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Useful Articles by the Home Not Alone Staff:

One Article about Communication

Communicating with Elders

David W. Stephen, PhD

“I’m not DEAF,” snapped Arlie, 91, while her daughter was explaining something in an overly loud voice.  Communicating with elders is an essential part of caregiving.  But, like the proverbial obnoxious American tourist abroad trying to communicate with a non-English speaker, simply turning up the vocal volume does not necessarily solve the problem. 

If you experience difficulties communicating with an elder, avoid adding the barrier of thinking, “Well, what do you expect?  He’s old!”  Age does not need to be a communication impediment.  There are some helpful techniques to bridging the age gap.  Let’s examine some of the key elements in communication between caregivers and elders. 

Throughout this article, for simplicity, we will call the elder person “Grandma” or “Grandpa” and the caregiver will be “you.”  Unless noted, we presume Grandma is mentally alert and has good hearing.

MANNERS:  Let’s say Grandma and you and the oxygen supply man are together discussing today’s delivery.  He speaks directly to you about her account and you reply to him. You and he  make several verbal exchanges.  Leaving Grandma out of the direct discussion can be demeaning to her.  Neither you nor the delivery man are deliberately being rude, but it is more polite to attempt to include Grandma.  If she says, “I don’t know, you two work it out,” then that’s fine, but she should FEEL included.  It’s a matter of dignity.  Even if Grandma has dementia, her social skills may be intact and she may feel excluded.  Feelings matter in communication.

FORMS OF ADDRESS:  I clearly recall a young man in a Charles Dickens novel who respectfully referred to his mother and father as “the aged parents.”   While age may elevate a person’s status in some minds, it may also be a sensitive issue for the aged parents.  My 80 year old mother let me know in no uncertain terms that she was insulted by my use of the adjectives “aged” and “elderly” when describing her.  I’m lucky I got off with a scolding rather than a spanking!  Again, feelings matter in communication.

A more common faux pas is the “Sweetie, Honey, Sugar, Dearie” appellations that some caregivers use when addressing an elder.  Their intentions may be good, but we know that good intentions may pave the wrong road.  When my teenage nephew’s friend addressed me as “dude” to my face, my immediate response was, “That’s DOCTOR Dude to you, young man!”  I’ve earned my title, my status and my respect.  Such feelings do not diminish with age, they probably intensify.  The terms of endearment we use with children may insult a senior.  It’s not a good idea to think that old people are just like little children.  Wearing diapers and dribbling apple sauce down your chin does not mean Grandpa has reverted to infantile social status when it comes to communication.  Avoid the natural tendency to correlate advanced age with diminished communication skills, even if dementia is a present.

HAPTICS:  In personal communication, haptics refers to the sense of touch, touching, or being touched.  Everyone has their own tolerance for physical contact.  Although this may change throughout our lives, preferences do not change rapidly.  I’ve found it very helpful to simply ask, “When you are feeling unhappy, how can someone else show you their concern?  Do you like a good hug, holding hands, a pat on the knee, a quick and friendly squeeze on the shoulder?”   Of course, personal relationships affect this greatly, but it’s good to know Grandpa’s limits, preferences, moods, and the context of the current situation. 

PROXEMICS:  Proxemics is closely related to haptics.  Proxemics is the study of personal space between people.  The comfort zone or distance for interpersonal communication varies from culture to culture.  The “public zone” for most Americans is 6-12 feet and is used for non-intimate, non-affectionate communication.  The “intimate zone” is within less than 18 inches, and getting closer than this is a direct violation of personal space (unless both parties consent to such close quarters).  However, there is also a “personal zone,” also 0-18 inches, that allows co-workers to come comfortably in close contact or even to touch each other if working conditions require it. 

I recently demonstrated these three proxemics during a college lecture by making an adult male student uncomfortable when I stood extremely close to him while speaking to the rest of the class.  But, while remaining within close intimate range, when I switched to speaking directly to him, touching his desk and personal papers on it, pointing out his thorough note taking and suggesting changing a word, his discomfort disappeared.  His “intimate zone” became an acceptably comfortable and nonthreatening “personal zone”when we had a mutual task requiring proximity.  The rest of the class remained comfortable in the “public zone.”

So, if you need to touch or handle Grandpa, explain what you are going to do, how you intend to do it, and what he can do to help.  This changes the proxemic dynamic from intimate to personal, from a violation of space to an understanding and acceptance of the close physical working relationship.

OCULESICS:  Oculesics is the use of eye contact in communication.  In eldercare, oculesics is often under-rated, especially when Grandma or Grandpa is sitting or laying down.  This gets complex because eye contact is directly related to the context in which it is made.  It’s not enough just to look at each others’ eyes.  Try to make eye contact at a face to face level. You should literally try to put yourself on the same physical level.  Fortunately, my 53 year-old knees permit me to squat beside a wheelchair so I can put my head above my body and look Grandma in her wheelchair right in the face while we talk.  This is preferable to leaning over because bending over while standing up is still a dominant position to someone seated.  This is very important if you wish to establish equality.  If Grandpa is prone or sitting up in bed, it is preferable to pull up a chair to talk, rather than perch on the edge of the bed or to stand. The point is, if you wish to make effective eye contact, make sure the rest of your body is in harmony with the message you wish to send with your eyes.

IN GENERAL:  Basic communication requires only three simple things, a message, a sender, and a receiver.  But nothing involving human behavior is that simple.  If Grandpa has hearing loss, reduce background noise, make sure he can see your lips, enunciate, use simple sentences if necessary, or try writing notes in large block letters.  Make reminder lists. In most all cases, give extra communication clues like pointing to objects and using nouns. (“Do you want THESE slippers?”)  Encouragement helps, frustration hinders. Take extra time and be patient.   

It has been my personal experience that clearing up emotional issues first, improves communication in general.  Last week, I could not understand a client’s utterance, even after he repeated it several times.  (Ironically, we had been talking about how improved his speech was.) Rather than let frustration build, I said, “I’m going to go check something in the kitchen and think about what you are trying to tell me.  I’ll be back in a few minutes and we can try this again.”  I returned with his granddaughter, Angie, later and he clearly said, “SHE understands me.”  That’s what he was trying to tell me, “Angie always knows what I’m saying.”  This was another lesson that has helped me learn that miscommunication can be as much the problem of the receiver as the sender. 

(SIDEBAR - QUIZ)

Match the terms about communications on the left with the descriptions on the right.

1. selective hearing                               A. spatial dimensions, body space

2. haptics                                      B. physical communication at a distance

3. oculesics                                   C. circumstances and status

4. gestures                                   D. communication through colors

5. language                                  E. bodily contact

6. chromatics                                F. eye contact or direction of gaze

7. contextual communication                        G. symbols conveyed using sounds and speech

8. proxemics                                H. politely feigning poor hearing

(answers: 1H, 2E, 3F, 4B, 5G, 6D, 7C, 8A)

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