Helen:Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month, and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some pretty amazing people. You will hear what health literacy is, why it matters, and ways we all can help improve health understanding.

Today, I’m talking with Dr. Carolyn Speros, who is a nationally recognized expert in patient and public health education. As a nurse, she has worked in nursing education, administration and advanced practice, all focusing on systems and strategies to promote health literacy.

Dr. Speros is associate professor of nursing at the University of Memphis and also maintains a practice as a nurse practitioner.

Welcome, Carolyn.

Carolyn:It’s good to be here and talk with you, Helen.

Helen:I first met you, so to speak, when I was reading the article that you wrote in The Online Journal of Issues in Nursing. The name of the article is “More Than Words: Promoting Health Literacy in Older Adults.”

I was so wowed by reading this article. Not only are you addressing a topic that is near and dear to my heart and that I’ve been focusing on for a while, but you included so many how-to strategies. Thank you for being willing to share these with the listeners of Health Literacy Out Loud.

Carolyn:It’s my pleasure. It’s a topic that I’m very passionate about.

Helen:Let’s put this into context. What’s so special about the learning needs of older adults?

Carolyn:There are several things. First of all, older adults are subject to changes associated with aging. So many times, those of us who communicate with our older adult patients fail to accommodate those changes. We often teach just like we teach patients in other age groups.

Helen:What are some of those changes? Can you give us some examples?

Carolyn:Sure. There are certainly cognitive changes that are associated with aging, along with psychological and physical changes.

Some of the cognitive changes are the inability to do what I call “mental multitasking” and putting a lot of pieces of information together. Another kind of change we often see is a decline in what we call “fluid intelligence” or the process of reasoning. That’s why you see a lot of elderly people get so frustrated if you rush them.

Helen:Is it multitasking or that you’re asking people to think about something and do it physically? What is included in that multitasking or fluid intelligence?

Carolyn:It’s managing a variety of different bits of information and recalling them from their short-term memory. Here I am, aging myself at 61. I find myself a lot of times not being able to recall certain things that I need to use just to function or make a certain decision.

As we age, the ability to recall those multiple bits of information declines. That’s why we recommend, when teaching and communicating with elderly patients, that you keep it down to three to four different concepts. That’s the max. People just can’t process more than that.

Helen:Is there a factor with time? I know it’s always an issue that our appointments aren’t long enough. We’re always having to get hither and yon and do something else. Is that more acutely a problem with the older population?

Carolyn:It is a huge problem. I know in my family practice, we are seeing patients at a very quick pace. We have to see a lot of patients.

It is something that has to be accommodated for because in the end, you’re going to find that if the patients don’t understand what you’re talking about or guiding them through, then they’re going to be coming back and having more questions. In the end, they’re not going to be compliant or able to manage like you hope that they will.

Helen:What can we do with the very real constraints we have of limited time?

Carolyn:What I try to do myself is be as efficient in teaching as possible. I’ve tried to master these principles so that when I have an older adult that comes in, I know my communication is as effective and efficient as it can be.

I try to pace my speaking throughout the examination and teach from the very minute that I see the individual so that I maximize the limited time that I have with my patient in the practice.

We also do try to work with our scheduling staff so that the older patients are scheduled in the mid morning, if possible. They’re rested and more receptive to the teaching and communication that we have with them at that time, as opposed to being rushed or tired in the afternoon. They’re kind of collapsing mentally at the end of the day.

There are certain kinds of controls that we try to build into the systems in which we work.

Helen:That makes sense. I would think that maybe you have a little bit more time in mid morning, too, when you’re not as rushed.

Carolyn:Exactly.

Helen:You talked about all the changes. Thank you for addressing the cognitive ones. What about the others?

Carolyn:The psychological ones are very real to the elderly people. They have to deal with loneliness and the depression associated with that. There’s a loss of independence and almost a grief response that they go through with that. Certainly, it’s hard to generalize across the board, but many elderly people suffer with that.

Often we don’t address that as we work with our patients. As we talk with them, we tend to just tell them what we think they need to know without taking these emotional and psychological concerns into consideration.

Helen:Can you give an example of how you would do that in practice?

