The Elderly: A Request

[JKL33]

We do not need to raise our volume and use a higher pitched voice when dealing with elderly confused patients. All it does is make things worse. Their brains are not going to suddenly understand if only we speak louder and louder and higher and higher. However, what they perceive as our "agitation" (louder and higher voices) does increase their agitation.

I am no kind of hearing expert but have been taught that with age-related hearing loss (presbycusis), the hearing loss often begins with higher frequency sounds anyway. So all the "honeeeeey, do you need to peeeeee?" yelling that we tend to do is not helping anything.

I have had very good response to getting close and speaking in a lower, almost quiet but firm tone. It seems to have a calming, comforting effect. Using preferred names helps.

It may sound silly but the above scenario is heart-breaking every time I witness it. I know there is an insurmountable pile of things on our plate, but this is such a simple thing that we can do better. It actually takes less energy than the alternative.

These are not our honeys, they aren't two years old and their life isn't a carnival ride.

Sorry, hitting a little close to home. I am asking everyone to give it some thought, try to change your practice if you are one of the well-meaning guilty, and gently share with newer peers who may be trying really hard but are genuinely ignorant all the same.

Thank you.

[Kitiger, RN]

[nursej22, MSN, RN]

Yes, this is great. I might also add, many of these tips are useful when speaking to people who are English language learners. And try to avoid jargon.

[Davey Do]

Great topic JKL! Well written post chocked full of sound (no pun intended) information.

@Kitiger I like to hear some background information on this interesting notebook journal.

[Davey Do]

This thread hits home with me, experiencing some slight hearing loss in my right ear due to an MVA at the age of 19. Back in 2000, I had surgery for a cholesteatoma in that ear with implantation of prosthetic plastic ossicles. I also suffer from chronic random tinnitus which sound like crickets without Buddy Holly.

I have no problem hearing people only if they enunciate. They don't have to speak loudly, just clearly. I hear them better if I can see their lips move.

I had very little problem when I was in my 20's working in surgery. The surgeons also used finger symbols for instruments, which helped.

One of the first pre-reqs I took for my RN in the '80's was a sign language course in ASL . That really helped with hearing-impaired patients.

There's a great classic rock radio station in the next town over that has a hearing aid commercial. Since JKL gave me permission in the Breakroom's Ars Gratia Artis forum to post images on her threads, I would like to share a fitting comic. I had fun with the hearing aid commercial in my Blank Comic Book and some of the narrative is verbatim from the commercial:

 

[Wuzzie]

We have a rule with my mom. If we ask her a question she gets 4 minutes to answer. While she has some mild dementia mostly it’s because she has difficulty hearing us and she needs time to figure out what we said. If we rush her answers it makes her anxious and more likely to say something off the wall. 

[Davey Do]

The ability to laugh at oneself and our impairments is a mentally healthy method of dealing with difficult situations.

For example, I was assessing a patient in a wheelchair who had recently received trauma resulting in his paraplegia. I asked him how tall he was.

"Right now," he replied, "I'm about 4 1/2 feet tall".

Being somewhat hearing impaired, I use close caption while watching, for example, DVDs. My medical nurse Belinda and I were watching an episode of NCIS and, at one point, had my back to the TV and didn't hear what was said. Our conversation went like this:

Me: Did she say, "I'm licking the corn"?
Belinda: No! She said, "I'M LEAVING THE CORPS"!

Sometimes it seems that medical transcriptionists are hearing impaired. I made this meme from a past story of what an allnurses' member told of something a doctor dictated and what the transcriptionist heard:

 

 

[Kitiger, RN]

6 hours ago, Davey Do said:

@Kitiger I like to hear some background information on this interesting notebook journal.

I wrote that a while back. My Mom was hard of hearing all my life, and as we got older, her hearing got worse. At a restaurant, I automatically put her with her back to the window. I touched her before speaking. When she didn't understand me, I repeated once, and then rephrased. 

