Practice Management

Communicating Effectively with Older Patients Who Have Cognitive Impairment

Consider these tips for clear and concise communication

Older couple looks medication information together

The size of America’s older population is expected to increase dramatically in the next three decades. As the aging population grows, the number of individuals living with cognitive impairments, such as dementia and Alzheimer’s disease, will also increase.

PCPs are on the front lines of diagnosing and treating patients with age-related cognitive impairments. Many patients with cognitive impairment have at least one chronic condition, and health care providers are tasked with communicating treatment recommendations clearly and concisely. Lorraine Sease, MD, a Duke family medicine physician, offers the following tips for physicians on effective communication with their older patients.

Talk to patients one-on-one. If the patient is comfortable, Sease encourages physicians to speak to patients in a one-on-one setting. “It can be hard for family members to let the patient talk,” she explains. Other providers, such as a physician assistant or nurse, can gather more information from the family member or caregiver at the same time.

Gathering a full patient history is imperative when determining appropriate treatment, but time constraints can be challenging. Sease asks her patients’ family members to submit written information that she can review before the visit.

Direct patients and caregivers to support networks. “Helping families navigate caregiving challenges is one of my hardest issues,” Sease says. The behavioral issues that are often associated with dementia and Alzheimer’s disease, such as agitation, aggression, and major personality changes, can create safety concerns for caregivers. Sease advises patients and caregivers to call the Alzheimer’s Association 24/7 helpline if they have questions (800-272-3900). Additionally, many states provide family support programs that are free to their residents, such as North Carolina’s Duke Dementia Family Support Program, which offers resources for staying engaged while social distancing.

Review medications. Clinicians may sometimes prescribe medications and forget to consider whether that medication is still indicated months or years later. Older patients often see multiple health care providers, and their PCP may not be aware of all the medications that a patient has been prescribed. “It’s easy when you’re a new provider to look at a medication list and say, ‘These three drugs are probably not worthwhile.’ It’s harder when you’ve been seeing somebody for 10 years, and these things have added on over the years,” Sease explains. She makes an effort to regularly review medications with patients and recommends that patients ask their providers whether they still need a specific drug that has been prescribed.


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