We'd like to be better at working with older adults.

November 2, 2011 9:22 AM

I work in a research lab that is transitioning from working with young adult populations to working with 60 year old and up adults. Most people in the lab who don't have experience with older adults (myself included) are finding the transition frustrating and difficult at times. Can you recommend some resources to help us work better with older adults?

I'm really looking for any information you can provide at this point, but I'm not really looking for very specific anecdotes. Books, articles, papers, websites, anything! Even your personal experience working with seniors in a medical or research field would be helpful. As it stands now, I think we are doing a "good" job, but I think we could be a lot better and saner at the end of the day. If it matters, we are doing psych (memory) research, with little to risk to the patient/participant.

Thanks in advance!

posted by two lights above the sea to Human Relations (14 answers total)

You haven't explained what's difficult or frustrating.
posted by shoesietart at 9:32 AM on November 2, 2011 [2 favorites]

From my clinical and research experience working with both populations:
* Allow more time than you would expect
* Have written instructions as well as verbal instructions
* Only ask one question at a time - we all tend to get overexcited and ask several questions in a row without waiting for the person to answer. This tends to fluster some people.
* Allow more practice trials than you might for students
* If you are using computers, bear in mind that simply using a computer may make them feel anxious or incompetent, so you need to allow a lot of supported practice if you don't want to affect your results
* Allow more silences and explicit requests for them to ask questions or share concerns. Sometimes older people aren't as pushy as students and will quietly worry/get it wrong instead
* Try to keep the conversation on-topic without rudely cutting them off. This can be quite a skill.

Of course these are all generalisations and I've worked with plenty of bossy, on the ball, technologically-accomplished 85 year olds, but on average the above advice holds true.
posted by kadia_a at 10:00 AM on November 2, 2011 [2 favorites]

I do not work with older adults, but I have worked in labs and social services for a long time.

1) You're working in a lab. It's probably at a university or a hospital. Go to the library at your university or hospital (or a university affiliated with the hospital) and do a search for "working with older adults", "elder practice" etc. Find a book that seems relevant to the type of work you do with your elders and attack it.

2) Talk to your supervisor if there are possibilities for taking a class on working with older adults and having the lab foot the bill.

3) Find a faculty member or another lab PI at your university or one near by who works with elderly, email them to ask if you could come for an observation day or just talk to someone in that lab about their procedures.

Basically, you are a researcher - research! Good luck, and it will get better as you guys accumulate more experience. Short hand - be attentive, be respectful, don't assume frailty.
posted by Shusha at 10:01 AM on November 2, 2011 [1 favorite]

Best answer: Oh, and you might want to record yourself doing a session and listen back to catch all the patronising stuff you might be saying.

"Now let's have a look at this one"
"I think we're getting a bit tired"

For a lot of people this slips out without thinking about it. It might take you a while to stop using this sort of 'elder speak' entirely but it will pay off in terms of better rapport if you can.

Other stuff I thought of:
* Expect higher levels of fatigue - they may have multiple health conditions that cause tiredness, or where the medication causes tiredness.
* Expect sensory difficulties. Explicitly ask if they wear glasses or hearing aids. Have your standard invitation letter prompt them to bring them. Know how to replace a hearing aid battery. Get happy with cleaning glasses.
posted by kadia_a at 10:04 AM on November 2, 2011

Best answer: I'm coming at this from cancer research, where we do a lot of interventional trials that include patients over 60. It can be difficult to find literature about this population because everyone is moving away from the "elderly" word. :) Some just call them "older populations", so that's another thing to search for (but still hard to find general advice about how to ensure their participation in clinical trials).

In my own experience, I find older populations rely on their doctor as the authoritative figure. So if you're calling these folks up out of nowhere, you probably won't get a good response. But if you can approach folks based on a doctor's introduction or another authority figure, that's better. Try to have a doctor available (preferably one the patient is familiar with) that can answer questions and give advice. You can still use your authority as the trial liaison, but I think it's always a good plan to say "Dr. So-and-so is always available to take your questions." and continually reference the doctor so the patient feels that they're being followed by someone they view as an authority figure.

