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Massage Today
September, 2008, Vol. 08, Issue 09

Communicating With Elders Who Have Special Needs

By Ann Catlin, LMT, NCTMB, OTR

Do you serve older adults in your practice? Regardless of whether you see your elder clients in your office, a long-term care facility or at their home, being able to communicate effectively can increase your confidence and make the experience more enjoyable for both of you.

Communication is our way of exchanging information, but more importantly, it's our way to build relationships. Making an effort to learn how to relate to our elder clients who have special needs deepens our ability to connect with them.

Whether you are serving a robust, active older adult or an elder who suffers from a debilitating disease, you need to be sensitive to the conditions that impact their ability to communicate effectively. It's common to feel uncomfortable with how to handle a situation when an elder's condition impacts their ability to communicate. There are two things you can do that will help. First, become familiar with the obstacles affecting communication and learn a few ways of getting around them. It still is possible to communicate effectively by learning some simple skills. You will save yourself and your client frustration and embarrassment, and your experience will be a much more positive one.

Cultural Attitudes

We live in a culture that undervalues our elders. We have all most likely been affected by the prevalent social attitudes, beliefs and assumptions about older adults. Our own belief system affects our understanding of the elder's perspective. For example, our society seems to believe elders are no longer productive and no longer contribute to society. Based on this belief, we might assume the elder's goals or sense of purpose in life are somewhere in the past and we might overlook an inherent part of who this person is as a human being.

How to help:

  • Challenge your own "cultural wiring" and avoid stereotyping.
  • Open your mind and heart to accept an elder as a whole human being no matter what the age or condition of the body or mind.

Sensory Changes

Hearing loss: There are several reasons for hearing loss, including genetic factors, repeated exposure to loud noise, viruses or brain damage from a stroke or tumors. Many older adults gradually lose their hearing.

How to help:

  • Face the person directly and be on the same level.
  • Reduce background noises.
  • If you have to speak louder, try lowering the tone of your voice. Lower tones are more easily heard.
  • Use short sentences.
  • If the person uses a hearing aide, be sure they are wearing it.
  • Use nonverbal communication-like gestures, facial expression and touch.

Effects of Disease or Disability

Many elders suffer from chronic or debilitating conditions that impact communication in unique ways.

Lung disease: Emphysema, asthma and chronic obstructive pulmonary disease (COPD) all decrease lung capacity, resulting in shortness of breath. People with severe lung disease might avoid conversation and become withdrawn when the effort to speak makes them "winded."

How to help:

  • Don't expect them to talk to you when doing any other physical activity like walking or getting dressed or eating.
  • Allow plenty of time. Don't rush.
  • Try placing a pillow on the person's lap to support their upper body or sit at a table so they have a surface on which to lean forward. By supporting the upper body, it conserves energy that can be used for communication.
  • Gentle massage of the upper back and chest can ease muscle tension associated with shortness of breath.

Brain injury and disease: Stroke, Parkinson's disease and traumatic injury can all affect the ability to communicate because of impaired motor skills associated with speech, as well as impaired function of the speech and language centers in the brain.

Dysarthria is the term used to refer to slurred speech resulting from the inability to coordinate the muscles used in speaking. This makes speech hard to understand.

How to help:

  • Be patient and respectful.
  • Ask simple yes/no questions.
  • Ask them to point or use gestures to help get their message across.
  • Ask the person to write it down.
  • Give permission to just be quiet and enjoy receiving your touch.

Aphasia is a complex communication disorder that affects the person's ability to process language. The most common cause of aphasia is stroke. There are two kinds of aphasia: expressive and receptive. The person with expressive aphasia has difficulty finding the right words or forming thoughts into speech. Receptive aphasia is the inability to understand spoken language.

How to help:

  • Check with other caregivers or family members to find out which communication methods have been successful and then use the same methods.
  • Avoid finishing the person's sentences for them.
  • Decrease any competing background noise.
  • Try alternate forms of communicating such as writing or drawing.
  • Speak slowly and allow the person time to respond.
  • Talk to the person like an adult, but use simple short sentences.

Oral health: Elders sometimes have a difficult time maintaining healthy teeth and gums. Some issues that can arise include poor-fitting dentures (which might not be used at all); failure to be vigilant about daily cleaning; periodontal disease; or dry mouth from medication side-effects. Clearly, there is a link between any condition of the mouth that causes discomfort and verbal communication. I once knew a woman in a skilled-nursing facility whose speech was very slurred and extremely hard to understand because she had no teeth. After seeing her several times to give her a massage, I discovered she had dentures she kept in a drawer. She just needed a reminder to put them in.

How to help:

  • If the elder wears dentures, be sure they are using them.
  • If the dentures fit poorly or cause pain, pass this information on to the family or the nurse so it can be addressed.
  • Offer a sip of water, or a mint or lemon drop for dry mouth.

When you feel more confident with your ability to handle communication challenges, you will be more at ease to shift your focus away from the physical condition to what is even more important - the well-being of the elder you are serving at the moment. You will be freer to simply allow yourself to be present and connect with the elder as a human being - a form of communication that speaks louder than words ever can.

"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around." - Leo Buscaglia


  • Dreher B. Communication Skills for Working with Elders. New York: Springer Publishing Company, 2001.
  • Solie D. How to Say it to Seniors: Closing the Communication Gap with Our Elders. New York: Prentice Hall Press, 2004.

Click here for previous articles by Ann Catlin, LMT, NCTMB, OTR.


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