February 2001 Bulletin

Elderly patients need special connection Show patience, kindness, but don’t be condescending

By Sandra Lee Breisch

Some elderly patients are a little hard of hearing, slow on comprehending clinical jargon and/or create confrontational visits by challenging your every word and treatment plan. Caring for them can be a difficult undertaking—even if they’re not frail or don’t have Alzheimer’s disease.

"Certainly, there’s a subset of elderly patients who need special attention," says Peter Pompei, MD, director of the fellowship program in geriatric medicine, Stanford University Medical Center, Stanford, Calif. "But there’s a slippery slope of being too condescending by treating every aging patient like a child. It’s not really fair to paint every elderly patient with the same brush."

To be sure you’re not on a "slippery slope" with your elderly patients, Dr. Pompei suggests patience, kindness and offers helpful hints:

• Give the patient extra time due to poor communication, nervousness, lack of focus or other reasons.
• Hold the visit in a quiet, well-lit area. Sit facing the patient.
• Speak slowly, clearly and maintain eye contact. Be sure your mouth is visible for patients who are lip-readers. Speak loudly, but do not shout.
• If the patient has a hearing deficit, provide hearing devices or amplifiers.
• Be prepared to repeat or revise information so the patient understands you. Tell your patient to repeat what you just said.
• Encourage patients to bring a tape recorder to remember what was discussed during the visit.
• Tell patients to bring a family member or friend to the visit so diagnosis/treatment recommendations are clearly understood.
• If your patient needs an interpreter, suggest they bring one. Or, have a staff member assist you.
• Provide a bulleted one- or two-page information/instructional sheet with large print. (Many patients will not tell you they have vision problems.) You can also provide more detailed sheets.
• Charts or models of hips, knees or shoulders are helpful so patients understand what their orthopaedic condition is and what care will be provided.
• Direct patients to visit your web site or other medically approved web sites.
• Simplify medical jargon by talking in nonclinical terms.
• Discuss one topic at a time so you do not confuse patients and/or create information overload.
• Give patients an opportunity to ask you questions. Or assign a nurse, physician assistant, or other entrusted health care practitioner to do so. Follow-up on all questions.
• If the patient is confused, contact their family members or friends to clarify information.
• Don’t get upset over sharp, confrontational patients. Welcome it and don’t feel challenged. Encourage those patients to express themselves and engage them to tell you more.

Always, give your patient good care by "treating them like they’re your parents or grandparents," suggests Elton Strauss, MD, chief of orthopaedic trauma and reconstructive surgery, department of orthopaedic surgery, Mount Sinai Medical Center, New York.

And be "more patient" with a grumpy patient, says Dr. Strauss. "Ask them, ‘why are you grumpy?’ or, ‘what upset you?’ If they feel that you’re interested enough and caring to ask what’s wrong with them—not just why their knee is swollen—it’ll calm them down. And they’ll communicate with you."

Simplify medication instructions. "Let’s say the patient is taking drug A and you want them to take drug B," explains Dr. Strauss. "I’ll write them a note that says, ‘Do not take drug A anymore. Instead you are to take drug B.’ And I write down, ‘take one tablet in the middle of breakfast so that you’re eating food.’ I also ask them to repeat what I just wrote down so I know they understand."

To help patients understand a musculoskeletal problem such as an arthritic hip, Dr. Strauss shows them a picture of a normal hip and writes ‘normal’ on it. "Then, I show them a photograph of an abnormal hip and put their name on it, so they understand what their hip looks like," he says. "I’ll give them those papers to take home."

Remember, making that special connection with the aging patient is critical to achieving good outcomes, says Dr. Pompei. "And most physicians can do it, if they try."

Communicate welcomes suggestions about future topics for the column on patient-physician communications. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.