Carolyn:I’m fortunate that in a family practice, I can see people over time. I can get to know them better. I just try to work with that individual as much as I can. I may know that they’ve recently lost their spouse, or they may share that. I’ll ask about their family. It’s all part of the assessment.

Try to ask them specifically and get to know them as a person in terms of what makes them happy. What kind of social support system do they have? Do they get out and do the kinds of things that energize them or help them deal with some of the issues that they’re going through?

Helen:Thank you. I really appreciate hearing that. My background is that I worked as an occupational therapist in psychiatry for many years, so it really resonates when we see people as people, with all their issues that are going on, including emotional ones.

You talked about one that really resonated with me about grieving the loss of independence. Sometimes we think about grief just from losing a spouse, loved one or maybe a function, but really, grieving that independence is vital in somebody’s life.

Carolyn:It is, and so much of our teaching should be directed toward helping someone sustain that independence as much as possible. If you can reach that as a common goal, the elderly person may be more receptive to what you’re trying to share with them.

It may be a different type of independence than you and I may imagine, but given the physical and functional limitations that elders are experiencing, teaching something that’s realistic within those constraints can give that individual a lot of hope.

Helen:I know from my mother’s last days about the importance of hope in her life. What she hoped for and what was realistic and achievable may have changed from when she was younger, but there was always some measure of hope.

Carolyn:That’s right. That is the common goal, that you have a sensitivity to that and appreciate it.

Helen:Thank you. The third part you talked about was the physical changes. Tell us more about that.

Carolyn:As people age, we all go through a great deal of physical change. Particularly, the vision and hearing change and dramatically impact receptivity to teaching.

There are very specific visual changes that we can address. Of course, the presbyopia or decreased visual acuity is something to work with, along with the changes in the structure of the eye. The yellowing of the lens affects an individual’s perception, for instance, of colors on the blue end of the spectrum.

I always try to encourage others to do this and do it in my own practice. I avoid highlighting or using any colors that are blue or green, like violet, for instance. Stay away from those and go for the brighter colors of the spectrum.

Helen:Thank you for that. I wanted the listeners to know that I’ve actually done a podcast about visual changes as people age. We’ll put a link on the Health Literacy Out Loud website.

Carolyn:Please do because there is a lot involved in doing that.

Certainly, hearing changes. That’s associated with the presbycusis that occurs. You may have a podcast on that as well.

Helen:Not yet.

Carolyn:It’s avoiding those high-pitched sounds. The elderly tend to have problems processing them.

Helen:What is a high-pitched sound?

Carolyn:It’s a female voice, for one thing.

Helen:Oh dear!

Carolyn:Yes, there are a lot of female voices that are very high-pitched. We just need to be conscious of that and lower the pitch of our voice. We don’t need to lower the loudness of it, but the pitch.

Helen:When you talked about the loudness, there’s no benefit in shouting, is there?

Carolyn:There is no benefit in shouting. If you get an appropriate distance and face your patient, many patients as they age are so dependent on looking at your facial expressions, reading your lips and watching what you say. It’s just something that we need to be cognizant of as we talk with people who are older.

Helen:Thank you for putting all of that into context along with your many strategies of what to do. I know you do a lot of work and teaching about health literacy. How do you frame this within the greater principles of health literacy?

Carolyn:In terms of working with the elderly, these are probably our most vulnerable patients as I’ve worked with nursing people and people in medical fields. These are our biggest users of our healthcare services and the ones who are affected most by chronic illness.

There is so much education and communication that goes along with managing those chronic illnesses. Our impact is greatest if we just adapt how we work with this particular group of patients. Our work is extended beyond just how we work with other age groups.

Helen:I really like the way that you expand the definition of health literacy to include all of us and those of us who are most vulnerable, for whatever reason. That certainly is the way that I frame health literacy too.

Talking about framing, I know that you and I go with the same theory behind what we do. That’s called the “theory of geragogy.” It’s a way of teaching. I wonder if you could explain that for some of our listeners.

Carolyn:I was first introduced to the term “geragogy” in the ’90s. Originally, it came out of Germany from the educational group who built and expanded on Malcolm Knowles’ theory of adult learning, which is andragogy.

Geragogy is really teaching in a way that compensates and adapts to the cognitive, physical and emotional changes that go along with aging, just like we’ve been talking about. It is a process of teaching that is very specific to this older age group.

