Communication with The Elderly

Objectives:
By the end of the lecture the student will be able to:-
1-Define communication process.
2-Differentiate between ways of communication.
3-Identify types of communication.
4-Identify factors that affect communication among elderly.
5-Identify the role of nursing with communication:
6-Determine how to communicate with the hearing impaired person.
7-Determine how to communicate with the visually impaired.
8-Determine how to communicate with Alzheimer patient.

Outlines:
1. Definition of communication process.
2. Ways of communication.
3. Types of communication.
4. Factors that affect communication.
5. The role of nursing with communication:
6. Communication with the hearing impaired person.
7. Communication with the visually impaired person.
8. Communication with Alzheimer patient.

Introduction:
Communications with older people is important and require extra time
and patience because of physical, psychological and social changes of
normal aging.
Even more efforts are needed in nursing homes where 60% to 90% of
residents may actually have disabilities. Each person participates in
communication in unique individuals who interacts his or her own
personal values, beliefs, Perception, culture and understanding with how
the world operates.
Definition Of communication process:
A Process by which people share ideas, knowledge, experience and
feelings through the transmission of symbolic messages.
Ways of communications:
 Two way communication:
1. Includes feedback from the receiver to the sender.
2. Both sender and receiver listen to each other and exchanging ideas
and thoughts.
3. Effective way of communication.
Examples:
 Interviewing.
 Face-To-Face.
 One way communication:
1. Is one-way towards the receiver not from the receiver.
2. The receiver listens to or reads the target language but does not
respond.
3. Is not effective way of communication.
Examples:
 Listening to programs, radio.
 Reading books and magazines.
Elements of Communication Process:
Seven major elements of communication process are:
1. Sender:
The person or persons responsible for creating a message to be sent to
others.
2. Message:
 Can be ideas, thoughts, information, feeling that a person wants to
share with another person, also can be verbal or non-verbal form of
communication.
3. Encoding:
Ability of sender to transform message into a form that can be sent
such as words.

4. Communication Channel:
The medium, through which the message is sent, may be written, oral
or visual.
5. Receiver:
The person or persons who are receiving the created messages.
6. Decoding:
Ability of receiver to mentally processing the message into
understanding.
7. Feedback:
The process of ensuring that the receiver has received the message
and understood in the same sense as sender meant it.

Factors that influence communication:

A-Personal factors:
 Perception and Values: affect the person’s interpretation of the
message. People can see the same object and perceive different
things.
 Culture: Each culture teaches people how to use language,
massage and technique that differ from other cultures.
 Attitude: A positive nurse attitude toward the elderly can enhance
the communication.
  Trust: Trust is central to a therapeutic nurse – relationship; trust
implies confidence, dependability in a relationship.
 Emotional state :such as anger and anxiety affect the way of
communication and its effectiveness.
 Physical factors: such as pain and illness.
 Intellectual: such as level of education, language.
 Social: as difference in culture and language.
B-Environmental factors:
 Seating arrangement
 Movement of chairs
 Inadequate light
 Noise
 Lack of privacy.
 Too hot or too cold place
Types of communication:
The two type of communication are verbal and non-verbal. 10% of all
communication is verbal a 90% in nonverbal.
A- Verbal communication:
 Any form of communication involving words, spoken, written or
signed
 Effective verbal communication require
 Speak with confidence.
 Think before you speak.
 Be clear.
 Be concise.
 Don’t talk too much.
 Be aware of your body language.
 Attentive listener.
 B- Nonverbal communication:
 The way of communication without the use of words e.g.
Body language which includes (posture, gestures, facial expressions,
eye contact), Touch, tone and volume of voice and dress
 The most accurate form of communication.
Barriers of communications:
 Inappropriate reassurances.
 Making judgments.
 Giving advice, telling the person what should be avoided.
 Challenging.
 Scolding.
 Improper questioning.
The role of nursing with communication
1) Communicating with the hearing impaired:
1. Be aware of the person's health issues.
2. Approach the person from the front and close enough to the person
before you begin speaking to get individual’s attention.
3. If a hearing aid is used, make sure it is in place and that the batteries are
functioning.
4. Communicate at face level and at the side of the good ear.
5. Call patient by his/ her name.
6. Maintain eye contact and smile.
7. Keep your hands away from your face while talking.
8. Reduce or eliminate background noise as much as possible.
9. Avoid eating, chewing or smoking while talking; your speech will be
more difficult to understand.
10. Speak slowly, directly in a normal fashion without shouting.
 11. Use simple words, clear and precise questions and sentences for
easier understanding and repeat message in a different words if not
understood, rather than repeating the original words over and over.
12. Write messages and use simple picture if necessary.
13. Use a pictogram grid or other device with illustrations to facilitate
communication (if patient is deaf)
14. Combine verbal with nonverbal (body language) methods of
communication
15. Don’t hurry the patient and allow time for him to respond, being in a
rush will create stress and barriers to effective communication.
16. See that the light is not shining in the eyes of the patient.
2) Communicating with the visually impaired:
 Get the person’s attention before you start talking.
 Address the patient by his name or a light touch on the arm.
 Clearly identify yourself and others with you.
 Ensure adequate lighting on your face and eliminate glare.
 Allow the person to touch you.
 Communicate at face level.
 Use the words "see" and "look" normally;
 Speak slowly, directly in a normal fashion without shouting.
 Tell the person if you are leaving and who will remain in the room or if
he will be alone
 Use intensity colors (red, orange) for furniture and pictures.
 Use enlarged font size and contrast in printed material (e.g., black
marker on white paper)
 Use low-vision assistive devices, such as talking watches and talking
books.
 Do not change the room arrangement or the arrangement of personal
items without explanation.
 If the person is blind;
 Describe the room layout and where things are.
 Offer your arm while walking.
 Pause before stairs or curbs and alert the person.
 Let the person know his position in relation to objects
 Use sound and smell clues.
 Encourage familiarity and independence whenever possible.

