ANGELES UNIVERSITY FOUNDATION 

COLLEGE OF NURSING 

NCM 0114 - CARE OF THE OLDER PERSON

MODULE  6

Communicating with Older Adults

Module Overview

The art of communication is one of the major competencies expected from a nurse. It is
this skill that connects a nurse to a patient to have an effective and efficient nurse-patient
relationship. It is the art of communication which opens the door for a patient to entrust his life
in the care of the nurse. It affects the outcome of nursing care from the beginning up to the
termination of nursing care. 

In this module, you will build your capabilities in communicating with the older adults
specifically covering the following topics (1) information sharing (2) formal or therapeutic
communication (3) informal or social communication (4) non-verbal communication (5)
acceptance, dignity and respect in communication (6) barriers to communication and lastly (7)
skills and techniques in communication.

You will spend 2 learning hours in this module. Below are the details of the content and
the estimated time of completion.
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Learning Outcomes

At the end of the module, you should be able:

LO12: Ensure a working relationship with the older person based on trust, respect, and shared
decision making using appropriate communication strategies and techniques.

You will be required to view selective videos in advance prior to your video conference with
questions to reflect on to open up your thoughts about communication with the older adults

1. What special considerations should be taken when communicating with older adults?
2. Have you experienced difficulty in communicating with an older adult and what are those
barriers?
3. What are the means in observing acceptance, dignity and respect in communicating with
older adults?
4. What are the skills and techniques in communicating with older adults?

Let’s get started with this learning prepared for your module. Be sure that you will view these
video links so that you will be able to answer the Learning Activity Sheet Number 9 for this
course. Enjoy watching and learning!

HOW EFFECTIVE HEALTHCARE COMMUNICATION CONTRIBUTE TO HEALTH EQUITY

(7.14 minutes)
https://www.youtube.com/watch?v=dOZLf-RYvHk

COMMUNICATING WITH THE ELDERLY AND DISABLED 

(3 minutes)
https://www.youtube.com/watch?v=U9xEzuz-wJo

 HOW COMMUNICATION INFLUENCES TREATMENT OUTCOMES 

( 2:52 minutes)
https://www.youtube.com/watch?v=FA-I70PjWAw
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COLLEGE OF NURSING 

Communication links all of us to each other and to the environment

and is a key factor in how we relate and coexist (Mauk, 2018)

Communication to be effective should be a dynamic process that includes an on-going

exchange of information with feedback, context, clarification, language, definitions, and removal
of barriers between the sender and the receiver. However, such an effective one is a challenge
when you communicate with the older adults, several factors must be considered.
Communication in general depends heavily on intact senses of a person such as the

INFORMATION SHARING
Older adults when necessary often share control of their personal health information and
decision making with family and friends. Patient portals can help with information sharing, but
concerns about privacy and autonomy of elderly patients remain. Health systems that
implement patient portals would benefit from guidance about how best to implement access to
portals for caregivers of elderly patients. A qualitative study was conducted among the older
adults aging 75 years old above and family caregivers who care for such age, between the
period of October 2013 to February 2014 which aims to explore how these individuals approach
sharing information. 1 Two main themes emerged and 7 lessons as well.
First main theme is that sharing of information has consequences and the lessons were:
(1) elders and caregivers have different perspectives on what is seen as the "burden" of
information,
(2) access to medical information by families can have unintended consequences, and
(3) elders do not want to feel "spied on" by family.
Second main themes is that control of information sharing is dynamic:
(4) elders wish to retain control of decision making as long as possible,
(5) transfer of control occurs gradually depending on elders' health and functional status,
(6) control of information sharing and decision making should be fluid to maximize
elders' autonomy, and
(7) no "one-size-fits-all" approach can satisfy individuals' different preference

1
"Information Sharing Preferences of Older Patients and Their ...."
https://www.researchgate.net/publication/279807586_Information_Sharing_Preferences_of_Older_Patients_and_Their_Fam
ilies. Accessed 21 Sep. 2020.
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FORMAL OR THERAPEUTIC COMMUNICATION – is a conscious and deliberate process used to

gather information related to a patient’s overall health status (physical, psychological, spiritual
etc) and to respond with verbal and nonverbal approaches that promote the patient’s well-being
or improve the patient’s understanding of ongoing care.

INFORMAL OR SOCIAL COMMUNICATION - a simple chitchat has a place in nurse-patient

communications.
☺ if a nurse talked only about things related to health treatment, they would know little about
their patients
☺ small talk, pleasantries, and conversations about the weather, a favourite television show
or the latest news can demonstrate that the nurse thinks of the patient as a real person, not
just a patient.

NONVERBAL COMMUNICATION
● Symbols
● Tone of voice
● Body language
● Space, distance, position

** Proxemics – is the study of the use of personal space in communication

refers to how close we allow someone to get to us

before we
feel uncomfortable
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COLLEGE OF NURSING 

PUBLIC SPACE
- at this distance, there is no real
positive or negative connection
with the other person

SOCIAL SPACE – is a comfortable distance for a casual

relationship in which communication is at an impersonal level.
If a nurse stays this far away from his patient, the message being
communicated is indifference.

