Doctor-patient communication is an essential, though sometimes challenging, aspect of the health care process. The following suggestions can help you work with older patients to optimize care and make the most of your time and resources.

Tips for communicating with older patients

Effective communication can help build satisfying relationships with older patients to best manage their care. It can strengthen the patient-provider relationship, lead to improved health outcomes, help prevent medical errors, and make the most of limited interaction time.

Interpersonal communication skills are considered so important that they are a core competency identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties.

These key communication tips can help facilitate successful interactions with all of your patients, including older adults:

• peak to the patient as a fellow adult. Having physical, sensory, or cognitive impairments does not lessen the maturity of an adult patient. Those who are older might be used to more formal terms of address. Establish respect right away by using formal language as a default (such as Mr. or Ms.) and avoiding familiar terms, such as “dear,” which could be perceived as disrespectful. You or your staff can also ask patients how they prefer to be addressed.
• Make older patients comfortable. Ask staff to ensure patients have a comfortable seat in the waiting room and, if necessary, help with filling out forms. Staff should check on them often if they have a long wait before they are seen. Patients with impaired mobility may need to be escorted to and from exam rooms, offices, restrooms, and the waiting area. They may require assistance with climbing on to the exam table or removing clothing or shoes.
• Avoid hurrying older patients. Be mindful if you are feeling impatient with an older person’s pace. Some people may have trouble following rapid-fire questioning or torrents of information. Try speaking more slowly to give them time to process what is being asked or said, and don’t interrupt. Once interrupted, a patient is less likely to reveal all of their concerns. If time is an issue, you might suggest that your patients prepare a list of their health concerns in advance of appointments.
• Speak plainly. Do not assume that patients know medical terminology. Use simple, common language and ask if clarification is needed. Check to be sure your patient understands the health issue, what they need to do, and why it is important to act.
• Address the patient face-to-face. Don’t talk to patients with your back turned or while typing. Many people with hearing impairment understand better when they can read lips as well as listen. Watching a patient’s body language can also help you know whether they understand what you’re saying.
• Write down or print out takeaway points. It can often be difficult for patients to remember everything discussed during an appointment. Older adults with more than one medical condition or health concern benefit especially from having clear and specific written notes or printed handouts. That way, they have information to review later about their health conditions, treatments, and other major points from visits.
• Recognize that people from different backgrounds may have different expectations. Be sensitive to cultural differences that can affect communication with your patients. When needed, provide professional translation services and written materials in different languages.

Compensating for hearing deficits

Age-related hearing loss is common: About one-third of older adults have hearing loss, and the chance of developing hearing loss increases with age. Here are a few tips to make it easier to communicate with a person who may have difficulty hearing:

• Make sure your patient can hear you. Ask if the patient has a working hearing aid, look at the auditory canal for excess earwax, and be aware of background noises, such as whirring computers and office equipment.
• Talk clearly and in a normal tone. Shouting or speaking in a raised voice distorts language sounds and can give the impression of anger, and a high-pitched voice can be hard to hear.
• Face the person directly, at eye level, so that they can lip read or pick up visual clues.
• Indicate to your patient when you are changing the subject, such as by pausing briefly, speaking a bit louder, gesturing toward what will be discussed, gently touching the patient, or asking a question.
• Keep a notepad handy so you can write down important points, such as diagnoses, treatments, and important terms.
• Use amplification devices if they are available in your clinic or hospital.
• If your patient has difficulty hearing the difference between certain letters and numbers, give context for them. For instance, “m as in Mary” or “five, six” instead of “56.” Be especially careful with letters that sound alike.

Compensating for visual deficits

Visual disorders become more common as people age. Here are some things you can do to help manage the difficulties in communication that can result from visual deficits:

• Make sure there is adequate lighting, including sufficient light on your face. Try to minimize glare.
• Check that your patient has brought and is wearing eyeglasses or contact lenses, if needed.
• Make sure that handwritten instructions are clear. When using printed materials, make sure the type is large enough (at least 14-point font) and the typeface is easy to read.
• If your patient has trouble reading because of low vision, consider providing alternatives, such as audio instructions, large pictures or diagrams, and large pillboxes with raised markings.

