Working with Older
Adults
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Older patients may bring special challenges so make sure you’re up to the task
Working with older patients in your practice can bring special challenges. There are many normal changes that take place with aging which can affect the way patients act and react to their eye exam or even their time in the dispensary. It’s important when working with the older population to pay special attention to their needs. These patients are also more likely to have eye health problems so properly educating them on diagnoses and eye care is of critical importance.
Cognitive Changes
According to the US Department of Health & Human Services (HHS), aging results in normal changes in cognition—specifically reduced processing speed, greater tendency to be distracted, and reduced capacity to process and remember new information at the same time (called “working memory”). While HHS reports that these normal changes can sometimes lead to false stereotypes or beliefs that older adults are cognitively impaired, they are in fact just a normal part of the aging process. Still, these changes may mean modifying the way you educate the patient on their diagnosis or even on what you’re doing as you go along with the exam.
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Sally Halim, OD of Village
Eyecare
in Woolwich, NJ |
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“You definitely have to take your time and make sure the patient is clear on what’s going on and what you’re telling them,” says Sally Halim, OD, of Village Eyecare in Woolwich, NJ, who has worked with a number of older patients at her practice. “Things change so quickly in our industry. The patient may be used to older technology. I find that it’s important to explain what you’re doing as you proceed through the exam so that the patient is not surprised or fearful in any way.”
Halim says she’s also found that older patients can be strongly affected by past negative experiences in the healthcare world. They may be less likely to let a negative experience go and may harbor those bad feelings long term. If they had a poor experience with a past eye doctor, they may be even more reluctant about new technology or procedures. |
“You have to assure older patients that have had a bad experience that it doesn’t mean those things will happen again,” Halim says. “It’s almost like you have to win them over which can be difficult. But it’s important to be understanding of any difficult medical experience they’ve been through and recognize that it may be affecting their current experience with you. Explain everything you’re doing and help walk the patient through the exam every step of the way. Taking that extra time with them may be all it takes to make them comfortable.”
Health Literacy and Comprehension
Older patients also have a different level of health literacy that needs to be addressed. Not only may they not be familiar with newer technology, but they may also have factors working against them in their comprehension of medical information. According to the HHS, older patients’ comprehension of health information may be impacted by any number of issues including vision and hearing problems, stress, fatigue, depression, and the use of medication. They also typically have to manage multiple medical conditions increasing their chances of being distracted or forgetful, according to the HHS.
Fortunately there are some techniques you can try to help convey the correct information to patients and ensure they comprehend it. The HHS says that repeating essential information is important. But the HHS says that frequent repetition of information that is “not true” may result in the information being remembered as “true” simply because older adults are more likely to interpret the increased familiarity of a message as being true. In other words if you repeat that the patient should “not take the medication with food” several times, they may remember it as “take the medication with food. Therefore, the HHS advises emphasizing the desire actions, not the actions they should avoid.
When communicating, the HHS also recommends staying focused on important details and not letting too much unnecessary detail creep into the message as this only leaves room for confusion or for the patient to forget the vital details. The HHS also suggests personalizing information whenever possible to help the patient remember it and also to minimize distractions.
And of course, be prepared to take your time. The HHS says that a slower pace may be needed and that means factoring extra time into your appointment depending on the patient. “Learning to communicate better and making sure the patient comprehends the most important details may mean slowing down,” agrees Halim. “Don’t insult the patient but also be careful not to rush through important information. Take the time to make sure they understood what you’ve told them.”
In the Dispensary
Once your patient has moved on from their eye exam and into the dispensary, they still have special needs that should continue to be addressed. Every patient is different but older adults may be more likely to be unfamiliar with new lens technology and may require more education on why you’re recommending a certain product.
“You may need to take the time to explain why it’s better to go with a different material—such as one that’s lighter,” says Halim. “I have found that some older patients believe they’re getting more for their money by going with something heavier or bigger even if it’s not more comfortable. You may need to explain why lighter weight lenses cost more but also how they can make the patient more comfortable. Like any age group, you have to learn to speak their language based on their experiences and what’s important to them. Be careful not to do this in a condescending way. Just understand that older patients may not be as up to date with newer technology and may have more questions.”
Of course you always have to look at the flipside. Many older adults have embraced the Internet and have read up on new technology. Some are into the latest fashion trends and will want frames that are currently “in style.” The bottom line is that you have to be willing to work with each and every patient at their own level, says Halim. That can require some customization of your message. Be prepared to meet the needs of each patient that walks through your door and you’ll likely see them back
soon.
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