by Megan Flaherty
July 7, 1998

Some patients are mysteries, but there are plenty of clues to figure out their attitudes and expectations. One hint is age: Old and young patients have different beliefs about health care and ways of interacting with health professionals.

Nurses who understand these generational differences will be one step ahead when it comes to working well with their patients.

Seniors: draw them out

Many seniors expect a paternalistic rather than an egalitarian approach from healthcare providers, experts say. To successfully work with this type of patient, a health professional must elicit questions and concerns, and broach the sensitive issues. If the patient has trouble coping with open-ended inquiries, health professionals should present choices or pose questions that can be answered with a yes or a no, according to the National Institute on Aging.

Seniors need this extra nudge because they may not want to bring up concerns they suspect may be trivial or ask questions for fear of seeming to challenge the clinician, the NIA says. They may also be embarrassed to bring up topics like sexuality and depression.

Nurses should encourage older patients to become informed about their health, said Nancy Cirone, MSN, RN, a diabetic educator and education director at Bucks County and Parkview hospitals in Philadelphia. She urges the elderly patients in her diabetic support group to always have a list of questions when they see their physician. "I tell them, ‘If you don’t, you’re wasting your time and the doctor’s time.’ " She emphasizes that patients are ultimately responsible for their own health. "When patients say, ‘My doctor will take care of me,’ I say, ‘Well, does your doctor live with you? The doctor can prescribe the proper medication, but you have to take care of yourself.’ "

Another tip for working with seniors: Take your time. Elderly patients are sensitive about being rushed through appointments, said Richard L. Kravitz, MD, MSPH, director of the Center for Health Services Research in Primary Care at the University of California, Davis. "They have more complex issues that require more time," he said. Providers should slow down, allowing seniors time to formulate their thoughts. Physicians are especially guilty of rushing patients, Kravitz said. During the average interaction, the physician interrupts the patient within 18 seconds of the patient’s opening statement, he said. "The short answer is that we need to listen better," he said.

Boomers and younger: partners in health

Working with younger patients presents a different set of challenges. Because baby boomers are likely to educate themselves and ask their providers a lot of questions, health professionals have to be on their toes. A patient can know more about an issue than a provider by doing some research, Kravitz said. That patient becomes an expert, and the provider becomes an "expert interpreter," he said.

In these cases, it’s important not to feel criticized or threatened by the patient’s knowledge, experts say. "It’s not good business to get irascible," said Steven Steiber, PhD, senior vice president and healthcare practice director at Opinion Research Corp. International in Evanston, Illinois.

Young adults are also likely to investigate health issues and may request certain treatments or medications. When that happens, health professionals should dig for underlying concerns, Kravitz said. The provider may learn, for example, that the patient who simply has headaches and requests a CT scan had a relative who died of a brain tumor. Then the provider should reassure the patient that a brain tumor would cause other symptoms, like seizures and double vision, Kravitz said.

For Cirone, one of the pluses of working with younger patients is their bravado. The young patients with diabetes she works with generally don’t have the fear of injecting themselves that older patients have. Cirone sees differences in how patients of different ages want to be educated about their disease. The young adults generally want to watch a video about their disease first and then look to Cirone as a resource person. "They want to take control and be in charge of what they learn, how they learn, and how much they learn," she said. Older patients usually prefer to talk to her first and then take reading materials.

No excuses

The younger generations—more than the older generations—think health professionals should have top-notch interpersonal skills and high levels of sensitivity along with technical expertise, said Mary P. Malone, JD, MS, executive director of consulting services for Press, Ganey Associates in South Bend, Indiana. Younger people expect superior communication skills and clear explanations of their conditions and treatments.

But patients of all ages agree that health professionals should be good listeners, spend enough time with them, respect their input, and be knowledgeable and thorough. The standards are high, but obtainable, Malone said. "Some providers say patients have unrealistic expectations. It’s absurd to say patients’ expectations are too high because then you have an excuse to always underperform," she said.

Previous Stories
PART ONE
Generations
Three generations and three different expectations for their own healthcare.

Pulling the Plug
Medical futility. Who has the power to decide?

Editor's Note
Bending the Rules
Policies were meant to be broken.

Rural Technology
Cows, computers and continuing education.

Breast cancer and designer estrogens

Crime and Punishment?
Could you go to jail for a medication error?

Tips for making an elderly patient feel at ease
+Make the environment welcoming. Be sure the office is physically accessible.

+Address the patient by his or her last name, using the title the patient prefers. Using the patient’s last name conveys respect and promotes an atmosphere of equality.

+Maintain an unhurried pace. Many older people function well only if unrushed.

SOURCE: Working With Your Older Patient: A Clinician’s Handbook by Barbara Gastel, MD. Published by the National Institutes of Health.