Communication Barriers

Specialties Geriatric


I am a brand new nursing student in need of some advice. I need some ideas on how to communicate with a client in their mid-ninties. I've only been working with this client for one clinical and I will have them for the next 2 weeks. They don't speak at all and I'm not sure if they understand what I'm saying. They don't respond when I ask them to squeeze my hand. I've asked the nurse who takes care of this client on a regular basis what the situation is (such as a stroke?) and their response was that they "are just very old". :confused:

Any ideas or suggestions would be gratefully appreciated.


411 Posts

I have just studied this in my Validation Therapy training. First the instructors had us lay down, close our eyes and do deep breathing to relax us. Then, we were instructed not to open our eyes and they walked through the room, making noise, dropping books, coming close to us, overhead paging, etc. The point was to re-enact a scenario of a resident in a vegetative state, with their eyes closed and what they might hear or feel. To start, always always always tell the resident what you are doing before you do it. Make eye contact, get down on one knee at wheel chair level if possible. Use touch- very little at first until a trusting relationship has been established. Validation Therapy is based on the losses of the very old which may result in an inward , closing in to the kind of resident that you describe. Think of all the losses, mobility, financial, role of breadwinner, husband, father, social losses- loss of spouse, friends, etc, loss of independence, loss of dignity- think of the horrible reality of three shifts of people you don't know doing unspeakable things to you, waking you up at night, changing you, wiping your butt, making noise, etc. Close in more! Your job would be to move in slow and try to establish a relationship from his perspective. Find out what he did for a living, look in the chart and call a relative for infromation. Touch should be possibly on an arm, and later maybe a small brush of the cheek. This resident may speak later, I have had this happen. Sometimes they just have better days than others. Think about what kind of music might have been popular during his life and learn that song (try music from WWII, there were some great songs from that era and that would have put this man in his 40's) or earlier, from the twenties - I feel you are my sunshine has been utilized ad nauseum, but the residents seem to really enjoy it. If he was religious, a tape of old hymns may be appropriate. Always introduce yourself and tell him what you are doing and why, even to go so far as saying you are a student with an assignment. Don't give up, but keep your sessions to only 10-`15 minutes. Think of all the senses and how you would stimulate them- a light sent of woman's cologne, or a light man's cologne, flowers, bread baking. The touch of cotton, (sounds like the commercial!) or velvet. PM me if you need more ideas or try validation therapy on a search engine for more informatiion.

Good Luck,


223 Posts


A key issue when communicating with older people is RESPECT

Please remember that when you were born that a person of that age had already achieved all the life transitions into old age.

No pet names such as sweetheart or honey. Find out how they wish to be addressed.

No condersending fondling of hair or touching unless wanted

Always get eye contact- if patient sat in chair kneel down to their level.

Inform them that you are a student and would like to learn. Talk about current affairs. Tell them something about you[ but not too personal like your partner;) ]

Many years ago I looked after a lady for several weeks she never spoke or indicated that she understood anything that anyone said,would not respond to any form of communication at all. She would just sit in the chair, eat when fed etc

Then one day when we were transfering her back to bed she peed all over my shoes:roll :roll

She started to giggle then.......... belly laughed

I said @ you wicked lady, you know what you are doing and she said to me My dear I am too old to care. BUT that was funny ..........I must admit I had to agree with her. She just could not be bothered. I later found out from her that if she played the decrepid old lady she would get more response from staff

A very valuable learning experience

Good luck to you



1,244 Posts

I usually start by touching the shoulder or the unaffected side if they've had a stroke. I get to eye-to-eye level, but not quite directly in their face, and speak so they can see my lips move to form simple yes/no, 1-word-answer questions.

Like, "Hi" (eye contact and biiiiiiiiiig smile) "How are you today?"

Count slowly to 30 to give them time to answer.

If no answer, continue with your very brief explanantion of what you'll be doing: "I'm here to clean you up" "Just stopped by to say hello" "I need to take some blood" etc.

If you look at their eyes and it looks like they WANT to answer, but can't, SAY SO. Say, "I can see that you want to say something. Maybe it won't come out. But we'll figure out a way to talk anyway, ok?"

I got so into this technique, I remember once that I had a patient who I communicated with completely with facial expression, and the doctor came by and asked me how she was. I gave him a 2 minute diatribe, beginning with, "Well, she told me she has pain, but the pain meds aren't working for her...."

When he was startled into protesting that "But this patient doesn't speak," I said, "Oh yes she does," and made him watch us as we "talked" without words. He upped her pain meds. :D

adrienurse, LPN

1,275 Posts

This may sound bizarre, but do you have a pet? Do you carry on a conversation with a dog or cat? It's that easy.

Lean in close (once she knows you and just start talking. Talk about her shirt, her pictures on the walls, what she just ate, what's on TV. Anything. Look closely at her responses. Is she paying attention to what you are saying? Is there a smile, any acknowledgement? Eye contact? Look fo cues. That is your encouragement to keep on.

Believe me, it gets easier with practice. I don't even notice that I'm doing it anymore and my residents love it.

Purple Princess

151 Posts

i had a patient that was extremely hard of hearing recently. No matter what i did( face him, speak loud and clear, simple words, and even spoke into his right ear which he could still hear out of) to communicate with him didn't work. We both got frustrated but he just started to get really upset. So i just decided to leave it go and left the room. I had been trying to just thank him for being patient with me as we both had a rough two days together.

CoffeeRTC, BSN, RN

3,734 Posts

I skimed thru the other replies and just wanted to add a few things.. What about speech therapy.. were they consulted, what do they suggest. Does family have any suggestions? Just keeping comunication simple short and direct helps too.

CoffeeRTC, BSN, RN

3,734 Posts

I skimed thru the other replies and just wanted to add a few things.. What about speech therapy.. were they consulted, what do they suggest. Does family have any suggestions? Just keeping comunication simple short and direct helps too.

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