Families and caregivers as part of the health care team

Family members and other informal caregivers play a significant role in the lives of their loved ones. They may provide transportation and accompany an older adult to medical appointments. In many cases, they act as facilitators to help the patient express concerns and can reinforce the information you give. But first, to protect and honor patient privacy, check with the patient by asking how they see the companion’s role in the appointment.

It is important to keep the patient involved in their own health care and conversation. Whenever possible, try to sit so that you can address both the patient and companion face-to-face. Be mindful not to direct your remarks only to the companion.

You might ask the companion to step out of the exam room during part of the visit so you can raise sensitive topics and provide the patient some private time if they wish to discuss personal matters. For example, if you’re conducting a test of a patient’s cognitive abilities, you might ask the companion to step out so they can’t answer questions or cover for the patient’s cognitive lapses.

Some patients may ask that you contact their long-distance caregivers to discuss conditions or treatment plans. Make sure these patients fill out any necessary paperwork giving permission for you to speak with specific family members or friends if they are not present at the appointment.

Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairment. If a family member has been named the health care agent or proxy, under some circumstances they have the legal authority to make care decisions. However, without this authority, the patient is responsible for making their own choices. When necessary, set clear boundaries with family members and encourage others to respect them.

Discussing medical conditions and treatments

Approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions. Clinicians can play an important role in educating patients and families about chronic health conditions and can connect them with appropriate community resources and services.

Most older patients want to understand their medical conditions and learn how to manage them. Likewise, family members and other caregivers can benefit from having this information. Physicians typically underestimate how much patients want to know and overestimate how long they spend giving information to patients. Devoting more attention to educating patients and their caregivers can improve patients’ adherence to treatment, increase patients’ well-being, and save you time in the long run.

Clear explanations of diagnoses are critical. Uncertainty about a health problem can be upsetting, and when patients do not understand their medical conditions, they are less likely to follow their treatment plans. It is helpful to begin by finding out what the patient understands about their condition, what they think will happen, and how much more they want to know. Based on the patient’s responses, you can correct any misconceptions and provide appropriate information.

Treatment plans need to involve patients’ input and consent. Ask about their goals and preferences for care and focus on what matters most to them. Check in with your patient about feasibility and acceptability throughout the process, thinking in terms of joint problem-solving and collaborative care. This approach can increase the patient’s satisfaction while reducing demands on your time.

Treatment might involve lifestyle changes, such as a more nutritious diet and regular exercise, as well as medication. Tailor the plan to the patient’s situation and lifestyle and try to reduce disruption to their routine. Keep medication plans as simple and straightforward as possible, indicating the purpose of each medication and when it should be taken. Tell the patient what to expect from the treatment.

These tips may help discussions about medical conditions and treatment plans:

• A doctor’s advice generally receives the greatest credence, so the doctor should introduce treatment plans. Other medical team members can help build on the doctor’s original instructions.
• Let your patients know that you welcome questions. Tell them how to follow up if they think of any additional questions later.
• Some patients won’t ask questions even if they want more information. Consider making information available even if it’s not explicitly requested.
• Offer information through more than one channel. In addition to talking with the patient, you can use fact sheets, drawings, models, or videos. In many cases, referrals to websites and support groups can be helpful.
• Encourage the patient or caregiver to take notes. It’s helpful to offer a pad and pencil. Active involvement in recording information may help your patient better retain information and adhere to the treatment plan.
• Repeat key points about the health problem and treatment plan at every office visit, providing oral and written instructions, and check that the patient and their caregiver understand the information.
• Provide encouragement and continued reinforcement for treatment or necessary lifestyle changes. Call attention to the patient’s strengths and offer ideas for improvement.
• Make it clear that a referral to another doctor, if needed, does not mean you are abandoning the patient.

