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Causes mental, emotional, and physical exhaustion

Can be caused by a variety of things: to little sleep, try to do more than they can handle, little to no support, feeling overwhelmed, lack of privacy, and more

Symptoms of burnout are not limited to: feeling tired, stressed, anxious, anger/irritability, hopeless, gaining or losing weight, withdrawing from friends and family, having difficulty making decisions/trouble concentrating, or misusing drugs or alcohol

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Caregiver Burnout; Causes, Symptoms & Prevention

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Caregivers tend to burn out from being overstressed from caring for an ill or elderly loved one. There are ways to help prevent burnout, such as talking to a friend or therapist.

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It is made up of three things​: best available evidence​, clinician's knowledge and skills​, and patients wants/needs

It is a six-step process approach that is a systematic circle​: assess, ask, acquire, appraise, apply, and evaluate. (this cycle can be repeated if the outcome is not what was wanted)

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Learn More About ‘Powerful Tools for Caregivers’ For Older Adults

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Help caregivers take better care of themselves while caring for a friend or relative.

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Very popular 22 question self-report assessment​

It does not include many common factors like age, gender, location, language, living situation, marital status, or employment status, it is just asking questions pertaining to all care givers

It would be easy to gain broad information about caregivers and solutions without the additional stress these factor put on it

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Know what is out there and available to caregivers

There are so many listed online resources in this bookshelf, and they all contain helpful knowledge for a caregiver

It is important to be actively looking for resources to help

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Caregivers need to be educated on self-care, the medical side of patient's needs, and how to communicate with healthcare workers.​

There are many different resources that are available to caregivers, the Rosalynn Carter Institute for Caregiver is one that is local to Americus, however, a lot of these resources can be easily accessed online

There are online course for how to handle situations and what a caregiver should know, there are articles explaining the best ways to communicate with healthcare, and there are different methods posted for how a caregiver can take care of themselves.

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Get hands-on caregiving help like how to care for bed sores, expert advice on services including occupational therapy and palliative care and more.

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Resources are free, online, and easy to access for all caregivers

Longtime advocates for caregivers in policies, health, research, and public awareness on all levels ​

Have a variety of well researched articles published

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Looking for quality information, support, and resources related to family caregiving? Sign up for CareNav, a free online dashboard loaded with personalized information that matches your unique caregiving needs.

The mission of Family Caregiver Alliance is to improve the quality of the life for family caregivers and the people who receive their care. Find out more about our work.

We are excited to provide many resources in Spanish, Chinese, Vietnamese, and Tagalog.

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Looking for quality information, support, and resources related to family caregiving? Sign up for CareNav, a free online dashboard loaded with personalized information that matches your unique caregiving needs. The mission of Family Caregiver Alliance is to improve the quality of the life for family caregivers and the people who receive their care.

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Caregiver are highly affected by these two things, 40-70% of all caregiver have experienced clinical signs of depression

Caregiver experience feelings of loneliness because of depression which can lead to serious medical health effects

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Caregiver Isolation and Loneliness - Family Caregiver Alliance

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Just eighteen months ago, Kelly felt like she was a different person. At the time, her career and her husband were her top priority. Kelly was able to spend long days at her job and relaxing weekends away in the mountains with her husband. Since then, Kelly’s mom was diagnosed with dementia. Being the only child, Kelly has become the primary caregiver for her mother who is becoming increasingly agitated and confused. Kelly now spends her weekends looking after her mom. She has cut her work days short to manage her mom’s medical appointments and other care needs. While Kelly loves her mother and wants only the best care for her, she is finding herself feeling increasingly lost as her new life includes less balance and more focus on her mother than herself. Kelly is not alone in her struggles as a family caregiver. Statistics reveal that between 40 and 70% of family caregivers experience clinical symptoms of depression, which can often be caused by feelings of isolation and loneliness associated with the caregiving experience. It can be a dark and difficult period for those caregivers who experience these feelings of isolation.

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Prioritizes the needs, experiences, and behaviors of people in a creative problem-solving way​

Multiple benefits like enhanced outcomes, improved usability, accessibility, and more

Centers around the idea that caregivers just not know what resources are out there.

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Human-Centered Design: Instilling a Sense of Humanity in Health Care Innovation

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OSF HealthCare is employing the use of human-centered design to better understand the people it serves and solve health care problems.

