Sunday, November 4, 2012

Talking with Older Adults in a Crisis

Photo by The National Guard
The prevalence of news stories about Hurricane Sandy this week reminded me of a set of guidelines I composed for how to talk with older adults in a crisis. (For general information on how to cope in a crisis, see FEMA's page on the topic.)

Before getting to the specifics, it's important to avoid Elderspeak, a form of baby talk that people too often use to address older adults.

People are usually well meaning when they modify their speech this way, but the result too often is that the older adult feels patronized. Read this post on Elderspeak to learn more about its features, tone and harmful effects.

Nevertheless, healthy aging does often require conversationalists to make some adjustments.  I suggest starting with a normal conversation features and then adjust as you receive input about possible limitations. Don't start with the assumption that people have limits such as bad hearing and compromised cognition.  If you guess wrong, you've already broken trust.  The American Speech Language Association (ASHA) shares these tips for communicating with older adults.

These additional guidelines were composed in 2010 for local police officers interviewing older adults after suffering from an accident or from a crime, but they might be helpful in other crisis settings.  You can remember key points through the mnemonic E.L.D.E.R. 

Environment.   Secure an environment free from distractions. Older adults often have problems filtering out excess noise, light and movement, so try to escort a mature adult in crisis into a more isolated and calm area.

Language Aids.  If someone is displaced by a crisis, they might have forgotten to bring language aids such as glasses, dentures or hearing aids.   Without them, communication is more challenging.  If you ask about them, the person might be carrying them in a purse or pocket. A gentle reminder might prompt them to retrieve the needed item.

Delirium.  Sometimes people will discount older adults' confusion as senility when the problem could be a medical condition. Disruptions to a routine might mean that a person forgot to take regular medication.  A person might appear confused or delirious.  In addition to improper medication adherence, the older adult might show delirium merely because he or she is dehydrated. Or the cause might be an infection or a change in blood pressure. Also, people with cognition problems are more prone to delirium in response to a crisis.  Sticking to a routine helps people with memory problems cope, so that when routine is disrupted, the person sometimes falls apart because of the cognitive and emotional overload of a crisis. Hospitalization can sometimes trigger such a problem.  If you can't help the person focus and communicate, it might be prudent to call 911.

Exchange. Some older adults have problems processing conversation, so they need information labeled more clearly and presented in smaller segments.

  1. Announce the purpose of your questions so that they can use their attention to focus on WHAT you are saying instead of spending mental energies trying to figure out WHY you are saying it. 
  2. Focus only on one thing at a time since multitasking is more and more difficult as people age. Being in a crisis can make their cognition even more compromised.
  3. Give the older adult time to respond. It make take them a while to process what you are saying, time to formulate their response. 
  4. Ask them to repeat key information back to you so that you can check comprehension.
  5. Perhaps invite them to take notes if they need to  manage a lot of new information simultaneously or if they must remember your instructions in order to do something at a later time or place.
  6. Help them understand your message by use of nonverbal communication--body language, intonation, gestures, etc. Also recognize that they may struggle to produce nonverbal communication and pragmatics that refine their speech and makes meaning more specific.
Also, recognize that older adults might seem to stray off topic. Just keep requests short and uncomplicated.  If they wander to topics that are more familiar to them, it may be a signal that they need clearer instructions or that they are having problems described in these guidelines.  Also, wandering might be their way of resisting the role in the conversation that you are assigning to them: needy, dependent, uninformed, etc. Try communicating respect for what they do know and have achieved as a way to promote cooperation.  If you listen carefully for the purpose behind the wandering, you might learn something very important.  This is true for people of all ages and circumstances.

Reasoning.  Many of the above guidelines have already indirectly addressed issues of reasoning or cognition. But this is an overt reminder to check the person's ability or limits to these cognitive functions: attention, memory (working memory, short-term memory, and long-term memory), problem solving, etc. In healthy aging, most people experience cognitive slowing which basically just means people need to reduce multitasking, take notes, and spend a little more time to communicate.

Some might cross over from cognitive slowing into a diagnosis of mild cognitive impairment (MCI) which might be a precursor to dementia.  But do not assume that an older adult has dementia or MCI. Most of the time, their struggles to communicate in a crisis are just a product of cognitive and emotional overload. If you are interested in age-related changes to communication, I recommend Angela N. Burda's book. Review.

The above guidelines are applicable to those affected by a catastrophe such as Sandy. But for more information about how to help older adults through a crisis, see the collection of links gathered by SAMSA about helping older adults and other special populations following a hurricane or other traumatic events.

Related:

Hospital-Induced Delirium
Is It Dementia or Delirium? 
Elderspeak: Baby Talk Directed at Older Adults


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