The ABC of communicating with older, frail or cognitively impaired patients | from the Journal of American Geriatrics Society and Leicestershire Partnership NHS Trust

With face masks restricting how staff and patients express emotion and use non-verbal communication, older, frail or cognitively impaired patients experience extra difficulty because they:

• cannot read your lips and see facial expressions
• cannot hear you clearly, and
• may be confused and unsure.

Non-verbal communication can be an effective way to communicate with someone who has dementia. Often their ability to interpret and use body language is retained longer than the ability to communicate verbally.

Two doctors published an ABC mnemonic to remind staff how to have positive interactions with older patients. Subsequently, this was made into a poster by Leicestershire Partnership NHS Trust.

1. Attend Mindfully – prepare for the conversation and how you will support them. Reflect on how you normally communicate and the many asymmetries in communication with older patients so you are aware of the gestures and cues you normally rely on. Practice how, when wearing PPE you can communicate more clearly.
2. Behave Calmly – patients will feel more at ease and familiar with you if they feel they are being respected. Make sure to:
   a. Approach from the front
   b. Maintaining their personal space, drop down to their eye level
   c. Give them time to acclimatise to you, show them your badge
   d. Give them your full attention, try not to interrupt them and project a calm attitude
3. Communicate Clearly – find a quiet place and make sure they have any hearing aids or glasses they normally use. Communicate slowly using short sentences and gestures. Make sure they can hear you (raise your voice). Remember they cannot see your face clearly so express emotions rather than just smiling for example. Also, use of pictures or communication charts could be helpful.

Sources:
"Maintaining Our Humanity Through the Mask: Mindful Communication During COVID-19" by Mathias Schlögl MD, MPH and Christopher A. Jones MD, MBA. Journal of American Geriatrics Society, Letter to the Editor, 13 April 2020. https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16488

Leicestershire Partnership NHS trust has produced a poster for staff based on the article above: https://twitter.com/catatonia55/status/1253791035026747395