Study: Evidence-Based Strategies for Communciating with Adults in Long-Term Care

In a recent Clinical Review, Kristine Williams, RN, PhD, found that the communications skills of long-term care workers are a key factor in the quality of life and care for older adults in long-term care settings.  In fact, communication with older adults in these environments can be optimized if health care professionals use evidence-based strategies, because residents in those environments rely on staff for over 75% of their communication opportunities.

Clinical review results: 

  • Normal and abnormal physical and cognitive changes due to aging present communication barriers that put long-term care residents at risk for ineffective communication encounters
  • Institutional factors present communication barriers that put long-term care residents at risk for ineffective communication encounters
  • Health care professionals in long-term care settings need to be aware of these aging and institutional factors and use evidence-based strategies to ensure person-centered communication with residents

Estimates indicate that Americans aged 65 and older will more than double by the year 2050; as a result, the number of older Americans in need of supporting long-term care services also will dramatically increase.   While years of healthy life are increasing along with life spans, supportive care services will be necessary to overcome common limitations experienced by older adults due to the normal changes associated with aging, chronic conditions associated with aging, and Alzheimer’s disease and other dementias that lead to progressive disability.

It’s important to note that the population of dementia sufferers also is projected to double by 2050.  Currently, at least 70% of those aged 65 and older require supportive long-term care services at some point, and estimates are that 40% will reside in a nursing home (at least for a short rehabilitation stay).  With these growing demands on health care providers with geriatric expertise, it will be critical to make long-term are more person-centered.

Through research and discussion, Williams determined that communication is critical to person-centered care.  Nursing home residents report their ability to relate to staff who care for them through communication is a key factor in their satisfaction with life in long-term care.  Plus, nursing staff who report relationships with residents also report higher job satisfaction and lower turnover rates.

Also according to Williams, research demonstrates how communication promotes independence and autonomy for residents or can contribute to dependency, depression, behavior issues, and other negative outcomes.  This fact clearly demonstrates the need for effective communication in long-term care settings.

Barriers to Communication

Certain barriers to communication do exist for older adults in long-term care situations, a critical realization for any professional serving in the long-term care industry.  Vision and hearing loss are challenges, as are cognitive changes such as reduced processing speed and working memory.

Stroke and Parkinson’s disease also make communication a challenge for older adults.  Plus, the very fact that the residents had to move from their homes and away from significant others who served as communication partners poses barriers to their effective communication with caregivers in their new communities.

Overcoming Barriers

  • Person-Centered Care – Health care providers should take the time to learn about residents’ backgrounds, history, and family.  Families can aid in this process by providing recorded autobiographies, memory boxes, and photo displays.
  • Ignoring Talk – Include the residents in discussions about their care, to make them feel valued and appreciated.
  • Intergenerational Communication – Care staff may have ageist views and stereotypes of older adults that result in modified communication with them, and the resulting elderspeak has negative effects on the residents.  Caregivers should refrain from using intimate terms of endearment, asking closed questions and suggesting correct answers, and substituting “we” for “I.”
  • Communication Assessment –Health care providers should make an individual assessment of the communication and cognitive abilities of residents in their care and modify communication on an as-needed basis only.
  • Nonverbal Communication –Caregivers need to be aware of the messages they are sending through nonverbal communication and make it a priority to look at the residents, maintain eye contact, and use appropriate facial expressions.  Health care providers also need to ensure they are not committing elderspeak through nonverbal communication, such as looming over the shoulder of a seated older adult.
  • Hearing Support –Speak with gradually louder volume until a comfortable level is reached and do not use a high-pitched voice.  Minimize background noise and frequently check hearing aides for battery power and cleanliness.
  • Cultural Competence –Those health care providers who are not native English speakers or who have accents will need to be especially aware of the effectiveness of their communication with residents.  Validating that the older adult has heard and understood the communication may be necessary.
  • Encouraging Function –Use communication to prompt residents and provide cues and reinforcement to encourage and improve functional independence.
  • Dementia –It is even more important to resist using elderspeak with patients who experience dementia; research shows older residents with dementia were more than twice as likely to resist or respond to care with aggression or displeasure than when staff used normal adult communication.  Keep in mind that residents with dementia have slowed processing speed and reduce working memory, so avoid excessively slow speech when communicating with them.  It may be necessary to repeat questions and statements and use paraphrasing.
  • Staff Training –Training and educational programs should include specific information on effective communication with older adults.  Periodic training sessions should be provided with new information on evidence-based communication developments.

Overall, health care providers need to be aware of the challenges older adults face in communicating and be cognizant of whether they are adding to the barriers of effective communication themselves.  Establishing interpersonal connections may be the first step toward more effective communication with residents, especially because providers should strive to improve the residents’ quality of life through person-centered care.

What challenges have you faced in communicating with residents in the senior living communities you serve in? Discuss in the comments below.

Image via Flickr by BisGovUK

Post by Angela Stringfellow

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