Communication and Interpersonal Skills with Older Adults
Core concepts
Effective communication with older adults requires positioning, sensory accommodation, and respect. Face the resident, make eye contact at eye level, speak clearly at a moderate pace, and avoid shouting. For hearing loss, reduce background noise, face the person so lip-reading is possible, and use written notes or gestures if needed. For vision loss, identify yourself on entering and describe what you are doing. Aphasia requires patience, allowing time to respond and using yes/no questions or picture boards rather than finishing sentences.
Cognitive impairment
With dementia, use short sentences, one idea at a time, validation of feelings, and redirection rather than correction. Do not argue about facts. Therapeutic communication includes open-ended questions, active listening, reflecting feelings, and silence. Barriers include jargon, speaking too fast, using a raised voice, and talking over the resident to family members.
Traps in questions
A frequent trap is choosing the answer where the aide speaks to the family instead of the resident. Another is choosing "speak louder" for a hearing-impaired resident - the correct approach is lower pitch, clearer articulation, and reduced background noise. Questions about a resident with dementia often bait with "explain the facts logically"; the better answer is to redirect and comfort. Also watch for answers that promise confidentiality you cannot keep or that dismiss a resident's concern.
Worked example
A resident with hearing aids says she cannot hear you. The best first step is to check that the hearing aids are on and working, reduce background noise, and face her directly. Rule of thumb: check the equipment and the environment before raising your voice.