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This is the most important thing a caregiver can do

How could caregivers help someone to the best of their ability if they are not helping make themselves the best they can be​

Meditation, managing stress, general self-care, and counseling

Barriers: Being honest and making time for self-care activities

Can be hard for caregivers to accept that they might need help​. Caregivers overlook their own struggles and burdens because they are supposed to be fine all the time​

Making time for self-care activities​ because they already have very limited time so caregivers give up on ideas of self-care before they even tried ​

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Taking care of yourself is one of the most important things you can do as a caregiver. Caregiving is not easy - not for the caregiver and not for the person receiving care. It requires sacrifices and adjustments for everyone. Often, family caregivers must juggle work and family life to make time for these new responsibilities.

Caring for an older adult can also be rewarding. Many people find that caregiving provides a sense of fulfillment and that they like feeling useful and needed. But the ongoing demands of taking care of someone else can strain even the most resilient person. That's why it's so important for you to take care of yourself. This article can help you find ways to look out for your own well-being so you can be there for others.

How do you know if you need help?

Caregivers do a lot for others. Because there is so much on their plate, many caregivers don't spend time taking care of themselves. For example, they are less likely than others to get preventive health services, like annual checkups, and to practice regular self-care. As a result, they tend to have a higher risk of physical and mental health issues, sleep problems, and chronic conditions such as high blood pressure. They are even at an increased risk of premature death.

It's not always obvious when a person needs help. Watch out for these signs of caregiver stress:

​Share this infographic and help spread the word about caring for yourself while caring for others.

Feeling exhausted, overwhelmed, or anxious

Becoming easily angered or impatient

Feeling lonely or disconnected from others

Having trouble sleeping or not getting enough sleep

Feeling sad or hopeless, or losing interest in activities you used to enjoy

Having frequent headaches, pain, or other physical problems

Not having enough time to exercise or prepare healthy food for yourself

Skipping showers or other personal care tasks such as brushing your teeth

Misusing alcohol or drugs, including prescription medications

Don't wait until you are completely overwhelmed. Learn what your own warning signs are and take steps to minimize sources of stress where possible.

Caring for yourself as a long-distance caregiver

Long-distance caregiving brings its own kinds of stress. Caregivers who live far away may feel guilty about not being closer, not doing enough, or not having enough time with the person. They may even feel jealous of those who live closer and can do more. Many long-distance caregivers also worry about taking time off from work, being away from family, and paying for travel. Although they might not have the same stressors as a primary caregiver, long-distance caregivers should be aware of when they may need help, too.

How can you ask others to help?

When people have asked you if they can lend a hand, have you told them, "Thanks, but I'm fine"? Accepting help from others isn't always easy. You may worry about being a burden, or you may feel uncomfortable admitting that you can't do it all yourself. But many caregivers later say they did too much on their own, and they wished they had asked for more support from family and friends.

Understand that many people want to help, and it makes them feel good to contribute. If asking for help is hard for you, here are some tips that may help:

Ask for small things at first, if that makes it easier for you. Many large jobs can be broken down into simpler tasks.

If you aren't comfortable asking face-to-face, send a text or email with your request.

Consider a person's skills and interests when thinking about how they could help.

Be prepared with a list of things that need to be done, and let the other person choose what they'd like to do.

If someone offers to help, practice saying, "Thanks for asking. Here's what you can do."

Be honest about what you need and what you don't need. Not every offer is going to be helpful.

Be prepared for some people to say "no," and don't take it personally.

Learn more about sharing caregiving responsibilities with friends and family.

Who else can you ask for help?

Family and friends are great people to ask for help, but they are not the only sources of support for caregivers. Others who may be able to help include:

Your doctor. Tell your doctor that you are a caregiver. They can give you advice about taking care of your physical and mental health. Health care professionals may also know about support groups, respite care, and other resources offered in your community.

A counselor or other mental health professional. If you are feeling anxious, frustrated, or depressed, help is available. Ask your doctor for referrals to counselors, and check with your health insurance provider to find out about your plan's coverage.

Your local senior center, state office on aging or social services office, or local Area Agency on Aging. These organizations will be familiar with resources available in your community and may have tips for accessing them.

Your faith community. Larger congregations may host support groups for caregivers. You can also ask for guidance from your pastor, rabbi, or other religious leader.

What else can a caregiver do if they're feeling overwhelmed?