Confusion and cognitive problems

A patient may still seem confused despite your best efforts to communicate clearly. In those instances, work to:

• Support and reassure the patient, acknowledging when responses are correct or understood.
• Make it clear that the conversation is not a “test” but rather a search for information to help the patient.
• Consider having someone from your staff call the patient to follow up on instructions.

Cognitive impairment, however, is more than general confusion or normal cognitive aging. If you observe changes in an older patient’s cognition or memory, follow up with screening and diagnostic testing, as appropriate.

There are a variety of possible causes of cognitive problems, such as side effects from medications, metabolic and/or endocrine changes, delirium, or untreated depression. Some of these causes can be temporary and reversed with proper treatment. Other causes of cognitive problems, such as Alzheimer’s disease, are chronic conditions but may be treated with medications or nondrug therapies. Having an accurate diagnosis also can help families wanting to improve the person’s quality of life and better prepare for the future.

Read more about Assessing Cognitive Impairment in Older Patients and Caring for Older Patients With Cognitive Impairment.

Sensitive topics

Caring for an older patient requires discussing sensitive topics related to safety, independence, and health. Older patients may be hesitant to bring up certain problems and other concerns such as:

• Advance care planning
• Driving
• Elder abuse
• End of life
• Health care costs
• Long-term care
• Mental health issues, such as depression
• Sexuality and sexual health
• Social isolation and loneliness
• Substance use/misuse, including alcohol
• Urinary incontinence

There are techniques for broaching sensitive subjects that can help you successfully start the conversation. Try to take a universal, nonthreatening approach that frames the subject as a common concern of many older patients (such as, “Many people experience …” or “Some people taking this medication have trouble with…”). You can also share anecdotes about patients in similar circumstances, though always clearly maintaining patient confidentiality, to ease your patient into the discussion.

Some patients will still avoid issues that they think are inappropriate to discuss with clinicians. One way to overcome this hesitation is to keep informative brochures and materials readily available in the exam room and waiting areas.

To learn more, please visit https://www.nia.nih.gov/health/health-care-professionals-information/talking-your-older-patients.

COVID-19 is a respiratory disease that continues to affect people and communities worldwide. Older adults are more likely than younger people to get very sick from the disease. The resources below are from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), and other government agencies. This information can help older adults and their caregivers learn more about COVID-19, locate resources and services in their area, and find out about participating in COVID-19 research.

Information about COVID-19 and older adults

These resources provide health information, vaccine recommendations, and other guidance for older adults.

• COVID-19 Risks and Information for Older Adults: Risk factors, prevention, and other up-to-date information from the Centers for Disease Control and Prevention (CDC)
• Stay Up to Date With COVID-19 Vaccines: The latest CDC recommendations for COVID-19 vaccines and boosters
• COVID-19 Information Resources: Materials for older adults, people with dementia, and caregivers from NIA-funded research centers and other organizations
• COVID-19 Response: What Do Older Adults and People With Disabilities Need To Know? Information from the Administration for Community Living
• What Do We Know About Long COVID? Article from NIA about long-lasting symptoms of Long COVID in older adults
• Is it a Cold, the Flu, or COVID-19? Infographic from NIA showing the common symptoms of each illness

Finding COVID-19 resources in your community

These resources can help you find COVID-19 testing, vaccines, treatment, and guidance in your local area.

• COVID.gov: Community resources and guidance by county, including where to find masks, tests, vaccines, and treatment. Visit the website, call 800-232-0233, or text your ZIP code to 438829 (GETVAX) for COVID-19 resources in your area.
• Vaccines.gov: A searchable map of COVID-19 vaccination providers by ZIP code.
• COVID-19 Test-to-Treat Locator: An interactive map of local health clinics and pharmacies that test for COVID-19 and provide medications for treatment.
• State Health Departments: A list of all state and territorial health departments that provide local resources.
• Eldercare Locator: A service of the U.S. Administration on Aging that can help older adults find housing, community and in-home services, transportation, insurance and assistance programs, and benefits information in their community. Visit the website or call 800-677-1116.

