10/3/2019 Methods To Work With Seniors Pdf
As baby boomers increase in age, the face of the American population will change dramatically. By the year 2030, a projected 71 million Americans will be age 65 or older, an increase of more than 200 percent from the year 2000, according to the U.S. Census Bureau. It’s estimated that some 6,000 people turn age 65 every day and, by 2012, 10,000 people will turn age 65 every day.Aging health care consumers will increase the demand for physicians’ services.
In the United States, people over the age of 65 visit their doctor an average of eight times per year, compared to the general population’s average of five visits per year. Physicians should prepare for an increasing number of older patients by developing a greater understanding of this population and how to enhance communication with them.The communication process in general is complex and can be further complicated by age. One of the biggest problems physicians face when dealing with older patients is that they are actually more heterogeneous than younger people. Their wide range of life experiences and cultural backgrounds often influence their “perception of illness, willingness to adhere to medical regimens and ability to communicate effectively with health care providers.” Communication can also be hindered by the normal aging process, which may involve sensory loss, decline in memory, slower processing of information, lessening of power and influence over their own lives, retirement from work, and separation from family and friends. At a time when older patients have the greatest need to communicate with their physicians, life and physiologic changes make it the most difficult.Because “unclear communication can cause the whole medical encounter to fall apart,” physicians should pay careful attention to this aspect of their practice. This article provides suggestions compiled from an extensive review of the literature to help physicians and staff improve communication with older patients.
Syllabus outcomes, course work, assessment methods, etc. Maps/matrices can be used to review curriculum, select assessment methods, make comparisons, etc. Indirect Observations Information can be collected while observing “events” such as classes, social gatherings, activities, group work, study.
Many of the suggestions can be applied to patients of all age groups; however, they are particularly important with older adults, for whom less-than-optimal communication may have more negative consequences.If you walked into a room and wanted to listen to the radio, you would first have to plug it in to a power source. Similarly, when you walk into the exam room to communicate with your older patients, the first thing you have to do is “plug in,” that is, make a connection with them physically and emotionally. Once you’ve made that connection, you can then begin to communicate necessary information and instructions.
Below is a list of tips to help you achieve this.Allow extra time for older patients. Studies have shown that older patients receive less information from physicians than younger patients do, when, in fact, they desire more information from their physicians., Because of their increased need for information and their likelihood to communicate poorly, to be nervous and to lack focus, older patients are going to require additional time. Plan for it, and do not appear rushed or uninterested.
Your patients will sense it and shut down, making effective communication nearly impossible.Avoid distractions. Patients want to feel that you have spent quality time with them and that they are important. Researchers recommend that if you give your patients your undivided attention in the first 60 seconds, you can “create the impression that a meaningful amount of time was spent with them.” Of course, you should aim to give patients your full attention during the entire visit. When possible, reduce the amount of visual and auditory distractions, such as other people and background noise.,.Sit face to face. Some older patients have vision and hearing loss, and reading your lips may be crucial for them to receive the information correctly.
Sitting in front of them may also reduce distractions. This simple act sends the message that what you have to say to your patients, and what they have to say to you, is important.
Researchers have found that patient compliance with treatment recommendations is greater following encounters in which the physician is face to face with the patient when offering information about the illness.Maintain eye contact. Eye contact is one of the most direct and powerful forms of nonverbal communication. It tells patients that you are interested in them and they can trust you. Maintaining eye contact creates a more positive, comfortable atmosphere that may result in patients opening up and providing additional information.Listen.
The most common complaint patients have about their doctors is that they don’t listen. Good communication depends on good listening, so be conscious of whether you are really listening to what older patients are telling you. Many of the problems associated with noncompliance can be reduced or eliminated simply by taking time to listen to what the patient has to say. Researchers have reported that doctors listen for an average seconds before they interrupt, causing miss important information patients are trying to tell them.Speak slowly, clearly and loudly. The rate at which an older person learns is often much slower than that of a younger person. Therefore, the rate at which you provide information can greatly affect how much your older patients can take in, learn and commit to memory., Don’t rush through your instructions to these patients. Speak clearly and loudly enough for them to hear you, but do not shout.Use short, simple words and sentences.