PERSONAL SPACE – the optimal distance for close interpersonal communication with
another person. A nurse who communicates from within this space is usually viewed as
concerned and interested
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** The space within 18 inches of the body is considered intimate space. Most people allow only
trusted individuals to get this close. Entering the intimate space without permission is usually
perceived as a threat.
● Gestures
● Facial expressions
● Eye contact

ACCEPTANCE, DIGNITY AND RESPECT IN COMMUNICATION

Let the person know you care through your:

❏ tone of voice
❏ facial expressions
❏ words
❏ gestures
❏ ability to listen to criticism, complaints, sadness without disagreeing, “correcting,”
retaliating, or withdrawing

Apply principles of sensitive listening

❏ Listen without interrupting, cutting the person off, or “tuning out” what is being said
❏ Listen for MEANING. What is the real problem?

Take time to be interested in the things that are right (positive parts of their life) as well as to talk
about their problems

❏ Show interest in positive attributes/strengths while talking about problems

❏ Overemphasis what is “wrong” may leave the person feeling worse
❏ Listen thoughtfully to personal stories, experiences: What is the person saying?
❏ Reinforce strengths, abilities, what is going well for person

Slow down and focus on the PERSON, what he/she is saying, doing, communicating!

❏ Hurried, task-oriented approaches interfere with seeing the person as a human being
❏ Talk while care is being provided, and not ONLY about the care itself!
❏ Think about the older person, long life lived, meaning of the current situation

Adjust the environment and routines

● Accommodate changes in vision

❏ Provide more light so that the older person can see you
❏ Avoid standing too close so that you don't get blurry
❏ Stay in front of the person where they can see you
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❏ Use yellows & reds vs. greens and blues for signs or markers
❏ Make sure that glasses are clean, comfortable, and ON the person!

● Accommodate changes in hearing

❏ Make sure that the person can read your lips.
❏ If you need to talk louder, try to lower your tone of voice.
❏ Check for earwax buildup.
❏ Make sure hearing aides are IN and batteries are fresh!
● Look carefully at the effects of the environment
❏ Is noise interfering with your attempt to communicate?
❏ Is the room light enough for them to see you and read your lips?
❏ Are they afraid that someone else will hear what they are saying, or that you will be
❏ interrupted? (e.g. Is their privacy being respected?)

● Assess the person’s level of personal comfort

❏ Are they physically comfortable?
❏ Are they distracted by hunger, thirst, pain, or needing to use the toilet
❏ What are they thinking or feeling? How might that interfere?

● Adjust how you interact with the older person

Think about your approach and language
❖ Give them time to answer your questions or tell you what they have to say
(Remember: reaction time slows!)
❖ Use words that are familiar and understandable; avoid medical jargon and
slang
❖ Be clear and concise; avoid long, wordy explanations or instruction

● Adapt your approach to accommodate changes in RECEPTION

❏ Use “yes/no” questions if needed to help participation
❏ Try large-print instructions or signs to improve function
❏ On-step instructions may increase comprehension and cooperation
❏ Add physical gestures to verbal cues to get the person started
❏ Limit choices to two options as needed to promote success

● Give them cues to help them think about "when" something happened or "how long" it's
been going on
● Check out what they are "telling you" with their nonverbals
● Take responsibility for misunderstandings; apologize and explain what you were
thinking/experiencing

● Adapt your approach to accommodate changes in EXPRESSION

❏ Listen for meaningful words and ideas, trying to identify the main theme or goal
❏ Respond to the person’s emotional tone and validate feelings (e.g., understandable
to feel frustrated, angry)
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❏ Accept/understand cursing or other foul language as an expression of distress

and discomfort – not an “insult” to you
❏ Using guessing (e.g., trying to replace words the person is having difficulty saying)
based on how well you know the person and the relationship you have; guessing
can been annoying to the person and may further increase confusion

BARRIERS TO COMMUNICATION

Age-related Changes

All five senses tend to decline those adults of advancing age. Most likely hearing and vision
changes are to affect communication, but other losses may affect how we think about older
adults. Just a few basic reviews of what you have learned in the previous modules on normal
changes in aging.

Hearing: A general loss of hearing may result from disease, noise, or bone changes; gradual
loss of ability to hear certain sounds such as "S, SH, and CH" and high frequencies is common

Vision: Changes in vision often include reduced ability to see distant objects, objects that
are too close (even faces) and certain colors; loss of ability to see to the sides (peripheral
vision) is common

Smell and Taste: Reduced ability to smell and taste (both good and bad things) is experienced.
Touch: Reduced ability to feel touch in general; also reduced ability to feel hot, cold, and
pain may be experienced

Reaction time slows: More time is needed to "process" the information and come up with "the
answer"

Disease and Disability

Many different types of disease, illness, and even medication side-effects may alter the person's
abilities to communicate.

