Talking With Your Older Patient: A Clinician's Handbook

Good communication is an important part of the healing process.

Studies find that effective physician-patient communication has specific benefits: patients are more likely to adhere to treatment and have better outcomes, they express greater satisfaction with their treatment, and they are less likely to bring malpractice suits.

Research also shows that good communication is a teachable skill. Medical students who receive communication training improve dramatically, not only in communicating with patients, but also in assessing and building relationships with them. Time management skills also get better. Interpersonal and communication skills are now a core competency identified by the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS).

Learning effective communication techniques—and using them—may help you build more satisfying relationships with older patients and become even more skilled at managing their care.

Communicating with older patients involves special issues. For example:

• How can you effectively interact with patients facing multiple illnesses and/or hearing and vision impairments?
• What’s the best way to approach sensitive topics such as driving privileges or assisted living?
• Are there ways to help older patients who are experiencing confusion or memory loss?

With questions like these in mind, the National Institute on Aging (NIA), part of the National Institutes of Health, developed this booklet.

Although referring to clinicians throughout the text, this booklet is intended for use by a range of professionals dealing directly with patients—physicians, physicians-in-training, nurse practitioners, nurses, physician assistants, and other health care professionals. The aim is to introduce and/or reinforce communication skills essential in caring for older patients and their families. Talking With Your Older Patient: A Clinician’s Handbook offers practical techniques and approaches to help with diagnosis, promote treatment adherence, make more efficient use of clinicians’ time, and increase patient and provider satisfaction.

Three points are important to remember:

• Stereotypes about aging and old age can lead patients and health professionals alike to dismiss or minimize problems as an inevitable part of aging. What we’re learning from research is that aging alone does not cause illness and that growing older does not automatically mean having to live with pain and discomfort.
• Many of this booklet’s suggestions may, at first glance, appear to be time-consuming, especially given the time constraints of most clinicians. However, an initial investment of time can lead to long-term gains for physicians and patients. Time-intensive practices need not be inefficient. You may get to know your older patient’s life history over the course of several visits rather than trying to get it all in one session.
• Older patients are diverse and unique, just like your younger patients. You may see frail 60-year-olds and relatively healthy 80-year-olds. Your patients may be culturally diverse. Some may be quite active while others may be sedentary. The techniques offered here encourage you to view all older people as individuals who have a wide range of health care needs and questions.

Many physicians, nurses, researchers, and other health care professionals were generous in providing information and advice on making this edition of the Clinician’s Handbook useful. The Institute is grateful for their thoughtful contributions.

Richard J. Hodes, M.D., Director
National Institute on Aging
National Institutes of Health