Caring for older patients: communication and resources

The medical assistant’s role in caring for the older patient

Older adult patients in the ambulatory care setting present a specific set of needs that require a certain amount of accommodation by the staff. For example, aging patients typically require more time to perform tasks and have questions answered. The office staff may want to hurry them so the day’s schedule can be maintained. In the best interests of the patient, however, they should be treated with respect and given whatever time is needed to prepare for examinations, ask questions and receive answers, and have procedures explained. A system that is sensitive to the needs of older patients does the following:

• Schedules longer periods for appointments
• Has adequate lighting in the waiting room
• Provides forms in large print
• Has an examination room equipped with furniture, magazines, and treatment folders specifically designed for older adults
• Invites a professional in the management of older patients for in-service training

Communication

The primary issue in elder care is effective communication. How you communicate with people is often influenced by what you know or do not know about them. Older people are subject to many changes that affect how they are able to interact with their environment. It is important to recognize these changes and to investigate one’s personal perception of older people to break down the barriers that prohibit effective communication.

As people age, they frequently experience a loss of control over their lives because of physical disabilities, economic constraints, and institutional living. Part of the medical assistant’s job is to help aging people maintain their dignity and independence while in the ambulatory care setting. Remember, regardless of their education, socioeconomic status, or age, each patient deserves to be treated with compassion and respect. Ask the patient directly what is wrong rather than discussing the patient with family members. It is also important to listen carefully and be specific and sincere when responding. When a patient is talking, take time to allow them to complete the sentence; do not finish it for the person. Give the patient your full attention rather than continuing with other tasks while the person is speaking. Older people may take a little longer to process information, but they are capable of understanding. Do not hurry through explanations or questions; rather, take time to review a form or give instructions as needed.

Resources

When medical assistants work with the geriatric population, the subject of living arrangements will likely come up. At any given time, only 5% of the older adult population lives in long-term care facilities. According to information published by the National Institute on Aging, older people live close to their children and are in frequent contact with them. People prefer to age in place—that is, they want to live in their own home environment as long as possible. Individuals are admitted to nursing homes because they are no longer able to perform daily living activities, such as bathing, dressing, eating, walking, and maintaining bladder and bowel continence. They also have difficulty with grocery shopping, housekeeping, and money management. Chronic health conditions and accidents interfere with the older person’s ability to perform these tasks.

Many resources are available to help seniors maintain their independence. Outreach programs, such as Meals on Wheels, deliver nutritious meals to the homes of older adults. Senior centers serve as a focal point for many activities and as a source of information. Transportation services provide rides to doctors’ appointments, daycare centers, shopping centers, and community events. Home health agencies provide several types of services, including personal care, shopping, transportation, and meal preparation. Some home health agencies provide a range of activities, from patient education to IV therapy; medical social services; physical, speech, and occupational therapies; and nutrition and dietary counseling. Advanced technology allows people to receive services at home that formerly were provided only in a hospital or a physician’s office.

Adult daycare centers provide socialization, recreation, meals, and, in some centers, physical therapy, occupational therapy, and transportation. These centers offer supervision for older adults who

Suggestions for effective communication with aging patients

• Address the patient as Mr., Mrs., or Ms. unless the patient has given you permission to use their first name.
• Introduce yourself and explain the purpose of a procedure before performing the procedure.
• Face the aging person and softly touch the individual to get their attention before beginning to speak.
• Use expanded speech, gestures, demonstrations, or written instructions in block print.
• If the message must be repeated, paraphrase or find other words to say the same thing.
• Observe the patient’s nonverbal behavior for cues indicating whether the individual understands.
• Provide adequate lighting without glare.
• Allow patients time to process information and take care of themselves unless they ask for assistance.
• Conduct communication in a quiet room without distractions.
• Involve family members as needed for continuity of care.
• When leaving a telephone message, remember to speak slowly and clearly and repeat the message in the same manner. It is difficult to interpret a message, and even more difficult to write it down, if the message was delivered in a hurried manner.
• Use referrals and community resources for support, such as these:
  • Alzheimer’s Association: www.alz.org (1-800-272-3900).
  • American Council of the Blind: http://acb.org (1-800-424-8666): Provides referrals to state and other organizations that provide services and equipment for the blind.
  • American Speech-Language-Hearing Association: www.asha.org (1-800-638-8255): Offers information on hearing aids, hearing loss, and communication problems in older people and provides a list of certified audiologists and speech pathologists.
  • Arthritis Foundation Information Line: www.arthritis.org (404-872-7100): Makes referrals to local chapters and provides information on various types of arthritis.
  • American Diabetes Association: www.diabetes.org (1-800-342-2383): Provides information and support for those with diabetes.
  • Eldercare Locator: www.eldercare.gov/Eldercare.NET/Public/Index.aspx (1-800-677-1116): Run by the National Association of Area Agencies on Aging; its helpline provides information on contacting local chapters that oversee services for older adults.
  • National Institute on Aging Information Center: www.nia.nih.gov (1-800-222- 2225): Provides information on aging health issues for patients, families, and healthcare professionals.
  • National Meals-on-Wheels Foundation: www.mowaa.org (1-888-998-6325).
• May be taken care of by family members in the evening but need care during the day. They also serve as respite for a caregiver.

Assisted-living facilities can be retirement homes or board-and-care homes. These facilities are appropriate for older adults who need assistance with some activities of daily living, such as bathing, dressing, and walking. Skilled nursing facilities provide 24-hour medical care and supervision. In addition to medical care, residents receive care that may include physical, occupational, and speech therapies. The objective of treatment is to improve or maintain the person’s abilities.