Communication Matters: Hospitals & Older Adults

Communication Matters: Hospitals & Older Adults

Many of us may be convinced that we’ll never be confined to a hospital bed; however, that probably isn’t too realistic. Mark Lachs, MD, author of Treat Me Not My Age: A Doctor’s Guide to Getting The Best Care As You Or A Loved One Gets Older, claims it is almost impossible to live a long life without ending up in the hospital at least once as we age. He also explains that good healthcare communication is an integral part of our ongoing care. Further, he emphasizes that we all have a responsibility to make sure that we get vital communication important for our best healthcare.

Sucked Up into a Communication Vacuum

Last month, I had to call an ambulance for my husband. He was transported to the nearest hospital. Thanks to the competence of the emergency-room staff, my husband’s condition was immediately addressed. All could have ended well at that point, but then he was admitted and spent the next two and a half days in limbo—a limbo that felt like a system-wide communication vacuum.

We could not get information about why my husband had been admitted, what the plan was for his care, or when he would be discharged. Some of the staff were generally effective and efficient in their communication. Others tended to be patronizing using language such as “honey” and “sweetie” when addressing my husband or me. One nurse told us how busy they were when we asked questions. (They were very busy and probably understaffed.) Frustrated with a lack of information, my husband chose to discharge himself after 2 1/2 days.

Communication Matters

Communication between healthcare providers and patients is crucial for both patient satisfaction and recovery. Various studies have revealed that patients are more likely to follow medical advice when they feel understood and can also understand treatment options. In a hospital setting, the ways in which doctors and staff interact with patients can result in “better clinical outcomes, reduced costs, and greater patient satisfaction…”  But when some of the communication is lacking, patronizing or indifferent, age-biased attitudes could be part of the problem.

A number of studies have shown that when dealing with older patients, some healthcare staff are more likely to use patronizing and ineffective communication. In one study involving nurses, the quality of interactions with older patients was associated with the nurses’ attitudes towards aging. “More negative nurse attitudes were related to shorter, more superficial, and more task-oriented conversations with older patients.”

Addressing Communication Gaps in Hospitals

Communication Training

 Reports have suggested an increased interest in communication training as part of medical school training. Some hospitals have also enlisted the help of training companies to help staff learn how to demonstrate better listening skills, demonstrate empathy, and use nonverbal skills to build rapport with patients.

In hospital settings where patients encounter several different healthcare workers, it is difficult to ensure that effective and appropriate communication is consistent and uniform.  Even when most all staff or exposed to one-shot communication training, the effectiveness of these efforts generally drops off after the initial training unless continually reinforced as part of the organizational culture.

 Creating a Culture of Communication

 Creating an organizational culture of communication is a function of leadership and involves promoting certain values, beliefs, and behaviors that are reinforced through rewards or other means. Again, such efforts are associated with better health outcomes, lower costs, and better patient outcomes.

Ten days after my husband discharged himself from the hospital, he, unfortunately, experienced a different type of medical emergency. Because the hospital closest to us could not handle the situation, my husband was transported to another hospital.

The next day when I arrived at the hospital where my husband had been sent, a doctor met me at the front entrance and spent about 15-20 minutes explaining my husband’s condition and the plan for his recovery. She also mentioned that she was still waiting for my husband’s health information from our local hospital. Fortunately, I did have a copy of my husband’s prescriptions, his doctor’s name, and number, and needed medical information with me.  The doctor then escorted me to my husband’s ICU room.

Immediately after my husband was out of ICU, a case manager met with both of us to discuss what improvements needed to happen before discharge. Right after talking with the caseworker, the hospitalist spent several minutes with my husband and me explaining what had happened and a plan for moving forward. He also answered our questions and expressed empathy for the stress we had both experienced.

My husband spent five days in this hospital. During those five days, I either met with doctors and nurses or received daily calls from both doctors and nurses who updated me on my husband’s condition and asked if I had any questions. Interactions with medical staff were positive, respectful, and informative.

When I visited my husband each morning, a young man near the entrance of the hospital took my temperature and checked me in as a visitor. After the first day, this young man greeted me with “Good morning, Paula!”  Each day that I visited, I was greeted in the same way.

Respectful communication at this second hospital was a system-wide effort. Clearly, the leadership at this institution had been working on developing a culture of appropriate and effective communication.

 Advocating for Ourselves and Our Loved-Ones

 In a perfect world, all healthcare professionals would use effective and appropriate communication—communication that is clear and conveys respect, empathy, and a willingness to listen to our health concerns. Of course, we don’t live in a perfect world, so it is up to us to advocate for the healthcare we need.

In his book, Treat Me Not My Age, Dr. Lachs offers some excellent advice for patient advocacy. One suggestion that helped me was to make sure that when my husband was transferred to a different hospital, the new hospital had needed medical information.

Informing ourselves and asking appropriate questions is something else we can do. When it comes to our healthcare and getting the answers we need, we cannot be timid. I highly recommend reading Lachs’ book for future reference—whether it is for your own benefit or the benefit of a loved one.

Quality healthcare communication is essential for our own health and well-being. We have a role to play in making sure that we get the information we need. 

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