. Individuals with a hearing impairment have a reduced
ability to hear across the spectrum of sound. In contrast individuals who are deaf
cannot hear. They rely on one of several forms of sign language as their primary
language.
Nursing Considerations in Communication with Individuals with Hearing
Impairment
a. To get the attention of the person, touch the person gently, wave, or use
another physical sign
b. Store assistive devices - heating aid, notepad, and ben Pen - Within reach
of the individual
c. Allow time for the conversation
d. If the individual uses a hearing aid, check to see whether he or she is
wearing it and that it is turned on
e. Minimize background noise
f. When speaking, face the person directly so he or she can see your lips and
facial expressions

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g. Speak clearly in a low-pitched voice; avoid yelling or exaggerating
speaking movements
h. Use short sentences
i. Don't hesitate to use read the notes maximize understanding and involve
the person in the conversation
j. Avoid chewing, eating, or smoking as you speak
k. Keep objects away from your face when speaking
l. Allow the individual to be involved in making decisions
m. Provide time for the individual to speak
n. Ask questions to clarify the message
Nursing Considerations in Communicating with Individuals who are Deaf
a. Note on the patient’s record but the individual is deaf and may need an
interpreter
b. Document whether the individual uses American Sign language or other
assistive communication
c. Use an interpreter for conversations regarding healthcare decision making
d. To get the attention of the person, Touch the person gently, wave, or use
physical sign
e. For assistive devices within reach of the individual

Nursing Department
f. Make certain Any emergency alarms essential for safety have a light or
visual alert to get the individual’s attention in case of emergency
g. Allow time for the conversation
h. When speaking, face the person directly so that he or she can see your lips
and facial expressions
i. Don't hesitate to use written notes who maximize understanding and
involve the person in the conversation
j. Avoid chewing, eating, or smoking as you speak
k. When using an interpreter, face the individual not the interpreter
l. Be mindful off your nonverbal expressions during conversations
m. Allow the individual to be involved in making decisions
n. Provide time for the individual to return communication and keep your
focus on the person
o. Ask questions to clarify the message

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IV. Bibliography:
Ebersole, P., & Hess, P. (2001). Geriatric Nursing & Healthy Aging. Mosby, Inc. A
Harcourt Health Sciences Company.
Eliopoulos, C. (2005). Gerontologic Nursing. Lippincott- Raven Publishers.
Emanuel, L., & Librach, S. (2011). Palliative Care: Core Skills and Clinical
Competencies. Expert consult online and print.
Kane, R., Ouslander, J., Abrass, I., & Resnick, B. (2013). Essentials of Clinical
Geriatrics. Adobe Garamound Pro by Cenveo Publisher Services.
Linton, A., & Lach, H. (2007). Matteson & McConnell's Gerontological Nursing:
Concepts and Practice. Elsevier (Singapore) PTE LTD.
Mauk, K. (2010). Gerontological Nursing: Competencies for Care. Jones and Bartlett
Publisher, Inc.
Meiner, S. (2015). Gerontologic Nursing. Mosby, Inc.
Touhy, T., & Jett, K. (2014). Ebersole and Hess' Gerontologic Nursing & Healthy Aging.
Mosby, Inc.


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Saint Mary’s University

SCHOOL OF HEALTH and NATURALSCIENCES

Course No.: NCM 114 Lecture

Subject: Care of Older Adult

Yr. Level: BSN 3

Contact Hours/ Credit Units: 2

Prepared by: Anne Margaret Callang Botor, RN, MSN (c)

Communicating with Older Persons

ability to communicate effectively to gather and share information as well as to build

communication is one key to success as clinicians.

II. Learning Objectives:

1. Identify physiological and psychosocial barriers to communication among older

1st Floor, Constant Jurgens (UB) Building

2. Acknowledge the nurse’s role and responsibility in the process of communication.

3. Utilize basic principles when communicating with older adults.

4. Discuss strategies to overcome communication barriers.

5. Communicate effectively, respectfully and compassionately with older adults and

shared decision making.

III. Core Content of the Chapter:

Communication is the process or means by which an individual relates

experiences, ideas, knowledge, and feelings to another. Communication is a

reciprocal process involving minimally two people, a sender and a receiver.

Effective communication depends on the ability of both to engage in the process

of sharing thoughts, ideas, and emotions.

Communication with older adults can be quite rewarding, though at times it is

1st Floor, Constant Jurgens (UB) Building

pose a barrier to communication.

The Basic Principles of Communication:

interest in the patient as person.

a. Ask questions about the past

b. Ask personal questions

c. Inquire about what is new and different

d. Ask about their hopes and dreams

e. Talk about facts or mutually shared events

f. Ask how and why questions

g. Reference current events that are meaningful to most people

2. Arranging the Environment- the second basic principle is to arrange an

environment conductive to communication. The environment should be

1st Floor, Constant Jurgens (UB) Building

we have to understand na hindi lahat

so kapag sinabi nating TID, ano ang TID?

message. Communication is critical in health care, yet many consumers

have difficulty understanding the language of health care due to language

barriers, illiteracy, or limited literacy.

4. Maximizing Understanding- the next principle is to maximize

understanding. The most important skill to help maximize understanding

is to learn to listen. Learning to listen is essential to good communications.

It is much easier to hear than it is to listen. Listening requires not only

context in which they are spoken.

5. Follow Through- the final principle is to follow up and follow through.

Words backed by actions help develop trust. A relationship built on trust

and concern for the welfare of others is critical to optimal health

1st Floor, Constant Jurgens (UB) Building

B. Formal Communication Group

particularly important when friends are no longer available. The advantage of

C. Informal Communication Group

The following are examples of such groups: