Geriatric EM Communicating with Older Adults in the Emergency Department

Communicating with Older Adults in the Emergency Department

By Surriya Ahmad, MD on behalf of the SAEM Academy of Geriatric Emergency Medicine

On any given shift, the groups of people an emergency physician communicates with can be broken down into at least three large categories: between departments, intradepartment, and with patients and families. Communication breakdown (i.e., miscommunication) can happen in any one of these groups; likewise, compromise in the ability to communicate in any one area can lead to preventable medical errors and affect patient care.

Although one may find that communication in one area poses problems for them, communication in another area may be a strength. There is also evidence that suggests that higher communication competence correlates with higher patient satisfaction, physician empathy, and lower physician burnout; however, more studies are needed. (AMA, WSJ, NEJM Catalyst, PubMed) There are unique challenges in the emergency department — distractions, volume, lack of space, time — that make communication difficult, especially with older patients. For example, hearing and visual impairment, which make communicating in a noisy emergency department especially challenging, and difficulties with manual dexterity, cognitive impairment, and language barriers. However, there are certain communication tips that can be used with older patients specifically with the aim of improving their experience in the emergency department (the following are adapted from the American Academy of Family Physicians): • Allow extra time. • Avoid distractions. (In a busy emergency department this is hard; however, it is doable.) Give your undivided attention for the first 60 seconds of the interaction, utilizing the limited time you have and being fully present in the moment. • Sit face to face. • Maintain eye contact and utilize other nonverbal communication. Looks, head nods, body positioning and posture, gestures, facial expressions, and even breathing contribute to the relationship and communication

between caregiver and older patients.

Mirroring a patient’s actions or tone of voice can also enhance trust. • Listen to understand rather than to respond. When talking to older patients, they will often surprise you and can tell you most of the story and often lead you to understand exactly what is going on with them. Listen to them. Even if you cannot reliably gain a history, do not miss the opportunity to try and simply connect with the patient in any way you can prior and in conjunction with conversations with caretakers and family members. • Speak slowly, clearly, loudly. • Use short simple words and sentences. • Stick to one topic at a time and be specific. Abstract thinking can be challenging for some older adults. • Simplify and write down instructions.

Use charts, models, and pictures, and summarize the most important points. • Allow time for questions.

It’s important to point out that many of the tips of communicating with older adults are really just good communication tips in general and can be adapted to any patient interaction. Ultimately, it is not just about basic communication tips, but also mixing these with empathy and compassion, with the goal of creating a therapeutic alliance and narrative: do not judge, be sincere, and build trust with your patient. Ultimately, this could reduce social isolation, and associated loneliness, depression, and anxiety in this vulnerable patient population. The emergency department may be the one opportunity your patient has to connect with someone — give your patient your undivided attention, even if for just 60 seconds.

“There is also evidence that suggests that higher communication competence correlates with higher patient satisfaction, physician empathy, and lower physician burnout.”

ABOUT THE AUTHOR

Surriya Ahmad a geriatric emergency medicine fellow, assistant attending physician in emergency medicine, and instructor in clinical emergency medicine at Weill Cornell/ NewYork Presbyterian Hospital in New York City. @emergencyimprov

About AGEM

The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”