Simplifying information and speaking in a manner that can be easily understood is one of the best to ensure that your patients will follow your instructions. Do not use medical jargon or technical terms that are difficult for the layperson to understand In addition, do not assume that patients will understand even basic medical terminology. Instead, make sure you use that are “familiar and comfortable” to your patients.Stick to one topic at a time.
Information overload can confuse patients. Avoid this, instead of providing a long, detailed explanation to a patient, try the information in outline form. This allow you to explain important information in a series of steps.
For example, first talk about the heart; second, talk about blood pressure; and third, talk about treating blood pressure.Simplify and write down your instructions. When giving patients instructions, avoid making them overly complicated or confusing.
Instead, write down your instructions in a basic, easy-to-follow format. Writing is a more permanent form of communication than speaking and provides the opportunity for the patient to later review what you have said in a less stressful environment.One way to accomplish this is to provide an information sheet that summarizes the most important points of the visit and explains what the patient needs to do after he or she leaves your office. (See an.) For example, instead of just telling older patients to take their medication and get some exercise, you can give them a visit summary to take home that includes detailed instructions, such as “Take a pill when you first get up in the morning,” “Walk around the block in the morning,” and “Walk around the block in the afternoon.”With such a list, the patient can mentally check off each item as it is completed each day.
Posting the information on the refrigerator or a bulletin board can help keep instructions fresh in the patient’s mind.Use charts, models and pictures. Visual aids will help patients better understand their condition and treatment. Pictures can be particularly helpful since patients can take home a copy for future reference.
You can find free images online in Medem’s Medical Library at. Click on “Anatomy and Medical Illustrations” under the heading “Diseases and Conditions.”.Frequently summarize the most important points. As you discuss the most important points with your patients, ask them to repeat your instructions.
If after hearing what the patient has to say you conclude that he or she did not understand your instructions, simply repeating them may work, since repetition leads to greater recall. The National Council on Patient Information and Education recommends having a nurse or pharmacist repeat instructions for taking medications, and it advises always combining written and oral instructions. However, be aware that if patients require a second or third repeat, they may become frustrated and disregard the information altogether.
An effective technique to try at that point is to rephrase the message, making it shorter and simpler. You may also want elderly patients to bring a family member or friend in during the consultation to ensure information is understood.Give patients an opportunity to ask questions and express themselves. Once you have explained the treatment and provided all the necessary information, give your patients ample opportunity to ask questions. This will allow them to express any apprehensions they might have, and through their questions you will be able to determine whether they completely understand the information and instructions you have given. If you have doubts, you may want to have a staff person contact the patient in 24 hours to review educational points.Using the radio analogy again, how nice would it be if, when you wanted to listen to the radio, it was already plugged in and playing music when you entered the room. This is where your staff can help. They can contribute greatly to your communication success by helping older patients feel comfortable and prepared for your consultation.
Here’s how:.Schedule older patients earlier in the day. Older patients often get tired later in the day, and medical offices tend to get busier as the day goes on.
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Scheduling older patients earlier in the day will bring them in when the office is quieter and will allow your staff to spend more time with them.Greet them. This is an important step in making older patients feel comfortable and important. Staff members should greet patients warmly when they arrive at your practice and should introduce themselves by stating their name and position.Seat them in a quiet, comfortable area. Because reception areas can be noisy and confusing, staff members should help seat older patients away from noise and disruptions. In addition, your waiting area seating should be firm and of standard height, with arm supports to make it easier for older patients to get around independently.Once the patient has checked in, bring them any forms that need to be filled out. Be prepared to provide any assistance the patient may need in reading or filling out forms. This will lower the amount of stress the patient may feel during the initial visit.Make things easy to read.