COVID-19 information for caregivers

These resources can help family, friends, health professionals, and other caregivers of older adults.

• If You Are Sick or Caring for Someone: Advice from the CDC for people with COVID-19 and their caregivers in non-health care settings
• COVID-19 Guidance for Adult Day Services Centers: Guidance from the CDC for reducing the spread of COVID-19 and maintaining safe operations
• Resources on COVID-19 for Caregivers and Older Adults: A list of resources from the Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation

COVID-19 services for veterans

These resources can help veterans and their families find COVID-19 information and services through the U.S. Department of Veterans Affairs (VA).

• COVID-19 Resources for Veterans: Latest updates and information from the VA
• COVID-19 Vaccines at VA: Eligibility and locations for COVID-19 vaccines for veterans
• Coronavirus FAQs: What Veterans Need To Know: Answers to questions about COVID-19 testing, vaccination, benefits, and research from the VA

Government programs and assistance

These resources provide information about health care coverage, financial assistance, and other government programs and benefits related to COVID-19.

• Medicare & Coronavirus: Details about Medicare coverage for COVID-19 vaccines, tests, and treatments. Visit the website or call 800-633-4227.
• Resources and Assistance for Homeowners and Renters: Information about housing concerns during COVID-19 from the U.S. Department of Housing and Urban Development. Free housing advice is also available by calling 800-569-4287.
• Protecting Your Finances During the Coronavirus Pandemic: Guidance on mortgages, student loans, and financial management from the Consumer Financial Protection Bureau.
• Avoid Coronavirus Scams: Advice for consumers from the Federal Trade Commission.

Participating in COVID-19 research

People who participate in clinical trials and studies help scientists better understand COVID-19 and discover new ways to prevent and treat this disease. These resources provide information about clinical research and ways to get involved.

• Understanding COVID-19 Clinical Trials: General information from NIH about COVID-19 clinical trials, including how they work and the benefits of participating
• NIH COVID-19 Research Initiatives: Ongoing efforts from NIH to accelerate research-based solutions in testing, treatments, and vaccines for COVID-19
• COVID-19 Clinical Trials: A current list of COVID-19 studies seeking participants from ClinicalTrials.gov

To learn more, please visit https://www.nia.nih.gov/health/covid-19/covid-19-resources-older-adults-and-caregivers.

Many falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help prevent falls and better ensure your safety.

Floors, stairways, and hallways

• Ensure there are handrails on both sides of any stairs, and make sure they are secure. Hold the handrails when you go up or down stairs, even when you are carrying something. Don’t let anything you’re carrying block your view of the steps.
• Ensure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Consider using motion-activated lights that plug into electrical outlets and automatically turn on when you walk by them to help illuminate stairwells and pathways.
• Keep areas where you walk tidy. Don’t leave books, papers, clothes, or shoes on the floor or stairs.
• Check that all carpets are fixed firmly to the floor, so they won’t slip. Put no-slip strips, which you can buy at any hardware store, on tile and wooden floors.
• Don’t use throw rugs or small area rugs.
• Don’t walk on slippery, newly washed floors.

Bathrooms

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place nonskid mats, strips, or carpet on all surfaces that may get wet.
• Remember to leave a light on in the bathroom at night or use a night light that turns on automatically in the dark.

Bedrooms

• Put night lights and light switches close to your bed.
• Keep a flashlight by your bed in case the power goes out and you need to get up.
• Place a landline or well-charged phone near your bed.

