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Elders, caregivers and communication barriers

by Isabel Fawcett

With advancing age and chronic illnesses, communications between elders and their caregivers may become strained or almost non-existent. Regardless of cognitive impairment, my personal caregiving commitment is to communicate, communicate, and communicate some more with elders in my life, including my beloved octogenarian mother to whom I am a full-time caregiver. There is always something to talk about unless caregivers choose otherwise.

Clinically diagnosed Alzheimer's, other dementias, Tourette's syndrome and strokes are just the tip of the medical iceberg of chronic diseases potentially affecting elders' communication skills.


Strokes, alone, may manifest as mental confusion, speech and other language problems. In fact, one of several warning signs of a stroke can be mental confusion, inability to reason or understand words spoken by others, or sudden-onset inability to speak. The wider effects of strokes on the body further hinders and complicates non-verbal communication skills, making it more complex for caregivers to engage in meaningful interactions with elders who are stroke survivors.

Strokes begin as an interruption of blood flow to the brain. The affected brain cells die due to oxygen deprivation. Depending on the part(s) of the brain affected by the stroke, survivors may become increasingly forgetful and appear out-of-touch with their surroundings. For some stroke survivors, facial expressions tied to the elder's emotions are suddenly non-existent or confusing for caregivers to interpret. A stroke survivor may laugh or cry at seemingly inappropriate times.

Such examples do not represent the entire spectrum of communication problems for stroke survivors, including elders. It is very important to note that strokes are no respecter of age. However, this content speaks to eldercare issues, in this case, chronic diseases that may significantly disrupt caregiver-elder communications.

Only Caregivers With Special Skills Need Apply

Even without chronic illnesses, with advanced age, some elders increasingly withdraw, becoming socially invisible. It is not uncommon for an elder's voice and intonation to soften with age, sometimes due to respiratory ailments. When some elders speak in an almost-whisper, they are often overlooked or entirely ignored by others.

Some adults speak to elders as if speaking to infants, comparable to how some parents choose "baby-speak" when communicating with their newborns. Elders are neither infants nor are they children. Cognitive and speech impairments do not erase elders' considerable life survival skills and lifetime accomplishments.

Just as some parents choose to speak normally to their newborns, even if the infant is unable to comprehend advanced language, there are some individuals who speak to elders respectfully in spite of elders' cognitive health issues. With elders who have disabling conditions, it is best to never presume lack of understanding simply because of the elder's disabilities.

Cognitive Disabilities Can Be Deceptive to Untrained Eyes

Years ago, I worked in an industry serving developmentally disabled individuals. Most residents were severely developmentally disabled and had multiple chronic illnesses. A few residents permanently relied on wheelchairs.

Back then, I met a severely disabled teenager as he sat in a wheelchair and appeared out-of-touch with his environment. His body was severely contorted as a result of multiple medical disabilities. I introduced myself to the young man whose body was not comparable to non-disabled teenage peers. His initial reply was more unintelligible than not due to slurring, yet I readily understood the word "hi," in response to my greeting.

I smiled as I told the young man a little about myself. What happened next is something I will always remember.

Though his speech was labored, his words slow and slurred, I had no trouble understanding what he said next. He explained to me that he was seated by the telephone waiting for a call back from his doctor's office and he might have to interrupt our conversation to take an important call. He explained that he was adamantly opposed to his doctor wanting to have his blood drawn for pathology review so soon after having ordered lab work less than a month ago.

The young man clearly spoke his mind as I stood listening in stunned silence. I was so proud of the fire in his belly at being his own healthcare advocate. "Good for you," I said. I also tempered my reply by advising him that his doctor may have other health concerns in mind which he may want to consider before making his refusal known to the doctor.

Vigorously and without malice, he reminded me that it was his arm, his blood, and his body, thus his right to make such decisions. He said this as he struggled to aim his deformed arm and rigid index finger to the precise spot on his opposite arm from which blood is customarily drawn by phlebotomists. He concluded his statements by enlightening me on existing research.

Meeting such a special young man remains a powerful reminder to me that disabilities do not define or confine the human spirit regardless of chronological age.

Elders Are Adults

Just as I listened to that teenager whom I have never seen since, as a caregiver, my chief communication objective is to first stop, then look, listen, and seek to understand what my beloved mother and elders are trying to say, even when words or memory may fail them on occasion. My mother is not socially invisible to me. When I speak, I speak with her, not at her or around her.

In my childhood, various adults made clear that Mom and Dad never talked down to their children when we were babies. Both addressed their children respectfully presuming hearing and a basic level of understanding on our part. Whether soothing intonation, reassuring touches, gentle repetitions, laughter, tears, hugs, tugs, or other forms of communication, their children were not socially invisible.

Our elders deserve such dignity and respect from their caregivers whether anyone believes they have earned their stripes, or not.