When Your Patients Aren’t Your Peers: Communicating with Older Adults as a New Physical Therapist

Jun 24, 2020
11 min read
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Good communication eases your patient’s worry, building trust in the first moments of a visit. Poor communication completely stalls your ability to deliver good care. You’ll spend valuable time- over many visits- removing barriers you unintentionally erected.

PT older adults

The exams are behind you - time for new challenges

You did all the right things. Aced your clinicals, earned your DPT, passed the boards. You got a state license and landed a job. You cleared academic and bureaucratic hurdles. Moved across the finish line from graduate student to practicing medical professional. That’s hard, I’ve been there, well done.

Besides those anticipated challenges, you faced a tumultuous job market. Healthcare organizations grappled with Medicare’s payment model changes in January 2020. The universe added Covid-19 to keep it interesting. Now you’re treating patients. There's no clinical instructor safety net. And you've discovered this is hard too.

You're synthesizing textbook knowledge with limited clinical experience to deliver high quality healthcare. That knowledge and skill set felt solid during practical exams, and even during the NPTE. But when an 80 year old is in front of you, in pain, your words matter as much- if not more than- your hands.

Good communication is key- and hard

Good communication eases your patient’s worry, building trust in the first moments of a visit. Poor communication completely stalls your ability to deliver good care. You’ll spend valuable time- over many visits- removing barriers you unintentionally erected.

This is so frustrating, and we’ve all been there. You chose to work in this field because you care. I’m confident there’s a story you can tell of your empathy for suffering humans. You’ve felt it, you’ve seen it, you want to ease it. So mis-stepping and creating more of it with your words hurts- and it feels like failure.

Think about a time you saw a healthcare provider for yourself and it wasn't helpful. You left fuming, feeling unheard and misunderstood. You carried out a problem that wasn’t addressed, felt it double in weight in the process. Sit with this memory and feel those emotions.

Now look down and see that you’re wearing the badge. You have a few letters after your name, you hold the power that can listen- or not. Acknowledge that you can create the same frustrating experience for your patients. Or you can connect with them.

Plan now, struggle less

I didn’t choose physical therapy as a career to work with aging, sick people. Sports injuries led me to PT. I'm the one who flipped through clinical rotation options dodging all signs of body fluids or old age. I landed a spot at a spinal cord injury center and thought it would be like the movie Murderball.

Despite my best efforts to only work with athletic paraplegics, I spent four weeks with individuals over 70. Was it a smooth learning experience? No. But I started learning how communication with older generations doesn’t have to be difficult or full of friction. It can be challenging, but that’s ok. Approach challenges with strategic communication and you’ll create space for growth- in you and your practice.

Fifteen years after my rocky start, I’m a seasoned geriatric PT. I wish I could give my younger self a few tips. They'd have nothing to do with tests and measures, or passing the NPTE.

Study generations- your own and your patients’- as a starting place. Embrace thoughtful intergenerational communication habits early in your career to struggle less. We know how to do this with our peers, our generation. But your patients often aren’t your peers, especially in geriatric practice.

Generations- understanding why and how

Let’s look at the generational grouping of you and your patients. And why the gap between you might be smaller than you think.

Social scientists group us into generations -age cohorts- spanning an average of 15-20 years. These groupings are useful for studying behaviors and values of individuals at specific stages of their lives. And of individuals who were born around a specific time, shaped by similar events.1

Instagram memes can make you think all humans are Millennials or Baby Boomers. But the first five generations listed below are active in today’s workplace.2 And the final three will comprise your geriatric patient population.

Here are the living generations as defined by the Pew Research Center. The generation names, their representation in our PT world, and a few major influences on each are below:

  • Generation Z. Born from 1997-present. 0-23 years old.These are today’s children, college students, and first year PT students. They are digital natives with an entrepreneurial spirit. They're influenced by childhood in a post 9/11 world, the Great Recession, and multiple wars.2
  • Millennials: Born from 1981 to 1996. 24-39 years old. Millennials today range from PT students to healthcare organization leaders. They are the largest generation currently represented in the US workforce.4 Known for prioritizing diversity and a work-life balance. They grew up influenced by the internet, Columbine, and 9/11.
  • Generation X: Born from 1965-1980. 40-55 years old.The veterans of the PT workforce, a strong presence in leadership roles and academic positions. Shaped by events including the AIDs epidemic and the Berlin Wall.
  • Baby Boomers: Born from 1946-1964. 56-74 years old. Like the older contingent of Gen Xers, these are our later career PTs and recent retirees. Baby Boomers comprise a growing proportion of a geriatric PT caseload. They often present with rehab needs following elective surgeries or due to chronic health conditions. Characterized as company loyalists with workaholic tendencies, Boomers came of age during the Vietnam War and the Civil Rights Movement.
  • Silent Generation or Traditionalists: Born from 1928-1945, 74-92 years old. They will comprise the majority of a geriatric PT caseload currently. Known for loyalty and dependability, shaped by World War II and the Great Depression.
  • Greatest Generation: Born before 1928, 93+ years old. These are our oldest living patients and loved ones. They weathered the Great Depression, fought in the world wars abroad, and supported the war effort from home.1-3

Generational identity- what’s yours?

