2. What to Say and How to Say It: Eradicating Communication Barriers A Presentation by: Jennifer Birkas, OT Reg.(Ont.) Audrey Brown, M.Sc., SLP(C), Reg. CASLPO

3. What Are the Barriers YOU Face When Talking to an Elderly Client? THEY have: –S–Sensory loss - hearing, vision –C–Cognitive impairments - attention, memory, etc. –L–Language barriers –W–Well-meaning caregivers –B–Beliefs/expectations about health care –F–Fatigue, physical limitations –V–Voice/speech/language disabilities (stroke, Parkinson’s) –C–Challenging communication environments

4. What About Your Clients? What Do They Experience with Us? WE have: –Expectations of the elderly –Limited time –Lots of education - technical jargon –Generation gap/less life experience –Narrow focus –Conflict in agenda

5. The Challenges Associated with Dementia Sensory Memory –problems with registration, recognition and identification Short Term Memory (Working) –problems with encoding/decoding Long Term Semantic, Episodic and Procedural Memory –problems with retrieval

6. Strategies for Sensory Memory Difficulties Be calm, slow and use deliberate movements Get close (but not too close), eye level Ensure attention first Open position and posture Use glasses, hearing aids, dentures

7. Strategies for Short Term Memory Difficulties Give extra time for responses Use a variety of modalities and cues One step instructions Keep words consistent if repeating Use an inviting tone Memory book or card with information for repetitive questioning behaviours

8. Strategies for Long Term Memory Difficulties Guest books, memory books, pictures Maintain environmental cues Avoid yes/no questions, use 2 choice Signs and photographs/pictures at eye level –Be mindful of font, colour and size

9. Clear Verbal Communication Organize your information Use common words - not jargon Give clients a chance to express how they feel and to tell their story Make direct eye contact Plan with your clients what they can do Let your client know what you are thinking

10. Clear Verbal Communication Explain procedures and ask permission during examinations Focus on your client Check that your clients have understood what you have said Use humour when appropriate Use written information as a back up

11. Literacy and Older Adults 80% of older adults are working with the lowest levels of literacy 60% never completed high school, 37% have less than Grade 9 education Well informed seniors are healthier - quality of life is better

12. Use of Written Materials with Older Learners Dark print on light background 14 point type size with serif (T versus T ) Non glare surface Lots of white space to separate ideas Include only essential information Circle or highlight the most important parts in brochures or written information

13. Think about the other 10% Posture –Forward (the sprinter pose) –Watch your hands! –Use of touch, proximity –Gestures Facial Expression –Eye contact, eye movement –Non-verbal communication can contradict verbal communication

14. Elderspeak Short sentences with simple grammar Exaggerated intonation Very LOUD, S-L-O-W talk Simple vocabulary, tag questions (“You’re hungry, right?”) Short directives (“Walk here”)