Now, I am hard of hearing. It's a "mild to moderate hearing loss." What that means is that I usually know when someone is talking to me. I just don't necessarily understand what she is saying. High tones are the hardest. As we know, high tones are the first to go. What a lot of people don't know is that "high tones" doesn't only apply to children and women with soft voices.

Most vowels are low tones, while most consonants are high tone. (Think 'clicking' sounds.) When you say "hat, cat, sat, stat" . . . what I here is "at, at, at, at." Really, I don't heat the "t", either, but my computer brain puts it in. And I'm left trying to run "at" through my computer brain while the speaker keeps speaking. 

That last comment in my journal, (Once you leave the room, the patient will turn to their visitor and say, "What did she say?) That last comment was Mom's song to me. Frequently.

[Davey Do]

What a wonderful journal! Interesting, well written, with good penmanship! The act of handwriting- versus typing- is such a therapeutic way in which to express our thoughts and feelings!

You gave some really great pointers, Kitiger, both in your journal and post. Exquisite.

I found I had a way of speaking to patients due to their altered mental status and/or hearing loss. I  would  speak ra-ther  slow-ly  and e-nun-ci-ate  each word. 

Once, after three 12 hour shifts, I ran into a buddy who asked, "Why  are  you talk-ing  to  me  like  that?" "Oops! I was on my geriatric psych nurse mode!

Something else I heard about but don't know much of is background noises. One morning after a MN shift, I was chatting with a nursing instructor. Two students were behind me talking and I had to say, "Excuse me, I can't hear what you're saying because of the other conversation".

The nursing instructor told me something along the lines of, "As we get older, it's more difficult to distinguish between sounds close and far away".

I also have difficulty with high nasally voices, as they're like scraping my fingernails across a chalk board.

Thanks for sharing the journal's background and for all the info, Kitiger!

 

[Kitiger, RN]

On 3/26/2022 at 6:56 PM, JKL33 said:

We do not need to raise our volume and use a higher pitched voice when dealing with elderly confused patients. All it does is make things worse. Their brains are not going to suddenly understand if only we speak louder and louder and higher and higher. However, what they perceive as our "agitation" (louder and higher voices) does increase their agitation.

I have had very good response to getting close and speaking in a lower, almost quiet but firm tone. It seems to have a calming, comforting effect. Using preferred names helps.

These are not our honeys, they aren't two years old, and their life isn't a carnival ride.

Earlier, I keyed in on elderly who are hard of hearing. I see now that you were mainly talking about the tendency to treat the elderly as though they were children. "These are not our honeys, they aren't two years old, and their life isn't a carnival ride."

You are so right.

An elderly person may need more physical help, just as a child might. But the elderly person also has a lifetime of experiences, relationships, knowledge, and wisdom. We do well to respect that.

[Kitiger, RN]

11 hours ago, Davey Do said:

Something else I heard about but don't know much of is background noises. One morning after a MN shift, I was chatting with a nursing instructor. Two students were behind me talking and I had to say, "Excuse me, I can't hear what you're saying because of the other conversation".

The nursing instructor told me something along the lines of, "As we get older, it's more difficult to distinguish between sounds close and far away".

When I have to decode two ongoing conversations, the problem is multiplied. Not only do I not hear all parts of each word, the two conversations also intermingle.

"My son oose the oo-dest thoughter."

 

("My son did the cutest thing." And, "Use three cups of water.")

[No Stars In My Eyes]

For years I have wanted to clutch healthcare workers and wait-persons by their collars and say "DON"T PEEP when you talk! Speak in a low tone from your diaphragm, instead of from the back of your throat!" Most of the time I never had problems with my patients hearing me, but when someone was talking in a too-sweet, high-pitched, little-girl-ish tone to one of them and they said "What? WHAT?"; I was the 'interpreter'.

This speech problem -- not someone's HEARING problem -- has irked me forever, and it seems especially prevalent in the South (no offense, but it is true.)