The common perception of this population is that they are old-fashioned and don't want to try anything new, and are not tech- or internet-savvy. This isn't necessarily true. Give your patients the opportunity to tell you what their level of education and tech-knowledge is. Asking rather than assuming (or abstracting based on the way they look or talk) is the way to go here.

It is probably the case that these folks have comorbidities or other conditions besides the one you're researching, so be aware of those, and that they may interfere with your patients' abilities. If you are doing an intervention-type trial, giving the patient a medication list to carry around is really beneficial.

And yes, everything kadia_a said. More time and preparation is key.

I have some conference slides for a session on enrolling patients over age 65 in clinical trials that might be useful to you. I'll MeMail you for where to send it.
posted by sarahnade at 10:09 AM on November 2, 2011

Best answer: There's some good advice already here that I don't have much to add to, but one small tip that has made a meaningful difference in our clinic is we keep a couple pairs of generic reading glasses handy. They might no be perfect, but have certainly allowed some patients to sign an informed consent form or complete a survey who otherwise would not be able to or would need to have it read to them (time consuming and potentially embarrassing).

Don't forget to sanitize between uses.
posted by Wretch729 at 10:15 AM on November 2, 2011

Response by poster: You haven't explained what's difficult or frustrating.

Technically, I have. However, I can't give you specifics because that would most likely cross some ethical lines, but if you aren't sure what would be difficult/frustrating about transitioning from college-age students to seniors citizens, I'm going to guess that you aren't qualified to answer the question.

Have you thought about talking to your parents?

I was pretty clear that I am looking for very specific advice that pertains to the medical/research field, NOT grandmother/parent anecdotes.


Some other info that might help: We do two different screening for the older adults, a phone interview which screens them based on medical and personal history, and a practice session to ensure that they aren't confused by our experiment and equipment and that they actually like doing it. We do use EEG, and they do a total of 8 in-lab EEG sessions.

Thanks so far!
posted by two lights above the sea at 10:16 AM on November 2, 2011

Best answer: I haven't worked with older people in a clinical setting, but I did spend a good part of this summer administering surveys to older people. I found that the most important thing was to slow down the rate of my speech. I tend to talk quickly, but taking the time to speak slowly and clearly (and often more loudly than normal, for people with hearing trouble), made a big difference and kept both me and the subject from getting frustrated from having to repeat things multiple times.

I don't know if this applies to what you're doing, but I was using a standard survey with some questions worded in a way which people often found confusing. I learned how to give it in a more conversational way that didn't force the subject to conform to the pace and logic of the survey instrument.
posted by MadamM at 10:30 AM on November 2, 2011

Also, patience. Rather than focusing on "ahh I need to get this person in and out in half an hour so I can get the next person in" I focused on following the individual pace of the person I was talking to, and enjoying the meandering anecdote they were telling me, or whatever.

Don't assume anything about the person's capabilities based on their age, or even think "Oh, a nice old lady!" There are plenty of not-nice old ladies, and plenty of very old people who are more functional and sharp than people 30 years younger than them.
posted by MadamM at 10:34 AM on November 2, 2011

Ah, I used to run fMRI studies with older adults and cognitive/language tests outside the scanner.

So more specifically than I said above:
* I used to get them to turn up 45-60 minutes for their scan slots and always have two researchers so one would be sorting out the previous participant and the other would be going through the informed consent paperwork slowly and carefully and doing any pre-testing necessary. With students they came 20 mins early.
* Everything was bigger print with fewer words on the screen (primarily for sensory reasons)
* If I was doing a screening questionnaire I would give lots of concrete examples derived from stuff people tended to forget: "So do you take any medication? No? That includes blood pressure tablets, calcium tablets, thyroid medication, statins . . ." This leads to a lot less wasted effort
(Note - did the same thing with students but the examples were different: "Do you have any piercings? No? Nipples? Anything more intimate?" - I once got a guy going as far as the scanner door before confessing that he actually had a penile piercing he had been too embarrassed to admit to and it had only just struck him that this was going to end badly . . .)
* I would say my cognitive testing took about twice as long with my older adults. An initial interview might be more than twice as long if you have to take any kind of medical history.
posted by kadia_a at 11:48 AM on November 2, 2011

Best answer: My wife once worked in a memory lab that specialized in research on older adults (and her only experience in the past was with college students) so I asked her for tips on how the transition was, she sent the following:

It is different than talking to your gramma and her friends, those people know you.

