The Einstein Geriatrics Fellowship Core Curriculum

The Einstein Geriatrics Fellowship Core Curriculum •A 20 part lecture series designed for first year geriatrics fellows •Covers the ACGME content areas for fellowship training

Communication and Interviewing Skills with the Geriatric Patient Debra Greenberg, PhD

Objectives • To review goals in interviewing older persons and their caregivers • To review interviewing skills that will facilitate interactions with an older adult

Introductions • How do you introduce self?

• How do you address the older adult?

Conditions for the Geriatric Interview • Privacy • Environment of the room • Ability to see and hear provider • Compensation for patients’ disabilities

Modification for the Hearing Impaired Person • Use slow, clear speech • Allow adequate time for the patient to respond • Assure adequate lighting to allow for simultaneous lip reading • Maintain visual contact "face-to-face" to allow for lip reading • High-pitched voices should be deepened Most hearing loss is high frequency

Modifications in Interviewing With an Interpreter • Interpreter vs. Translator • Interpreter should be non- family members whenever possible • The patient's permission should be obtained prior to using a family member/friend as a translator

Modification in Interviewing People with Dementia • Families and significant others should be interviewed separately whenever possible • When possible older person’s permission should be obtained prior to separate interviews

Geriatric Social History • Is there social support?

Geriatric Social History • Personal History • Place of origin • Level of education • Marital status and history • Children/grandchildren and their health • Religious background • Habits: Alcohol, Cigarettes, Exercise

Geriatric Social History Informal Support • Who do they live with? • Contact with family and friends Type/frequency of interaction -who visits?

• Activities/hobbies - where do they go?

• Significant losses: function abilities, lifestyle, significant others • Plans for the future

Geriatric Social History Formal Support • Current Financial Status • Insurance • Formal Supports – eg. home care agency • Involved Agencies

“The 3 P s” • P resenting issue • P recipitating issue • P erpetuating issue

Determine the Purpose of the Contact •

Presenting Issue

• Why is the person here? What do they want?

Routine health care New problem/new provider • A problem for the patient/ caregiver

Purpose of the Contact

Precipitating Issues

• What is their previous experience with health care? With other MD’s? • How have they negotiated the health care system in the past?

Purpose of the Contact •

Perpetuating issues

• What makes health practices and attitudes hard to change? • What do we want?

Style of Inquiry • Repeat or rephrase • Observe themes Shifts in topics, evasiveness • Follow-up on inconsistencies • Tolerate silence

Style of inquiry • Questions Open ended – “Who do you live with?” Multiple choices “ Which of these do you want to focus on today?” Closed ended – “How many drinks do you have a day?”

Style of Inquiry • Listening • Observing - hidden or unspoken clues • Interrupting • Using silence • Double tasking, documenting while talking or listening ?

Challenges • Conflict • Losing one’s temper • Dual interview • Door knob problems

What do our Patients Want?

• To establish and maintain relationships with medical staff • To maintain a sense of control over their bodies and lives • To involve important people in their lives in their health care or to defer to others or to maintain privacy and independence from others • To have their needs and fears heard • To have information about their health including prognosis, as requested

Is there a Joint Treatment Plan?

Resources and Limitations in Planning

• Impact of past or present roles, education, employment, and values, health care beliefs • Relationships and current support systems • Reaction coping style • Resources financial, insurance, short and long term plans

Reflection and Review of the Interview • Form an impression from verbal and non verbal clues of patient’s health care goals • Were the patient’s needs understood?

• Were you understood?

• Was the reason for the visit completed? • Left open? Further negotiation needed with the patient?

What is a good patient interaction?

• Balance the need for a good quality of care and a good quality of life • Determine patient preference, diagnosis and treatment options • Engage in joint treatment plan • Accomplish with empathy for the challenges of aging and our common humanity