Helen:Thank you. I like the way that you framed it in terms of compensating and adapting to what the other person brings us.

Let’s say we put into place a lot of these strategies and are doing our best to be very respectful and clear in how we’re communicating. How in the world will we ever know if we’ve done our job well?

Carolyn:Of course, I’m a huge believer in the teach-back technique of evaluating. It’s just giving our patients the respect of saying, “Tell me how you’re going to use this in your everyday life,” “Tell me what you’re going to be doing now that we’ve talked about this,” or “Is there anything different in terms of what you’re going to be doing that will help you along the way?”

Helen:Carolyn, I’ve run across this question lately. I know I have my own set of answers, but I’d be interested in yours. Some people are afraid that that question alone seems disrespectful. How can we frame it in ways that are respectful? I’m sure that you do that. I feel it’s respectful, but people sometimes feel like they’re putting the other person on the spot or testing them.

Carolyn:What’s interesting is that I don’t encounter that in my practice. A lot of it is just the compassion or caring that is transferred through every bit of your nonverbal and verbal behavior.

The element of respect is hard to articulate, but as I’m working with my elderly patients, from the very beginning, I try really hard to establish a relationship where there’s honest two-way communication. When I say, “Tell me how you’re going to be doing this,” that’s conveying genuine concern that they’re processing what it is that I’ve been sharing with them.

Helen:I hear that in your voice, for sure. I was just trying to address what I hear from other people. Maybe those are the folks who are writing the protocols or something. How can you say in any protocol, “Respect the other person”? You can say it, but how can you act on it? It certainly comes through strongly and clearly in how you are communicating with us.

Carolyn:It’s just very difficult to say what the steps are in caring and respect and articulate that.

Helen:Maybe that’s your next paper.

Carolyn:There is some work out there on caring that is excellent.

Helen:Talking about your next or past papers and all your work, how can listeners learn more about the concepts of health literacy and education with older adults?

Carolyn:We’re very fortunate that, as an area of interest, health literacy is being written about and studied more than I’ve ever seen before. You and I have been doing this for a long time. I go back to the early ’80s, when I became involved in patient education. We didn’t use the term “health literacy” at the time, but I’ve seen this whole area of interest and work expand.

I would encourage the listeners to read and search the literature. There’s such good work out there. People are doing amazing research and thinking in this area.

Helen:You’re one of our big thinkers in that area. I thank you. We will have a link to your article, the one that I referenced, on our website, as well as other resources.

Carolyn:That’s great.

Helen:Putting this together, Carolyn, you and I aren’t getting any younger here.

Carolyn:No, and that’s why I’m hoping that all of the people listening who are younger than us and will be future caregivers of us will put these kinds of steps in place as they touch, care for and communicate with us.

Helen:That’s what I was going to ask you. It’s exactly what I was thinking as you were talking about this. What would be number one on your wish list as we’re the ones being talked to and with?

Carolyn:That’s it. Number one is that I would hope my care provider would talk with me. They would come to know me as a person as best as they can, show that respect, and understand what kinds of limitations I have and what makes me unique as an older person. I’d like an appreciation of that and how to communicate with me directly. That’s my number-one wish.

Helen:I’m right with you. I hope that whoever will be my caregivers in the years ahead will listen to this podcast, read your article, and know how to communicate with us as individuals in a respectful way and ways we can understand.

Carolyn, thank you so much for sharing your wisdom, sensitivity and lessons learned with the listeners of Health Literacy Out Loud.

Carolyn:Helen, I appreciate the opportunity to do this. Thank you so much.

Helen:I learned a lot from Carolyn Speros and hope you did, too.

Health literacy isn’t always easy. For help clearly communicating your health message, please visit my health literacy consulting website atwww.HealthLiteracy.com. While you are there, feel free to sign up for the free e-newsletter, “What’s New in Health Literacy Consulting?”

New Health Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, as well as the Health Literacy Out Loud website, www.HealthLiteracyOutLoud.com.

Did you like this podcast? Did you learn something new? I sure did, and I hope you did, too. Please tell your colleagues and friends about Health Literacy Out Loud so together, we can let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.

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