How To Talk With an Older Adult About Their Health

Starting the Health Conversation

Many older adults manage chronic conditions and medications, see multiple health professionals, make treatment decisions and plan for health changes. Discussing health issues will help you understand the older adult's needs and preferences, and figure out what you can do. Before you talk with the older adult, ask yourself:

• What are my specific concerns about the older adult's health, healthcare team or future plans?
• What have I seen or heard that makes me have these concerns?
• What don't I know? What assumptions might I be making?
• Am I trying to convince the older adult to do what I think is best? Am I open to other possibilities?

Set a small goal for your first conversation. For example, your goal could be to learn about the older adult's medications, or to ask about going to the older adult's next medical appointment. Good conversation starters include health-related facts, friends' or family members' experiences, or news stories. For example:

• "I read that most people haven't documented their end-of-life wishes. Have you done this or thought about it?"
• "It helps Grandpa to have Uncle Bob go with him to medical appointments. Would you like someone to go with you?"
• "Did you know Susan's pharmacist found that some of her medications were causing her problems? Have you had someone look at all the medications you take?"

Be honest about your reasons for wanting to discuss health topics with the older adult. Acknowledge that the older adult might see the situation differently. During the conversation, focus on understanding the older adult's point of view. Don't push for decisions or actions right away. Don't try to cover too much in your first discussion. Try to end on a positive note. If you can, agree on next steps, like having another conversation or writing down all the older adult's medications

Responding to Negative Reactions During the Health Conversation

Everyone wants to have good care and be healthy. However, sometimes health discussions can bring up strong emotions. Older adults might feel intimidated by health professionals, confused by medications or embarrassed to ask for help. Well-meaning questions about their health might sound like attacks on their judgment or abilities. Listen carefully to what the older adult says. Remember that what you're talking about probably affects the older adult's life every single day.

During difficult discussions, do your best to share your thoughts calmly and clearly, using phrases like, "I am concerned" or "My feelings are". Focus on what you can agree on and how you can work together to support the older adult's health. You and the older adult might have different ways of speaking or thinking about health topics. Health discussions can be difficult when:

• You disagree about whether there is a health problem, or what the problem is.
• You disagree about what's most important. For example, you might want to plan for end-of-life decisions, while the older adult is focused on lowering blood pressure.
• You disagree about what's a good solution.
• You use or hear words differently, so that you say and mean X, but the older adult hears Y.
• You have different communication or decision-making styles.
• You want different people included in health discussions, or have different interpretations of what health professionals said.
• How you respond to each other is shaped by family patterns or social roles.

If the older adult has a negative reaction, it can help to ask why. Try to understand the older adult's point of view. If the older adult doesn't want to discuss it, don't push it. You might need to agree to disagree on some things. It's usually better to drop the subject and discuss it again later. If you understand why the last conversation was difficult, you might be able to find a better way to approach the topic next time.

Keeping the Health Conversation Going

Your follow-up conversations can help you and the older adult work together on health tasks. Follow-up conversations can be good opportunities to:

• Share and discuss new information
• Weigh the pros and cons of different options
• Ask if the older adult's needs or feelings have changed
• Involve professionals, family or friends whose opinions you both value

If you and the older adult agree on next steps during your first conversation, it can be easy to start the next one. For example: "Did you talk with the pharmacist about getting pre-filled pill boxes?" or "Here's what I found out about medical alert buttons." If the first conversation didn't end with clear plans, there are other ways to start a follow-up discussion. You might want to:

• Build on a specific point from the previous discussion: "You said your doctor isn't the easiest person to talk to. Why is that?"
• Discuss a different health topic: "I know you want time to think about your end-of-life preferences, but do you know who you would want to make medical decisions, if you couldn't?"
• Try to understand the older adult's point of view: "You said you don't want to get a hearing aid. Why? Is it the cost?"
• Explain why this is important to you: "It may seem like I'm overreacting, but a medical emergency could happen anytime. I want to make sure you get the care you want if that happens."
• Highlight how health might affect other things: "You mentioned that you're having trouble seeing at night. Having your vision checked could help you with driving."
• Space out conversations: It's been a few weeks since we talked about having a pharmacist go over your medications. Do you still think that's a good idea?"

Encourage the older adult to share thoughts and opinions by asking open-ended questions like, "Are any health tasks difficult or unpleasant for you?" If you ask lots of "leading" questions - like "Wouldn't you feel better if I come to your next medical appointment?" - it can seem like you're just trying to get the older adult to go along with what you want.

Try to have smaller, more frequent conversations, rather than a few big ones. That gives you both time to consider options before you discuss health topics again.

Avoid launching into a health conversation every time you talk with the older adult. Try to balance the "serious" talk with time simply enjoying each other's company

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