From the Guidelines
Communicating effectively with elders who have cognitive impairments requires a thoughtful and adaptive approach, taking into account their individual needs and preserving their dignity and respect. I've experienced communication challenges with elders who have cognitive impairments, particularly when they have hearing loss, visual loss, or gait and balance problems, as noted in the Alzheimer's Association clinical practice guideline 1. During conversations, I've noticed that elders may frequently lose their train of thought or repeat stories, and they may become frustrated if spoken to in a loud or slow tone, which can come across as patronizing. Some key considerations when communicating with elders who have cognitive impairments include:
- Being aware of any alterations in sensory or motor function, such as hearing loss or visual loss, which can impact communication 1
- Using a normal conversational tone and allowing extra time for processing
- Using shorter sentences and confirming understanding without being condescending
- Avoiding childish analogies and instead explaining things clearly and directly
- Considering the use of assistive communication supports, such as paper/pencil and communication boards/books, or high-tech devices like smartphones and speech-generating devices, as recommended in the guidelines for adult stroke rehabilitation and recovery 1 These experiences have taught me that cognitive changes don't diminish an elder's dignity or intelligence—they simply require adjustments in communication style, and by prioritizing respect, patience, and adaptability, we can find a balance between providing necessary clarity and preserving the respect and adult relationship that honors their lifetime of experience and wisdom.
From the Research
Challenges in Communicating with Elders
- Communication with elders can be challenging due to cognitive impairment, which can impact comprehension and communication, as well as other cognitive processes such as decision-making 2.
- The setting in which communication takes place can also affect the outcome, with some studies suggesting that in-home assessments may reveal the optimal cognitive function of geriatric patients 3.
- There are various instruments available for screening cognitive impairment, which can be categorized into different groups, including very brief, brief, self-administered, and test batteries 4.
Examples of Challenged Communication
- A study found that the use of visual methods can support communication with older adults with cognitive impairment, with the two major use contexts being elicitation of thoughts, feelings, and preferences in everyday life and health/healthcare related uses 2.
- Another study found that screening instruments can adequately detect cognitive impairment, but there is no empirical evidence that screening for cognitive impairment improves patient or caregiver outcomes or causes harm 5.
- Comprehensive geriatric assessment (CGA) has been shown to increase the likelihood that patients will be alive and in their own homes at follow-up, but may make little or no difference to cognitive function 6.
Factors Affecting Communication
- The testing site can affect test performance, with some studies suggesting that in-home assessments may be more effective than clinic-based assessments 3.
- The use of visual methods can support communication with older adults with cognitive impairment, but the effectiveness of these methods can depend on the context and the individual's cognitive abilities 2.
- The accuracy of screening instruments can vary, with some studies suggesting that the Mini-Mental State Examination is a reliable tool for detecting cognitive impairment 5.