Provide Written Materials

To accommodate the cognitive changes associated with aging, it is useful to provide written materials. Written materials help reinforce learning, prompt recall of information, and can be shared with caregivers. These handouts or pamphlets are most effective when used as a supplementary tool to reinforce verbal instructions. Encourage patients to leave handouts in a location they frequently visit in their home, like by the phone, so that it can be referred to frequently. To verify comprehension, ask patients to read a portion of the material and ask questions about what they read. Below are special considerations when developing written materials for older populations:

• No more than 3-5 key messages reinforcing the major points of the teaching
• Repeat main points multiple times
• Text should be easy to read, using large print with a high contrast between print color and paper
• Essential points should be bulleted or in list form
• Be direct and specific
• Use active voice and plain language

For further considerations, visit the CMS Toolkit for Making Written Material Clear and Effective for Older Readers.

Limit Distractions

Cognitive aging reduces older adults’ ability to learn, remember, and solve problems. These changes impact the ability to focus, so you may find older patients getting more easily distracted, from both environmental factors and extraneous information. It is important, when possible, to reduce distractions to compensate for the cognitive aging and hearing loss that older adults experience. This includes limiting background noise and excluding irrelevant information.

Stick to 3-5 Main Points Per Session

Research shows older adults have a decreased capacity to process multiple chunks of information at a time. This population also learns new information at a slower rate because of declining fluid intelligence. To offset cognitive aging, short-term-memory loss, and limited endurance, keep teaching sessions short and focus on 3-5 main points. Each topic should be presented as a small chunk of information, allowing time after each point for demonstration or review. If complex instructions are required, they should be separated into multiple sessions to maximize recall.

Speak Slowly & Enunciate with a Low Pitch

More than 50% of older adults are affected by hearing loss or impairment. During appointments, face patients when speaking to them and sit on their level. Speak slowly and enunciate your words to ensure your patients can hear you. Talking slowly will also ensure older adults, who often learn at slower rates, can take in information, and commit it to memory. Focus on lowering your pitch, as the elderly can hear lower pitches more clearly. Pitch is not the same as loudness, so raising your voice is not necessary.

Use Plain Language

One of the best ways to ensure patients will follow your instructions is by simplifying health information and using familiar words. Avoid technical terms and medical jargon and use everyday language that patients are comfortable with. Rather than “renal,” say “kidney.” Instead of “hypertension,” how about “high blood pressure?” Providers should not assume patients will understand even the most basic medical terms.

Be Specific

To avoid uncertainty, offer specific directions. Rather than telling a patient to “drink more water,” tell them exactly how many ounces they need to be drinking in a day. Specific instructions related to time, order, duration, and frequency will increase the chances instructions are followed through with.

Include Support Systems

Involving a patient’s support system is an effective way to promote health literacy. Encourage older adults to invite family members or caregivers to attend and participate in appointments. These family members can listen to instructions and later clarify details that were misunderstood or overlooked by the patient.

Validate Understanding using Teach-back Technique

The teach-back method is a technique to verify that a patient has understood the health information conveyed to them. It involves asking a patient to repeat back in their own words or demonstrating what was just taught. Studies have shown that the teach-back method is an effective way to bridge the gap between patient-provider communication and comprehension. 

With effective patient-provider communication, patients are more likely to adhere to treatment, have better health outcomes, and express greater satisfaction with their treatment.