3) Communicating with persons with Alzheimer’s Disease or related

disorders
1. Always approach the person from the front, or within his line of vision –
no surprise appearances
2. Introduce yourself, and explain why you are here.
3. If the person does not want to talk, go away and return later.
4. Sit closely, face the person at eye level and smile.
5. Note the response to touch and personal space.
6. Reduce or eliminate background noise as much as possible.
7. Combine verbal with nonverbal (body language) methods of
communication.
8. Avoid infantilization (don’t talk to him as a baby).
9. Speak slowly, directly in a normal fashion without shouting and greet
the person.
10. Use simple words, clear and precise questions and sentences and
repeat message in a different words if not understood
11. Ask only one question at a time. More than one question will increase
confusion.
12. Allow time for response, limit corrections and use positive statements.
13. Recognize feelings and respond.
14. Do not try to bring the person to the present or use reality orientation.
 Attitude toward Elderly
Objectives:
By the end of this lecture the student will be able to:
- Define the attitude.
- List the components of attitude.
- Understand factors affecting the attitude toward the elderly.
- Recognize of negative attitude toward elderly.
- Know the consequence of ageism.
- Apply gerontological nursing intervention to combat ageism.
Outlines:
- Definition of the attitude.
- Components of attitude.
- Factors affecting the attitude toward the elderly.
- Negative attitude toward elderly.
- Consequences of ageism.
- The role of gerontological health nurses to combat ageism.

Introduction:
Attitudes are not inherited they are acquired or learned by people
from the environment in which they interact. The sources of attitudes are
broadly classified into two sources:
1. Direct experience. 2. Social Learning
Definition:
A complex mental state involving beliefs and feelings towards someone or
something and tendency to act in certain ways (positive or negative).
Or, a way of looking at life; a way of thinking, feeling or behaving.
Components of Attitudes:
 Proposes that attitude has three related components – the affective,
behavioral and cognitive components – which are sometimes referred
to as the ‘ABC of attitudes’.

1-Cognitive component (Thoughts)

 Refers to the belief we have about an object, person, group, event or
issue.
 These are linked to what we know about the world and developed
through experience.
 Some beliefs are true and some are false.
 Some can be verified and some cannot.
2-Affective component (Feelings)
 Refers to emotional reactions or feelings an individual has towards an
object, person, group, event or issue.
 Based on a judgment which results in either a positive, negative or
neutral response.
3-Behavioural Component (Actions and reactions)
 Refers to the way an attitude is expressed through our actions (or
intended actions if an opportunity presented itself)
Example:
Cognitions (My job is interesting).
Affections (I love my job).
Behavior (I am going to get to work early with a smile on my face- my
intention to act).
Factors affecting the attitudes toward the elders:
• Social and cultural background.
• Sex.
• Level of education.
• Area of practice.
 • Interest in working with the elders.
• Years of experience.
• Type of care facility.
• Exposure to positive role model of aging.
• Characteristics of the residents such as functional and sensory deficits.
• Myths (having false information, negative images about elders).
• Influence of mass media.
Ageist attitudes may be excessively positive or negative, depending on
one's tendency to stereotype individuals based on their age.
Positive attitude toward aging:
 positive image occur when society see elderly persons as
o A transmitter of culture via generations.
o Active, vital and healthy persons in society and take better care of
themselves.
o Independent persons.
o Able to overcome their illness and adapting with aging changes

Negative attitude toward elderly:

 The negative image beliefs aged person to be forgotten, mentally
incompetent, unemployable, unattractive person and represent a load
on society.
 This negative image has a harmful effect on the elderly person who
accepts this negative image e.g. may deny aging and this appears in
many forms like (cosmetic surgery, hair transplant and use of anti-
aging products) especially in women that may harm their health.

 Ageism: (Old age is viewed negatively) & refers to discrimination

against individuals or groups based on age. Ageism has negative
consequences not only on elders, but on individuals, families, groups
and community levels.
 Consequences of Ageism:
 Not valuing the opinions, contributions and ideas of the elders.
 Treating the elders with disrespect.
 Physical care, verbal and nonverbal behaviors exhibited toward them
are colored by the beliefs held about them.
 Ageism can lower or destroy the self-esteem of elders.
 Limit the degree to which elder’s problems are worked up and
managed by health professionals.
 The elders become dependent and unacceptable.
 Lead to a variety of abusive behaviors about elders.

Role of the gerontological nurse to combat ageism

 Identify and eliminate personal attitudes of ageism by understanding the
realities of aging and identifying common misconceptions through
contact with individuals, families and community.
 Help in disseminating accurate information about the needs and
characteristics of the aging populations through mass media.
 Nurses who work with elders should act as role models for staff and
advocate for the rights of elders.
 Providing advice and educating the elders and family about aging
process and disabilities associated with aging.
 Nurses can refer others to agencies that can provide accurate and current
information on aging.
 Informing the family about the importance of involving them in every
aspect of their life as this will provide support, show respect and loving.
 Educating the staff about common changes associated with aging,
misconceptions and realities of aging.