Lighting in the waiting and exam areas should be bright and spread evenly throughout the room. Reduce all glare and avoid sitting older patients in shadows. Good lighting will help the patient’s ability to read printed material, see facial expressions and read lips. In addition, use large, easy-to-read print on all of your business cards, appointment cards, brochures and educational materials. Easy-to-read signs posted throughout the practice can also help to provide important information, since older individuals may be reluctant to ask seemingly obvious questions of the medical staff.Be ready to physically escort patients.
Assisting the elderly patient from room to room may be necessary, especially if there are steps or risers in the office. Make sure the patient is comfortable and that any immediate needs are filled.Check on them from time to time. If older patients will be in the examination or consultation room unattended for an extended period, check on them so they know you have not left them or forgotten them. If the doctor is delayed with another patient, let patients know that and keep them updated on how long the wait might be.Keep the patient relaxed and focused.
This is key to obtaining reliable information from the patient. Lightly touching the patient’s shoulder, arm or hand will help them relax and increase their level of trust. Also, call the patient by name (e.g., Mr. Thomas or Mrs. Johnson) so the visit seems personal and important.Say goodbye.
You want patients to have a good feeling about their visit and your practice. You want them to leave knowing how much you care about them and their health. One way to accomplish this is to walk the patient to the checkout desk, thank them for their visit and tell them goodbye.Communication is not an exact science; you will need to experiment and find which strategies work best for you and your staff. You will also need to remember that different patients have different communication needs, which may require different techniques. However, if you begin with the tips provided and if you train your staff to follow them, you will find increased levels of comfort and satisfaction among your elderly patients, and you will be better able to care for this growing population. Medical Never-Never-Land: 10 Reasons Why America Is Not Ready for the Coming Age Boom. Washington, DC: Alliance for Aging Research; 2002.3.
Thompson TL, Robinson JD, Beisecker AE. The older patient-physician interaction.
In: Nussbaum JF, Coupland J, eds. Handbook of Communication and Aging Research, 2nd ed. Mahwah, NJ: Lawrence Erlbaum Assoc; 2004.4. The challenge of communicating health information to elderly patients: a view from geriatric medicine. In: Park DC, Morrell RW, Shifren K, eds. Processing of Medical Information in Aging Patients: Cognitive and Human Factors Perspectives.
Mahwah, NJ: Lawrence Erlbaum Assoc; 1999.5. Ostuni E,Mohl GR.Communication with elderly patients. What did you say?
Tips for talking more clearly to patients. ACP Observer. December 1997.7.
Beisecker AE.Aging and the desire for information and input in medical decisions: patient consumerism in medical encounters. Haug MR,Ory MG.Issues in elderly patient-provider interactions. Thirty ways to make your practice more patient-friendly. In: Woods D, ed. Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004.10.
Communication Skills for Working With Elders. New York: Springer; 1987.11. Osborne H.Communicating with clients in person and over the phone.
Issue Brief Cent Medicare Educ. Breisch SL.Elderly patients need special connection. Am Acad Orthop Surg Bull. February 2001;49(1).13. Nussbaum JF, Pecchioni LL, Robinson JD, Thompson T. Communication and Aging. Mahwah, NJ: Lawrence Erlbaum Assoc; 2000.14.
Meryn S.Improving doctor-patient communication: not an option but a necessity. Hippocrates was right: treat people, not their disease. In: Woods D, ed. Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004:12–13.16.
Towards better doctor-patient communications. In: Bennett AE, ed. Communication Between Doctors and Patients. London: Oxford University Press. National Council on Patient Information and Education. Eight easy ways to make the medicine go down.
In: Woods D, ed. Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004:6–7.18. Breisch SL.Communicating with the elderly depends on listening skills. Am Acad Orthop Surg Bull. Seven ways to build trust with your patients on their first visit. In: Woods D, ed.
Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004: 23–24.
Theorists working the critical perspective view society as inherently unstable, based on power relationships that privilege the powerful wealthy few while marginalizing everyone else. According to the guiding principle of critical sociology, the imbalance of power and access to resources between groups is an issue of social justice that needs to be addressed. Applied to society’s aging population, the principle means that the elderly struggle with other groups — for example, younger society members — to retain a certain share of resources. At some point, this competition may become conflict.For example, some people complain that the elderly get more than their fair share of society’s resources. In hard economic times, there is great concern about the huge costs of social security and health care.
