A brief review of verbal and nonverbal communication with older adult considerations can benefit the healthcare worker. Nonverbal communication is gestures, expressions, and body language (Boyd, 2017). It encompasses more of the interaction than verbal communication. The psychiatric older adult client can be difficult to interpret if disabilities or cultural differences are present. Using understandable language to verbally validate nonverbal observations can help clear any perceived deficiency in the information exchange. Ten techniques can be used to improve the psychiatric interview with the older adult: acceptance, confrontation, doubt, interpretation, observation, open-ended statements, reflection, silence, and validation (Boyd, 2017). Acceptance is a therapeutic way to encourage information exchange in an open manner and is useful for establishing trust and building rapport (Boyd, 2017). The healthcare worker can practice this by saying things such as “It is ok to tell me about it—I would like to hear how it made you feel.” Confrontation is used with discretion when trying to confront reality for the older adult (Boyd, 2017). The healthcare worker can use confrontation gently to address inconsistencies; however, it has the potential to divide the therapeutic relationship and cause discourse in communication. Doubt is also used cautiously when a healthcare worker is certain the older adult is incorrect about factual information. The healthcare worker should assess for the presence of cognitive deficiencies if misinformation in the older adult’s communication is apparent. Interpretation is a technique that the healthcare worker can embrace when trying to help the older adult identify their thoughts and feelings. For example, if the older adult is adamant that they cannot attend appointments anymore after dark because they might wreck their car, the healthcare worker could state, “It sounds like you are scared to drive after dark. Let us chat about driving safety.” The older adult may respond to the interpretation, and the healthcare worker can work from the given response. Observation is the healthcare worker noticing and remarking on the older adult’s verbal and/or nonverbal behaviors (Boyd, 2017). It can be used by noting body language and remarking on it by saying, “I can see that you are reluctant to discuss this topic.” Open-ended statements are a method for getting the older adult to speak freely on topics to aid with insight (Boyd, 2017). The healthcare worker can start a statement with something like “Happiness means . . .” and have the older adult finish the sentence/thought. Reflection is a technique that gives the older adult permission to have uncomfortable feelings (Boyd, 2017). If the older adult asks a pointed question to the healthcare worker such as, “Should I stop drinking alcohol?” The healthcare worker can use reflection to answer back with, “Do you think you should stop drinking alcohol?” The use of reflection can keep the focus on the patient instead of the healthcare worker. Restatement is a therapeutic way of validating what the older adult is saying (Boyd, 2017). For example, if the older adult says, “I hate coming here,” the healthcare worker can restate the expression and say, “It sounds like you do not want to be here.” A similar technique is validation. It is used when the healthcare worker is searching for understanding (Boyd, 2017). When the healthcare worker uses it, it can sound like “I want to make sure I understood you”—and then describe what you think you heard. If restated or validated correctly, they both can reassure the older adult that you are listening and open to discussion. Silence is a communication tool that needs proper utilization with the older adult. With therapeutic silence, the healthcare worker remains silent but uses nonverbal facial expressions to show interest so that the older adult can have time to put their thoughts together (Boyd, 2017). The healthcare worker can try therapeutic silence early in the assessment and ask if the extra time is helpful. Extra silence during communication may indicate the need for intervention for the older adult or the need to change selected communication techniques. All communication techniques are useful for various situations. The healthcare worker will choose which technique(s) work best for each individual communication exchange. The healthcare worker can also have difficulties with communication if the older adult client is reluctant to talk or, inversely, is overly talkative. These challenges can be due to
poor cognition or resistance to change in the older adult (Jack et al., 2019). The healthcare worker needs a specific approach to address these situations. Recommendations for the reluctant patient include the following (Carlat, 2017): ● Use open-ended questions, allowing for an opportunity for free dialogue such as “What things make you feel sad?” ● Use continuation prompts such as “Go on” and “Tell me more.” ● Search for a neutral ground when the interview is going awry; talking on neutral ground can provide an easier and subtle way into difficult thoughts, feelings, or emotions. ● Remember that rapport and trust take time. ● Triage the information you need at each visit, and prioritize safety. Recommendations for the overly talkative patient include the following (Carlat, 2017): ● Use close-ended questions and multiple-choice questions to keep the patient’s answers brief (an interview needs open- ended questions as well, but closed questions and multiple choice can speed the interview along to maximize the information shared). ● Learn to politely interrupt. This requires empathy. If it was not covered prior to starting the assessment, a reminder of the allotted time of the interview helps reign in an overly talkative client. The older adult who is unable to communicate may experience high rates of loneliness and depression (Palmer et al., 2016). Depression in older adulthood is often accompanied by tears. This can make interviewing difficult for the healthcare worker. Traversing tears and sad emotions can be heavy and uncomfortable for the healthcare worker. Recommendations for the tearful patient include the following (Carlat, 2017): ● Refrain from self-disclosure. ● Provide tissues. ● Embrace any lengthy silences and lean into empathy. ● Try to understand the meaning behind the tears. ● Assess the frequency of tearful episodes. ● Validate that crying is acceptable if needed. ● Be aware that crying is also a sign of intense emotion and warrants further investigation; assess for safety. The healthcare worker should view each older adult client as an individualized opportunity. Being able to effectively communicate is crucial for the healthcare worker to assess and build trust with the older adult. Understanding the problems and difficulties the client is facing will not be possible if a mutual understanding is not present. There are a multitude of variations in communication styles and techniques the healthcare worker can utilize to nurture rapport, build trust, and foster a therapeutic alliance with the older adult. If more assistance is needed to connect and communicate with the older adult client, ask for help from family, caregivers, and/or your employer. An inability to communicate is determinantal to successfully meeting the The healthcare worker initiates a therapeutic conversation with an older adult and is focused on improving communication techniques to enhance the relationship and elicit information for assessment. The healthcare worker will use all of the following EXCEPT: a. Cultural competence. b. Inclusion of family or caregivers. c. Teach-back method. d. Terms such as honey and dear. mental health needs of the older adult. Self-Assessment Quiz Question #2
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Book Code: PYFL4024
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