For one thing, they might think about hiring an older adult to do the scheduling for older adults. Realize that they may move slower, but that does not mean they are not still cognitively sharp. Be respectful. sometimes this is hard for younger students to remember because many have not been raised to say Mr. Jones or Mrs (Ms) Parker or sir or mame . Do not call them by their first name unless they have given you the permission to do so. I think that may be the most important. Also, be cognizant of your language and speech. If they are talking to a 20 year old who says like and ya know all the time, they may not respect that student very much and choose not to continue in the lab. Don't rush them. They are giving you their time, act accordingly. Do not be afraid to talk to the older adults, you would be amazed at some of their stories and how genuinely funny they are.

I like the idea about hiring an older person to greet/schedule, that's what their lab did so the subjects' first encounter was with another older individual, which seemed to make them comfortable.
posted by mathowie at 12:44 PM on November 2, 2011

I work in a lab that does behavioral and neuroimaging experiments on memory in older adults. However, I'm not sure what exactly is frustrating to you, so I might also not be qualified to answer the question. Just in case it's helpful anyway, here are some things that we do differently when we have an older adult (OA) participant coming in to the lab:

During our phone screening, we have the person who is calling sit in a separate, quiet room. We don't have people with accent do phone screenings. We set a lot of time aside for the medical screening.

We explain who we are, our lab, why we're calling, and what's about to happen ("I'm going to ask you some questions about your health. Is that okay?") slowly and clearly.

I wear more conservative clothing on days I run OAs.

Since most of them aren't doing this for the money, I explain very generally how the research is helpful. Explaining what we're looking at is also a tactic to alleviate their concerns about "doing badly" on the experiments. ("My memory has gotten so much worse, I couldn't remember anything!" "I'm sure you did fine -- the most interesting part for us is actually what part of your brain is doing the remembering.")

We schedule them enough in advance such that if they do not have an email address, there is enough time for us to mail them directions to our lab.

Our parking lot requires calling via a code to get in, so we have a research assistant who knows what car they participant is driving (we ask when we schedule them) waiting at the gate ten minutes before each appointment. They call the lab from the gate and show the participant to their parking spot, then lead them up to the lab.

We always use the elevator when showing OAs up to the lab.

We ask them if they need anything to drink and point out the restroom on our way to the lab. During natural pauses in the experiment we ask them if they need a break.

If there aren't natural pauses in the experiment, we add some. Often, experiments need to be timed a little slower or have instruction reminders added in between tasks to have OA performance be comparable to young adult performance.

We keep notes in our database about participants we've had in before -- from their comfort levels ("had trouble looking at screen for 1 hr, half hour was fine") to their attitude ("became frustrated quickly") to their family ("has husband named Larry"). This helps us figure out who to bring in for what kinds of experiments, and to be friendly in conversation.
posted by Pwoink at 2:20 PM on November 2, 2011 [2 favorites]

Response by poster: I can't be that specific about this, but just to be clear (and hopefully stop people from making insulting snarky comments!), the frustrations stem from the transition to the new experiment, not from the older adults themselves. Right now we are working with both populations, but we will soon be working only with the older adults. Older adults are a special population, and college-age participants are probably the most laid-back, low-maintenance population ever. So when I said to the first commenter that s/he may not be "qualified to answer the question", I was implying that s/he may not have worked with these specific populations and may not understand why I am asking for help. Clearly, if you have been working with older adults from the start of your research career, you were most likely trained by someone who also has experience working with older adults and might not understand why we are finding this transition harder than we expected. We are in a very different situation, hence the reason I am asking this question.

Thanks for the wonderful (and patient) answers so far!
posted by two lights above the sea at 2:52 PM on November 2, 2011

Don't expect them to stand for prolonged periods. Lots of sore knees out there. For a lot of people on the verge of or already needing hearing aids but don't have them will only hear you if you're facing them.

(not a researcher but I have parents)
posted by doctor_negative at 12:03 AM on November 3, 2011