Kitchen

• Keep frequently used pots, pans, and kitchen utensils in a place where they are easy to reach.
• Clean up spills immediately.
• Prepare food while seated to prevent fatigue or loss of balance.

Outdoor spaces

• If you have steps leading to your front door, make sure they are not broken or uneven.
• Add non‐slip material to outdoor stairways.
• Keep the lawn, deck, or porch areas clear of debris, such as fallen branches.
• Consider installing a grab bar near the front door to provide balance while you are locking or unlocking the door.
• Turn on your porch light at night and if you leave during the day but plan on returning home after dark.
• In the winter, treat outdoor walkways with an ice melt product or sand to make them less slippery.

Other living areas

• Keep electrical cords near walls and away from walking paths.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Make sure your sofas and chairs are the right height for you to get in and out of easily.
• Keep items you use often at waist level or within easy reach.
• Don’t stand on a chair or table to reach something that’s too high — use a “reach stick” instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it’s steady and has a handrail on top. Have someone stand next to you.
• Don’t let your cat or dog trip you. Know where your pet is whenever you’re standing or walking.
• Keep a list of emergency numbers in large print near each landline phone and save them under “favorites” on your mobile phone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care providers can assess your home’s safety and advise you about making changes to lower your risk of falls.

Tools to get help

If you’re concerned about falling, set up systems to ensure you can get help if you fall. One option is installing an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it’s usually not covered by insurance.

Another option is to carry a well-charged cordless or mobile phone with you as you move throughout the house. Have close friends and family on speed dial. Consider setting up a smart home device (a small speaker that listens and responds to commands when you call its name) that can quickly connect you to contacts or emergency response teams. Some smartwatches can be set up to make emergency calls at the push of a button and others can even detect sudden fall-like movements and automatically call for help. Ask family and friends for help setting up these tools.

Home improvement resources

Many state and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, search the Eldercare Locator, or call 800-677-1116 to find your local Area Agency on Aging to see if there is a program near you.

To learn more, please visit https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room.

Many of us have favorite songs that can help us relax after a hectic day or get us moving on the dance floor. Music can also be a powerful gateway to memory; for example, a song from our past may bring back memories that trigger strong emotions.

But what is happening in our brains when we hear a song that is meaningful to us? Could music make older adults not only feel better but also improve their health? Much more research is needed before any definitive conclusions can be drawn, but there is growing scientific interest in music’s effects on the brain and body as we age.

How the brain is wired for music and memory

Psyche Loui, Ph.D., leads the Music, Imaging, and Neural Dynamics (MIND) Lab at Northeastern University in Boston. She also plays the violin in Boston’s Longwood Symphony Orchestra and in a variety of local pop and chamber music groups. In the laboratory, she seeks to understand how the parts of the brain that relate to musical perception and processing interact with brain regions controlling learning, memory, and emotions. Interested in music and science most of her life, she first became curious about how music might help people with dementia while volunteering at a nursing home as a high school student.

After little response from residents with advanced dementia to the Beethoven pieces she played on the piano, staff members encouraged her to try something a bit livelier from a book of traditional folk songs. “I just played some old familiar ditties and tunes, and then, amazingly, some of the residents knew all the words and started singing along in close harmony,” said Loui. “That just really struck me.”

Our brains are hard-wired to predict and anticipate familiar rhythms and melodies, Loui explained. It starts with the auditory cortex, the brain region that receives and processes sounds, including voices and music. “When we hear something that we enjoy, that engages not only the auditory cortex, but also the brain’s reward systems that are driven by the neurotransmitter dopamine, which motivates us to seek out and learn new information.”

Another key part of the brain’s dopamine-based reward system is the medial prefrontal cortex, which also processes memories about ourselves. “If I’m listening to music that I’ve enjoyed throughout my life, and that I find familiar, then the auditory system is active, but it’s also communicating and connecting with the medial prefrontal cortex,” said Loui.

