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Talking with Your Older Patient

Communicating with a Confused Patient

Working with patients who are cognitively impaired presents an ongoing communication challenge. For instance, they likely will have trouble following any instructions about their care, including how and when to take prescriptions. Make sure someone can closely monitor care management, and try to involve a care partner whenever possible.Nurse communicating with a confused patient

Here are some tips for effectively working with and communicating with cognitively impaired patients.

  • Try to address the patient directly, even if his or her cognitive capacity is diminished.
  • Gain the person's attention. Sit in front of and at the same level as him or her and maintain eye contact.
  • Speak distinctly and at a natural rate of speed. Resist the temptation to speak loudly.
  • Help orient the patient. Explain (or re-explain) who you are and what you will be doing.
  • If possible, meet in surroundings familiar to the patient. Consider having a family member or other familiar person present at first.
  • Support and reassure the patient. Acknowledge when responses are correct.
  • If the patient gropes for a word, gently provide assistance.
  • Make it clear that the encounter is not a "test" but rather a search for information to help the patient.
  • Use simple, direct wording. Present one question, instruction, or statement at a time.
  • If the patient hears you but does not understand you, rephrase your statement.
  • Although open-ended questions are advisable in most interview situations, patients with cognitive impairments often have difficulty coping with them. Consider using a yes-or-no or multiple-choice format.
  • Remember that many older people have hearing or vision problems, which can add to their confusion.
  • Consider having someone call the patient to follow up on instructions after outpatient visits.
  • If the patient can read, provide written instructions and other background information about the problem and options for solutions.
  • Address potential issues of driving, getting lost, and home safety each time you see the patient. And, encourage regular physical activity, social activity, hobbies, and intellectual stimulation, as well as a healthy diet. Some studies link these approaches to the maintenance of cognitive function.