l Try to address the patient directly, even if his or her cognitive capacity is diminished.
l Gain the person’s attention. Sit in front of him or her and maintain eye contact.
l Speak distinctly and at a natural rate of speed. Resist the temptation to speak loudly.
l Help orient the patient. Explain (or re-explain) who you are and what you will be doing.
l If possible, meet in surroundings familiar to the patient. Consider having a family member or other familiar person present at first.
l Support and reassure the patient. Acknowledge when responses are correct.
l If the patient gropes for a word, gently provide assistance.
l Make it clear that the encounter is not a “test,” but rather a search for information to help the patient.
l Use simple, direct wording. Present one question, instruction, or statement at a time.
l If the patient hears you but does not understand you, rephrase your statement.
l Although open-ended questions are advisable in most interview situations, patients with cognitive impairments often have difficulty coping with them.
Consider using a yes-or-no or multiple-choice format.
l Remember that many older people have hearing or vision problems, which can add to their confusion.
l Consider having someone call the patient to follow up on instructions after outpatient visits.
l If the patient can read, provide written instructions and other background information about the problem and options for solutions.
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