✔ Using a simple screen, such as the Mini-Mental State Examination, assess the patient’s cognitive function when alone with him or her.
Refer the patient to a specialist (e.g., neurologist or neuropsychologist) for diagnosis of cognitive impairment.
✔ Reassure the patient if there is no serious mental decline.
✔ Decide how to talk about serious cognitive problems, depending on how much the patient wants to know and can understand.
✔ Communicate with family members in a family conference, arranged with the patient’s consent.
✔ Suggest activities that the patient and family might still enjoy.
✔ Be alert to caregivers’ needs for information, resources, and respite.
talking with patients about cognitive problems 57
Keeping the Door Open
“Effective Communication”
Advising an older man about starting an exercise program . . .
counseling a woman about the proper way to take her osteoporosis
medication . . . discussing end-of-life care options with the
family of a long-time older patient who is dying. These are just some examples of the complex and sensitive issues facing clinicians who treat older people. Health care providers who communicate successfully with older patients may gain their trust and cooperation, enabling everyone to work as a team to handle physical and mental health problems that might arise.
Effective communication techniques, like those discussed in this handbook, can save time, increase satisfaction for both patient and practitioner, and improve the provider’s skill in managing the care of his or her patients.
Ongoing communication is key to working effectively with your older patient. If a patient does not follow recommendations or starts missing appointments, explore whether or not a diffi culty in communication has developed. Paying attention to communication increases the odds of greater health for your patient and satisfaction for you both.