From the Guidelines
To describe an elderly patient who has disorganized conversation patterns and is difficult to obtain a medical history from, I would recommend using the term "tangential" or having "circumstantial speech" as this is a common presentation in older adults with cognitive impairment or other geriatric syndromes, as noted in the clinician's guide to geriatric assessment 1. This patient may present with difficulty maintaining a focused conversation, frequently shifting between topics without completing thoughts, and requiring repeated redirection to obtain relevant clinical information. When documenting, you might note that the patient exhibits "tangential speech patterns with poor historical reliability" or "disorganized thought processes making history-taking challenging." These communication difficulties could stem from various causes including cognitive impairment, delirium, psychiatric conditions, medication effects, or simply a personality trait. Key strategies for effective communication with such patients include:
- Using simple language tailored to the patient’s educational level, as suggested by the American Society of Clinical Oncology consensus guideline 1
- Avoiding jargon and explaining medical terminology in lay language
- Providing information in small doses and checking for comprehension
- Involving family members or caregivers when appropriate, and scheduling longer appointment times to allow for more effective communication. Consider cognitive screening if this represents a change from baseline, as new-onset disorganized speech could indicate an underlying medical condition requiring evaluation, highlighting the importance of a comprehensive geriatric assessment 1. Patience is essential, as rushing may increase confusion and frustration, and employing strategies like using closed-ended questions and allowing brief periods for open expression before gently redirecting can facilitate more effective history-taking.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Describing an Old Lady with Difficult Conversation
- The old lady's conversation may be described as disorganized or tangential, making it challenging to obtain a clear history from her 2.
- Her behavior could be a result of various factors, including cognitive impairment, dementia, or other psychological conditions, which may lead to aggressive challenging behavior or behavioral and psychological symptoms of dementia (BPSD) 3, 4.
- To effectively communicate with her, it is essential to employ patient-centered communication skills, such as active listening, empathy, and open-ended questions, to understand her perspective and feelings 2, 5, 6.
- Using a structured approach, like the "ask-tell-ask" method, can help provide small chunks of information and facilitate a more organized conversation 2.
- It is crucial to assess her prior knowledge and preferences for information to tailor the communication approach to her needs and avoid overwhelming her with medical information 2.
Communication Strategies
- Engage in focused active listening to understand her concerns and feelings 2.
- Express empathy by naming her feelings, communicating understanding, respect, and support 2, 5.
- Use open-ended questions to explore her perspective and experience regarding her illness or condition 2.
- Avoid interrupting her and allow her to share her thoughts and feelings without interruption 2.
- Consider using narrative medicine as an approach to introduce, teach, and promote empathic concern among healthcare professionals 5.