Dysarthria: A medical term that is used to mean that a person has difficulty speaking because
they aren’t able to form (articulate) the words; speech may be slurred or difficult to understand

Oral Health: Loss of teeth may impair speech; medication side-effects that decrease saliva and
cause “dry mouth” may interfere
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COLLEGE OF NURSING 

Lung disease: Inadequate "wind" or respiratory capacity to speak can make the person difficult
to hear or understand; e.g., emphysema, asthma, COPD

Brain Injury: Several different types of brain disease and injury may result in loss of language

Aphasia: The medical term that is often used for disease-related loss of language; may be
either receptive and expressive; type of impairment include the loss of ability to name items, put
together sentences, understand and act on what is heard and read or write

Expressive aphasia: involves the loss of ability to express oneself through speech

Receptive aphasia: involves the loss of ability to understand the spoken word

Stroke: Cardiovascular accident (CVA), commonly called stroke, destroys brain cells in
specific areas of the brain; losses tend to be stable; may create either receptive or expressive
aphasia

Head trauma: Injury that causes brain cell death; losses tend to be permanent and stable

Dementia: Alzheimer's and other types of dementia destroy brain cells gradually with loss of
2
language occurring over time; losses are permanent and interfere with every aspect of person's
ability to communicate

Multiple factors: Brain diseases, particularly dementia, cause many different types of disability
along with loss of language; taking time to understand lost abilities and long standing habits
and traits is essential to high quality of care

Environmental factors

The physical and social environment in which communication and care occurs may have
positive or negative influences. Taking time to think about the health-care setting in which you
work with older adults may help identify factors that should be changed or adjusted.

Physical environment: Characteristics of health-related facilities influence the quality and

quantity of interactions; factors to consider include noise, confusion, competing demands for

2
"Effective Communication with Elders - POGOe Communication with ...."
https://fdocuments.us/document/effective-communication-with-elders-pogoe-communication-with-elders-contents-.html.
Accessed 21 Sep. 2020.
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COLLEGE OF NURSING 

the person’s time or attention, inadequate lighting, living configurations that are not conducive to
social interactions

Social environment: In health care settings role expectations including the “task-orientation,” of
staff, beliefs that “talking is not working,” and fears of being viewed as lazy for talking with older
adults, have a negative impact on psychosocial care

Summary and Conclusion

Communication whether it is verbal or nonverbal is a significant element in the entire

nursing process. You communicate from assessment up to evaluation of nursing care. It can be
in a form of formal or sometimes informal to make the patient comfortable in communicating
and may also help in establishing connection or rapport with the older adult. In communicating
it is important that acceptance be granted to every patient on how they wish to communicate. It
is observed with dignity and respect. Although in all ages and diversified patients, there would
be barriers that may be encountered specially with older ones who have existing conditions, it is
a challenge to a student nurse like you and soon to be a professional nurse to develop a skill in
communicating.

Reflection Questions: 

A patient was assigned to your care who happens to have both visual and
auditory deficits because of a chronic disease. She seems to be upset
because she feels that she is not understood by anyone because of her
deficits; hence, she opted to be withdrawn.

How would you create a plan of care for this patient by using the SBAR
model communication so that her needs would be addressed properly?

Recommended Viewing/ Reading: 

THE IMPORTANCE OF COMMUNICATION IN HEALTH CARE (4:56 minutes)

https://www.youtube.com/watch?v=b7YwrHNylTg

TIPS FOR IMPROVING COMMUNICATION WITH OLDER ADULTS

https://www.nia.nih.gov/health/tips-improving-communication-older-patients
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COLLEGE OF NURSING 

References

Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Wolters Kluwer.

Hirst, S. P., Lane, A.M., Miller, C.A. (2015). Miller’s nursing for wellness in older adults.
(Canadian ed.). Wolters Kluwer.
Mauk, K. (2018). Gerontological nursing competencies for care (4th ed.). Jones & Bartlett
Learning.
Meiner, S.E. (2015). Gerontologic nursing (5th ed.). Missouri, Elsevier Mosby.
Robnett, Regula H. & Walter Chop (2015). Gerontology for the Health Care Professional (3rd
ed.). Burlington, MA: Jones & Bartlett Learning.

Touhy, T and Jett, K. (2018). Ebersole and Hess’ Gerontological nursing & healthy aging
(5th ed.). Elsevier.

Williams, Patricia (2016). Basic Geriatric Nursing (6th ed.). St. Louis, MO: Elsevier.

Prepared by:

Mary Angelica P. Bagaoisan, RN, MAN Debbie Q. Ramirez, RN, PhD

NCM 0114 Instructor NCM 0114 Instructor

Contributor for Academic Year 2021-2022:

Jasleen S. Yumang, RN, MN

NCM 0114 Instructor

Peer Reviewed by:

Rolando Lopez Jr., RN, MN

NCM 0114 Instructor

Reviewed and Evaluated by:

Anna Lyn M. Paano, RN, MAN Sherwin M. Quizon, RN, MN

Level 3 Academic Coordinator Level 3 RLE Coordinator

Approved by:

Zenaida S. Fernandez, RN, Ph.D

Dean, College of Nursing