Section 2 - Managing the Ageing Dentition / 2.4 Article: Treating the Older Patient - Communication

Effective communication between clinician and patient is an essential part of delivering oral health care. The communication process is often complicated by the effects of age. For this reason, the AAFP has reviewed the literature to produce the following 12 recommendations for improving communication with older patients:

1. Allow extra time for older patients

Studies have shown that older patients receive less information from physicians than younger patients do, when, in fact, they desire more information from their physicians [1,2]. Because of their increased need for information and their likelihood to communicate poorly, to be nervous and to lack focus, older patients are going to require additional time. Plan for it, and do not appear rushed or uninterested. Your patients will sense it and shut down, making effective communication nearly impossible.

2. Avoid distractions

Patients want to feel that you have spent quality time with them and that they are important. Researchers recommend that if you give your patients your undivided attention in the first 60 seconds, you can “create the impression that a meaningful amount of time was spent with them.”[3] Of course, you should aim to give patients your full attention during the entire visit. When possible, reduce the amount of visual and auditory distractions, such as other people and background noise [4,5].

3. Sit Face to face

Some older patients have vision and hearing loss, and reading your lips may be crucial for them to receive the information correctly [6]. Sitting in front of them may also reduce distractions. This simple act sends the message that what you have to say to your patients, and what they have to say to you, is important. Researchers have found that patient compliance with treatment recommendations is greater following encounters in which the physician is face to face with the patient when offering information about the illness [7].

4. Maintain eye contact

Eye contact is one of the most direct and powerful forms of nonverbal communication. It tells patients that you are interested in them and they can trust you. Maintaining eye contact creates a more positive, comfortable atmosphere that may result in patients opening up and providing additional information [4].

5. Listen

The most common complaint patients have about their doctors is that they don’t listen [8]. Good communication depends on good listening, so be conscious of whether you are really listening to what older patients are telling you. Many of the problems associated with noncompliance can be reduced or eliminated simply by taking time to listen to what the patient has to say [4]. Researchers have reported that doctors listen for an average of 18 seconds before they interrupt, causing then to miss important information patients are trying to tell them [9].

6. Speak slowly, clearly and loudly

The rate at which an older person learns is often much slower than that of a younger person. Therefore, the rate at which you provide information can greatly affect how much your older patients can take in, learn and commit to memory [4,6]. Don’t rush through your instructions to these patients. Speak clearly and loudly enough for them to hear you, but do not shout.

7. Use short, simple words and sentences

Simplifying information and speaking in a manner that can be easily understood is one of the best to ensure that your patients will follow your instructions. Do not use medical jargon or technical terms that are difficult for the layperson to understand In addition, do not assume that patients will understand even basic medical terminology. Instead, make sure you use words that are “familiar and comfortable” to your patients [3].

8. Stick to one topic at a time

Information overload can confuse patients. avoid this, instead of providing a long, detailed explanation to a patient, try the information in outline form. This allows you to explain important information in a series of steps. For example, first talk about the heart; second, talk about blood pressure; and third, talk about treating blood pressure [10].

9. Simplify and write down your instructions

When giving patients instructions, avoid making them overly complicated or confusing. Instead, write down your instructions in a basic, easy-to-follow format. Writing is a more permanent form of communication than speaking and provides the opportunity for the patient to later review what you have said in a less stressful environment [4].

10. Use charts, models and pictures

Visual aids will help patients better understand their condition and treatment. Pictures can be particularly helpful since patients can take home a copy for future reference [6].

11. Frequently summarise the most important points

As you discuss the most important points with your patients, ask them to repeat your instructions. If after hearing what the patient has to say you conclude that he or she did not understand your instructions, simply repeating them may work, since repetition leads to greater recall [10].

12. Give patients an opportunity to ask questions and express themselves

Once you have explained the treatment and provided all the necessary information, give your patients ample opportunity to ask questions. This will allow them to express any apprehensions they might have, and through their questions you will be able to determine whether they completely understand the information and instructions you have given [6].


[1] Beisecker AE. Aging and the desire for information and input in medical decisions: patient consumerism in medical encounters. Gerontologist. 1988;28:330–335.

[2] Haug MR, Ory MG. Issues in elderly patient-provider interactions. Res Aging. 1987;9:3–44.

[3] Baker SK. Thirty ways to make your practice more patient-friendly. In: Woods D, ed. Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004.

[4] Dreher BB. Communication Skills for Working With Elders. New York: Springer; 1987.

[5] Osborne H. Communicating with clients in person and over the phone. Issue Brief Cent Medicare Educ. 2003;4(8):1–8.

[6] Breisch SL. Elderly patients need special connection. Am Acad Orthop Surg Bull. February 2001;49(1).

[7] Nussbaum JF, Pecchioni LL, Robinson JD, Thompson T. Communication and Aging. Mahwah, NJ: Lawrence Erlbaum Assoc; 2000.

[8] Meryn S. Improving doctor-patient communication: not an option but a necessity. BMJ. 1998;316(7149):1922.

[9] Schopick JE. Hippocrates was right: treat people, not their disease. In: Woods D, ed. Communication for Doctors: How to Improve Patient Care and Minimize Legal Risk. Oxford: Radcliffe; 2004:12–13.

[10] Ley P. Towards better doctor-patient communications. In: Bennett AE, ed. Communication Between Doctors and Patients. London: Oxford University Press. 1976:77–98.