“Generations are a lens through which to understand societal change, rather than a label with which to oversimplify differences between groups.”3

Do you resonate with the description of your generation? Identify with it, embrace it as being your generation? If not, you aren’t alone. Less than half- 40%- of the Millennial generation consider themselves Millennials. Generation X-ers positively associate more with their generation at 58%. Baby boomers top the chart with 79% identifying with their generation. Only 18% of the Silents consider themselves correctly grouped.

Older and younger members of each generation may identify with the preceding or following generation rather than their own. Some don’t feel the grouping applies to them at all. It’s no wonder, with the criticism that gets hurled at and between generations. We misuse a research tool, appropriating broad descriptors to critique individuals. And in the process we create misconceptions that lead to discord.4

Understanding generational differences in attitudes, and what can shape them, lays a foundation for effective communication. Scientists study attitude variation between generations by looking at:

  • Life cycle effects (or the age effect). Political engagement is a good example. It consistently increases with age.
  • Period effects. These are social or political events that impact an entire population, with lasting effects. Covid-19 is an excellent example.
  • Cohort effects. These are singular events occurring during formative years. Experience of the Great Depression provides an example- Gen X and Millennial members didn’t experience this and don’t have attitudes shaped by it.1

Patient communication- establish the scaffolding

High quality PT practice is delivery of solid clinical skills plus impeccable communication. Combine them to accomplish the following:

  • Connection- Building foundational rapport, essential before moving forward.
  • Treatment- Delivering skilled care, only possible if you established connection.

Motivation- Inspiring patients to adhere to your instruction, necessary for results.

You have the clinical skills. And you probably have excellent communication tools. Let’s look at ways to hone your communication with patients of older generations to help you connect, treat, and motivate. Here are three strategies you can put in place today.

  1. Identify your patient’s generation.

Does this tell you their personality? Their views and motivators? No, of course not. But it may tell you that in their formative years they faced deprivation and financial uncertainty. Or they went to war. Maybe participated in civil unrest. Acknowledging their life shaping experiences can cultivate compassion. They become a person, not just a patient. Think about your own generational influences too. You may find similarities in the types of experiences you’ve each encountered. This can help you see them more as a human, less as their diagnosis.

Use yes-and.

Have you heard “yes-and” used in comedy? Comedians use it in improv, and you can incorporate it into patient communication. I’d like to take back all the “yes-buts” I used early in my career. They get you nowhere. You may be right, and you expressed why, but your patient isn’t listening anymore. Your session is over. Say “yes” so they feel heard. Follow with “and (insert educational, skilled information here)”. Win-win.

When someone has lived through seven or eight decades, and they know what’s helping them, agree with them. The placebo effect is real, and so are those great exercises you’ve taught them. The two don’t need to compete.

For me, these conversations go like this. “My back feels better” or more often “I haven’t fallen” . It's followed by “I know it's because of (pick one: crystals, herbs, favorite pet’s ashes, favorite husband's ashes, good weather, bad weather)”. You get the picture. Sometimes cringeworthy, often humorous. Yes-and is a tool to build connection, and move forward with treatment. You'll remember these moments with a smile.

  1. Appreciate how motivation changes with age.

When I’m asked why I enjoy what I do, my first answer is always the same. People who have lived life full of good years and rough ones know what matters the most to them. And their goals for PT reflect that. Walk the dog, take care of my spouse, be present at a wedding. It’s contagious being near such focused energy, such clarity for existence.

Socioemotional selectivity theory explains that as our perception of remaining time decreases, we shift our focus more toward close relationships. And more on the present moment. We seek out knowledge acquisition less, because the time we have available to us to use it is minimal.5

Can this knowledge impact your communication, your treatment style, and then your outcomes? Reflect on- and ask about- what matters the most to your patient. Reconsider the extent of knowledge sharing that is essential. And create a treatment program that incorporates what is meaningful to them.

Could effective communication with older generations be more about finding similarities than differences? More about consensus than disagreement? I hope so.

References:

The Whys and Hows of Generations Research. People-press.org.

https://www.people-press.org/2015/09/03/the-whys-and-hows-of-generations-research/ Published September 3, 2015. Accessed March 30, 2020.

Generational Differences in the Workplace. Purdueglobal.edu https://www.purdueglobal.edu/education-partnerships/generational-workforce-differences-infographic/ Accessed March 31, 2020.

Dimock M. Defining generations: Where Millennials end and Generation Z begins. Pewresearch.org. https://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/ Published January 17, 2019. Accessed March 30, 2020.

Most Millennials Resist the ‘Millennial’ Label. People-press.org. https://www.people-press.org/2015/09/03/most-millennials-resist-the-millennial-label/ Published September 3, 2015. Accessed March 30, 2020.

Carstensen LL, Isaacowitz DM, Charles, ST. Taking time seriously. A theory of socioemotional selectivity. Am Psychol. 1999 Mar; 54(3): 165-181

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About Caitlin Woodyard PT, DPT, GCS

Caitlin graduated from Duke University and is a home health and
hospice PT in the Pacific Northwest.


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