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
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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
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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
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Current Financial Status
Insurance
Formal Supports – eg. home care agency
Involved Agencies
“The 3Ps”
• Presenting issue
• Precipitating issue
• Perpetuating 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
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Listening
Observing - hidden or unspoken clues
Interrupting
Using silence
Double tasking, documenting while talking
or listening ?
Challenges
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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 nonverbal 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