Talking With Your Older Patient: A Clinician's Handbook
Including Families and Caregivers
By communicating effectively with all the individuals involved in your patient's care, you can help him or her while also making efficient use of time and resources.
"What would you like your family to know?"
Dr. Hwang noticed that Mrs. Patrick wasn't getting her medication dosage quite right. Mrs. Patrick admitted that sometimes she does not remember everything prescribed for her to do. Dr. Hwang wondered if Mrs. Patrick should bring her daughter to her next appointment. Mrs. Patrick agreed, but at the following doctor visit she still came alone. Dr. Hwang was puzzled. When he asked her about it, Mrs. Patrick said that she was concerned her daughter wouldn't let her speak for herself and that she has some personal issues she'd like to discuss with him that she doesn't want her daughter to know about. Dr. Hwang assured her that he would keep her involved in the conversation about her health and that they could have some private time to discuss any personal matters. Next time, Mrs. Patrick brought her daughter to the visit.
Family and informal caregivers play an important role in the lives of their loved ones. They also play an increasingly important role in how the health care system functions.
Informal caregivers may be important "informants." They can also help to reinforce the importance of information you give or the treatment you prescribe.
To protect and honor patient privacy, be sure to check with the patient on how he or she sees the companion's role. In many cases, the caregiver or companion can be a facilitator, helping the patient express concerns and reinforcing what you say. But it is best not to assume that a companion should be included in the medical encounter. First, check with the patient. Conducting the physical exam alone protects the patient's privacy and allows you to raise sensitive issues. For instance, the best time to conduct a "mini-mental" test is during a private exam, so that a family member cannot answer questions or cover for the patient's cognitive lapses.
When a companion is present, be aware of communication issues that arise in three-party interactions. Whenever possible, try to sit so that you form a triangle and can address both the patient and companion face-to-face. Be careful not to direct your remarks to the companion. By not falling into this trap, you can prevent the encounter from feeling like a "two against one" match.
Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairments. If a family member has been named the health care agent or proxy, under some circumstances, he or she has the legal authority to make care decisions. However, without this authority, the patient is responsible for making his or her own choices. Try to set clear boundaries with family members, and encourage others to respect them.
Family caregivers face many emotional, financial, and physical challenges. They often provide help with household chores, transportation, and personal care. More than one-third also give medications, injections, and medical treatments to the person for whom they care. It makes sense to view informal caregivers as "hidden patients" and be alert for signs of illness and stress. Caregivers may find it hard to make time for themselves. Encourage them to seek respite care so that they can recharge and take a break from the loved one. And remember, your encouragement and praise can help to sustain a caregiver.
For more information on working with families and caregivers, contact:
Administration on Aging (AoA)
Caregiver Action Network
Family Caregiver Alliance
National Alliance for Caregiving
- Check with the patient on how he or she would like any family members or companions to participate in the medical encounter.
- Address the patient—try to avoid talking only to the family member or companion.
- Make it clear that the patient should make his or her own decisions unless legal authority to do so has been granted to someone else.
- Be alert to family caregivers' own health needs, including signs of stress.
Publication Date: October 2008
Page Last Updated: January 22, 2015