151 Mental Health Concerns and The Older Adult
Interpretation is a technique that the healthcare worker can embrace when try- ing 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 nonver- bal behaviors (Boyd, 2017). It can be used by noting body language and remarking on it by saying, “I can see that you are re- luctant to discuss this topic.” Open-end- ed statements are a method for getting the older adult to speak freely on top- ics 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 sen - tence/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 simi- lar technique is validation. It is used when the healthcare worker is searching for un- derstanding (Boyd, 2017).
When the healthcare worker uses it, it can sound like “I want to make sure I un- derstood you”—and then describe what you think you heard. If restated or vali- dated correctly, they both can reassure the older adult that you are listening and open to discussion. Silence is a commu- nication tool that needs proper utilization with the older adult. With therapeutic si- lence, the healthcare worker remains si- lent 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 assess- ment 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 se- lected communication techniques. All communication techniques are useful for various situations. The healthcare worker will choose which technique(s) work best for each individual communication ex- change. The healthcare worker can also have difficulties with communication if the older adult client is reluctant to talk or, inversely, is overly talkative. These chal- lenges can be due to poor cognition or resistance to change in the older adult (Jack et al., 2019). The healthcare work- er needs a specific approach to address these situations. Recommendations for the reluctant pa- tient 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
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