They argue that the medical bills of the nation’s elderly population are rising dramatically, taking resources away from the needs of other segments of the population like education. For example, while funding for education is cut back, funding for medical research increases. However, while there is more care available to certain segments of the senior community, it must be noted that the financial resources available to the aging can vary tremendously by race, social class, and gender.There are three classic theories of aging within the critical perspective. Modernization theory (Cowgill and Holmes, 1972) suggests that the primary cause of the elderly losing power and influence in society are the parallel forces of industrialization and modernization.
As societies modernize, the status of elders decreases, and they are increasingly likely to experience social exclusion. Before industrialization, strong social norms bound the younger generation to care for the older. Now, as societies industrialize, the nuclear family replaces the extended family. With increasingly precarious employment, the struggle to earn a living means that people often have to move away from family to work and the work itself consumes increasing time and energy that might be spent looking after family members. Societies become increasingly individualistic, and norms regarding the care of older people change. In an individualistic industrial society, caring for an elderly relative is seen as a voluntary obligation that may be ignored without fear of social censure.The central reasoning of modernization theory is that as long as the extended family is the standard family, as in preindustrial economies, elders will have a place in society and a clearly defined role. As societies modernize, the elderly, unable to work outside of the home, have less to offer economically and are seen as a burden.
This model may be applied to both the developed and the developing world, and it suggests that as people age they will be abandoned and lose much of their familial support since they become a nonproductive economic burden.Another theory in the critical perspective is age stratification theory (Riley, Johnson, and Foner, 1972). Though it may seem obvious now, with our awareness of ageism, age stratification theorists were the first to suggest that members of society might be stratified by age, just as they are stratified by race, class, and gender.
The value of a person (i.e., their status or prestige in society) is determined by their age, an ascribed rather than an achieved characteristic. Because age serves as a basis of social control, different age groups have varying access to social resources such as political and economic power. In this model, the privileges, independence, and access to social resources of seniors decreases based simply on their position within an age-category hierarchy. The elderly experience an increased dependence as they age and must increasingly submit to the will of others because they have fewer ways of compelling others to submit to them. Moreover, within societies stratified by age, behavioural age norms, including norms about roles and appropriate behaviour, dictate what members of age cohorts may reasonably do. For example, it might be considered deviant for an elderly woman to wear a bikini because it violates norms denying the sexuality of older females.
These norms are specific to each age strata, developing from culturally based ideas about how people should “act their age.”Thanks to amendments to recent legislation in all provinces (except New Brunswick), Canadian workers no longer must retire upon reaching a specified age. Age is one of the prohibited grounds of discrimination in employment across Canada.Age stratification theory has been criticized for its broadness and its inattention to other sources of stratification and how these might intersect with age. Feminist theory argues that an older white male occupies a more powerful role, and is far less limited in his choices, than an older white female based on his historical access to political and economic power. In other words, gender is a key variable needed to understand the issues of aging. Women’s status has traditionally depended much more on youth and physical attractiveness than men’s, so the devaluation associated with aging affects them much more powerfully.In addition, women’s earnings do not increase at the same rate as men’s in the latter half of their careers so more women enter retirement age with considerably less financial resources than men (Garner, 1999).
In 2007, the low-income rate for senior, single, unattached women was 14%. About 123,000 senior women living on their own lived in poverty compared to 44,000 men (Townsend, 2009).Finally, many senior women today were socialized in their experience as daughters and wives to grant the decision-making power to men, especially in the area of financial decision making. When they outlive their spouses, they are often suddenly burdened with decisions and tasks with which they they have had no experience.
