April 2002 Bulletin

Communicating with older patients

Hearing impairment, cognitive loss can create misunderstanding

By Jane F. Potter, MD

Musculoskeletal complaints and injuries are frequent reasons for physician visits, especially among older patients. Communicating with the older patient may be challenging, difficult, and even inhibitory in making the diagnosis and determining the appropriate treatment options.

If you are the first physician to evaluate the patient after an orthopaedic injury, it may be necessary for you to initiate multidisciplinary team involvement to perform a falls evaluation. Multidisciplinary team involvement will uncover remedial factors, reduce the future risk of fall and injury, and improve the patient’s overall quality of life.

Hearing impairment is the most common sensory impairment affecting older persons. There are many causes and treatments for hearing impairment. Unfortunately, there are also many patients who do not realize or acknowledge that they are hearing impaired and do not seek treatment. Hearing impairment presents as high-frequency hearing loss, an increase in sensation of loudness, and impaired speech discrimination.

Tips for communicating with hearing-impaired patients:

Reduced cognitive status is common and affects about half of older people by age 85 years. It may be a result of a chronic or acute disease affecting the brain, stroke, dementia, polypharmacy, and/or untreated depression. Reduced cognitive status can affect the patient’s acute presentation because the patient may tolerate or ignore symptoms, limit activities to compensate for symptoms or think that the symptoms are just typical of old age.

The older patient may be afraid of the illness or injury itself or fear hospitalization/institutionalization, which may lead to denial of symptoms. Further, the older patient may be unaware of an injury because other conditions mask symptoms. Patient adherence to recommendations may be reduced, because patients with dementia may understand the diagnosis and treatment plan initially but may be unable to remember later.

Tips for communicating with cognitively impaired patients:

Even older patients with normal cognition and hearing frequently experience increased stress during medical visits that results in reduced concentration and misunderstanding. Using the tips described above will increase the likelihood of communicating effectively with your older orthopedic patients, thus helping to improve patient adherence and reduce morbidity and mortality. Involving an interdisciplinary team will increase the patient’s likelihood of optimum recovery and improve his or her overall quality of life.

Jane F. Potter, MD is a Harris Professor of Geriatric Medicine and Chief, Section of Geriatrics and Gerontology, Department of Internal Medicine, at the University of Nebraska Medical Center. She also serves as Deputy Director for Orthopaedics, of an American Geriatric Society/Hartford Foundation funded Project: Increasing Geriatrics Expertise in Surgical and Related Medical Specialties.

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.

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