Working with like-minded researchers in the Boston area at the Berklee College of Music and Harvard Medical School, Loui and colleagues developed an eight-week mindful music-based listening program for healthy older adults. Participants showed stronger increases in functional connectivity between the auditory system and the medial prefrontal cortex — areas that generally become less active with age — compared to control groups. Their team is now testing out this intervention in older adults with memory impairments, hoping that music can help revive learning and memory functions through this connectivity.

Loui’s latest project is the Multimodal Musical Stimulation for Healthy Neurocognitive Aging study, which is designing and testing a device that pairs music selected by participants with rhythmic, colored LED light patterns. Supported with NIA small business funding, the technology is based on mouse studies in which Alzheimer’s disease-related brain deposits of tau and beta-amyloid proteins were reduced through light and sound stimuli. Loui and colleagues are working on prototypes to test the light and sound intervention as a potential therapy for older adults and for people living with mild cognitive impairment or dementia.

Singing to build cognitive and social connections

Another interesting area of research is the exploration of whether music can strengthen connections not just between our neurons, but also between people, to enhance social networks and reduce isolation and loneliness among older adults.

Can music reduce patient delirium in the ICU?

Between 70% and 80% of intensive care unit (ICU) patients who receive respiratory support from mechanical ventilators experience delirium — a syndrome of sudden, acute confusion that can occur after major surgery or during a serious illness. In some patients, delirium can cause agitation, aggression, or hallucinations while others may be drowsy. Patients who experience delirium tend to have longer stays in the ICU, and more than 30% of patients who develop it experience long-term cognitive impairment. They are also more likely to be transferred to nursing homes or rehabilitation facilities after they leave the hospital.

Soothing sleep with music in people living with dementia

People living with Alzheimer’s or a related dementia often experience sleep disturbances, such as insomnia or waking up during the night. These sleep problems can also disrupt their caregivers’ sleep, contributing to poorer physical and mental health in people who may already feel overwhelmed. For those living with dementia, sleep disruption has been associated with more time in health care facilities, poorer cognitive function, and faster disease progression.

Testing music to reduce agitation and aggression

Other investigators are testing whether music can ease daytime dementia-related issues such as agitation, anxiety, and aggression, all of which can be troubling for people with dementia and their caregivers. The METRIcAL – Music and MEmory: A Pragmatic TRIal for Nursing Home Residents with ALzheimer’s Disease project, led by Vincent Mor, Ph.D., and his colleague Ellen McCreedy, Ph.D., MPH, with the Brown University School of Public Health, explored whether customized playlists of preferred music could reduce disruptive or disturbing behaviors like pacing, calling out verbally, sundowning, or other common dementia symptoms, and lessen reliance on antipsychotic drugs.

The METRIcAL study was conducted in a real-world setting, with almost 1,000 residents with dementia in 54 nursing centers in 10 states. While the study did not find that personalized music was significantly effective in reducing agitated behaviors or psychotropic drug use, there were many lessons learned that could help inform the design of future trials.

Working in harmony: How can we use what we know?

NIA continues to fund research to investigate the potential of music as a therapy. In the meantime, Petrovsky encourages families and caregivers to pay attention to how a person they are caring for responds when music is playing, and which songs they seem to connect with the most.

Evidence on the effectiveness of music on medical conditions continues to be collected. In the meantime, older adults who enjoy music can consider if they want to include it as part of their future care preferences.

To learn more, please visit https://www.nia.nih.gov/news/could-musical-medicine-influence-healthy-aging.

Carter Nursing and Rehabilitation, in partnership with Reliant Rehabilitation, is excited to share resident Mr. Morgan’s Success Story!

Mr. Morgan came to Carter community after an illness and hospitalization that left him unable to return home independently. He says he is grateful to the Care Team and Therapy Team at Carter for helping him regain his strength and independence. He says he loves his home and cannot wait to get back there. He promises he will be back to visit. Congratulations to Mr. Morgan and his Care Team on their success!