This can be profoundly disempowering, particularly when adult children feel they need to step in and take over. As feminist critique is not simply about drawing attention to the injustice of women’s position in society, the question then becomes, how can senior women be empowered to develop new roles, recognize their strengths, and see themselves as valuable human beings (Garner, 1999)? Figure 13.19. The subculture of aging theory posits that the elderly create their own communities because they have been excluded from other groups. (Photo courtesy of Icnacio Palomo Duarte/flickr) Symbolic InteractionismGenerally, theories within the symbolic interactionist perspective focus on how society is created through the day-to-day interaction of individuals, as well as the way people perceive themselves and others based on cultural symbols. This microanalytic perspective assumes that if people develop a sense of identity through their social interactions, their sense of self is dependent on those interactions.
A woman whose main interactions with society make her feel old and unattractive may lose her sense of self. But a woman whose interactions make her feel valued and important will have a stronger sense of self and a happier life.Symbolic interactionists stress that the changes associated with old age, in and of themselves, have no inherent meaning. Nothing in the biological nature of aging creates any particular, defined set of attitudes. Rather, attitudes toward the elderly are rooted in society.One microanalytical theory is Rose’s (1962) subculture of aging theory, which focuses on the shared community created by the elderly when they are excluded (due to age), voluntarily or involuntarily, from participating in other groups. This theory suggests that elders will disengage from society and develop new patterns of interaction with peers who share common backgrounds and interests. For example, a group consciousness may develop within such groups as CARP around issues specific to the elderly including health care, retirement security, continuing care, and elder abuse focused on creating social and political pressure to fix those issues. Whether brought together by social or political interests, or even geographic regions, elders may find a strong sense of community with their new group.Another theory within the symbolic interaction perspective is selective optimization with compensation theory.
Baltes and Baltes (1990) based their theory on the idea that successful personal development throughout the life course and subsequent mastery of the challenges associated with everyday life are based on the components of selection, optimization, and compensation. Though this happens at all stages in the life course, in the field of gerontology, researchers focus attention on balancing the losses associated with aging with the gains stemming from the same. Here, aging is a process and not an outcome, and the goals (compensation) are specific to the individual.According to this theory, our energy diminishes as we age, and we select (selection) personal goals to get the most (optimize) for the effort we put into activities, in this way making up for (compensation) the loss of a wider range of goals and activities. In this theory, the physical decline postulated by disengagement theory may result in more dependence, but that is not necessarily negative, as it allows aging individuals to save their energy for the most meaningful activities. For example, a professor who values teaching sociology may participate in a phased retirement, never entirely giving up teaching, but acknowledging personal physical limitations that allow teaching only one or two classes per year.Swedish sociologist Lars Tornstam developed a symbolic interactionist theory called gerotranscendence: the idea that as people age, they transcend the limited views of life they held in earlier times.
Tornstam believes that throughout the aging process, the elderly become less self-centred and feel more peaceful and connected to the natural world. Wisdom comes to the elderly, Tornstam’s theory states, and as the elderly tolerate ambiguities and seeming contradictions, they let go of conflict, and develop softer views of right and wrong (Tornstam, 2005).Tornstam does not claim that everyone will achieve wisdom in aging. Some elderly people might still grow bitter and isolated, feel ignored and left out, or become grumpy and judgmental.
Symbolic interactionists believe that, just as in other phases of life, individuals must struggle to overcome their own failings and turn them into strengths.Finally, exchange theory (Dowd, 1975), a rational-choice approach, suggests that one’s status and role identity within social relationships depend on an ongoing exchange of social resources such as effort, time, money, support, and companionship. There is an implicit cost/benefit analysis that underlies the dynamics of social relationships in which individuals calculate the costs of their contributions to the relationship (in terms of effort, etc.) against the benefits and rewards they receive in return. Inasmuch as relationships are based on mutual exchanges, as the elderly become less able to exchange resources, they see their social circles diminish. There is less benefit for others to exchange with them.
In this model, the only means to avoid being discarded is to engage in resource management, such as maintaining a large inheritance or participating in social exchange systems via child care. In fact, the theory may depend too much on the assumption that individuals are calculating. It is often criticized for affording too much credit to material exchange and devaluing nonmaterial assets such as love and friendship.
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