If you're feeling overwhelmed by caregiving, tending to your own needs may be the last thing on your mind. But taking time for yourself can actually make you a better caregiver. If you can find small ways to lower your stress and boost your mood, you'll have more strength and stamina to take care of someone else.

Below are some suggestions that may help when you're feeling overwhelmed. Remember that you don't have to do everything all at once, especially if the thought of self-care just makes you feel more exhausted.

Be active. Find something active that you enjoy. That might be walking, dancing, gardening, or playing with a pet. Even short periods of exercise can be beneficial.

Eat well. Work on having a well-balanced diet that includes a variety of healthy foods. Drink plenty of water every day.

Prioritize sleep. Aim to get seven to nine hours of sleep each night. Develop a relaxing bedtime routine to make it easier to fall asleep. Try to go to sleep and get up at the same time each day.

Reduce stress. Experiment with relaxation techniques like meditation, tai chi, or yoga. Download a smartphone app with guided meditations or relaxing music. Many of these apps are free.

Make time to relax. Carve out time each week to do something you enjoy that has nothing to do with caregiving. It can be as simple as watching a favorite TV show, reading a magazine, or working on a hobby.

Keep up with your own health. Make that doctor's appointment you've been putting off. Tell your doctor that you're a caregiver: They may be able to suggest resources online or in your community.

Reach out for support. Talk to a trusted family member or friend or seek counseling from a mental health professional. Join an online or in-person support group for caregivers. These are people who will know what you're going through and may have suggestions or advice.

Take a break if you need it. Ask another family member or friend to step in, hire an aide to come for a few hours a week, or sign up the older person for an adult day care program.

Be kind to yourself. You don't have to pretend to be cheerful all the time. Feelings of sadness, frustration, and guilt are normal and understandable. Express your feelings by writing in a journal or talking with a friend.

Remember that you are doing the best you can and that you are not alone. Many caregivers have trouble tending to their own health and well-being. But give yourself credit for everything you're doing. Your caregiving makes a big difference in someone else's life.

The Caregiver's Handbook

Explore this guide to getting started with caregiving, finding support, and taking care of yourself.

If you're not the primary caregiver, how can you support that person?

In many cases, one person takes on most of the everyday responsibilities of caring for an older person. It tends to be a spouse or the child or sibling who lives closest. If you are not the primary caregiver, you can still play an important role in supporting that person.

Be sure to acknowledge how important the primary caregiver is in the older person's life. Also, discuss the physical and emotional effects caregiving can have on people. Although caregiving can be satisfying, it also can be very hard work.

You can lighten the primary caregiver's load by providing emotional support, taking on specific tasks, and even providing full-time care for a short period of time to give the primary caregiver a break. Ask them what you can do that would be most helpful. Staying in contact by phone or email might also take some pressure off the primary caregiver. Just listening may not sound like much, but it can mean a lot.

A primary caregiver - especially a spouse or partner - may be hesitant to ask for a break. Here are some ways you could help them get the rest they need:

Offer to stay with the older person for one afternoon a week, for example, so the primary caregiver can have some personal time.

Arrange for regular respite care in the form of a volunteer, an in-home aide, or an adult day care program.

If you live far away, travel to stay with the older person for a few days so the primary caregiver can take a vacation or just have some time off.

In time, the older person may have to move to a residential (live-in) facility, such as assisted living or a nursing home. If that happens, the primary caregiver will need your support. You can work together to select a facility and coordinate the move. The primary caregiver may need extra support while adjusting to the person's absence and to living alone at home.

You may also be interested in

For more information about caregiver health

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

​Share this infographic and help spread the word about caring for yourself while caring for others.

Feeling exhausted, overwhelmed, or anxious

Becoming easily angered or impatient

Feeling lonely or disconnected from others

Having trouble sleeping or not getting enough sleep

Feeling sad or hopeless, or losing interest in activities you used to enjoy

Having frequent headaches, pain, or other physical problems

Not having enough time to exercise or prepare healthy food for yourself

Skipping showers or other personal care tasks such as brushing your teeth

Misusing alcohol or drugs, including prescription medications

The Caregiver's Handbook

Explore this guide to getting started with caregiving, finding support, and taking care of yourself.

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Taking Care of Yourself: Tips for Caregivers

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Taking care of yourself is one of the most important things you can do as a caregiver. Find tips for making time for yourself.

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Financial assistance programs​

Budget and plan for care expenses​

Consult a financial advisor​

These are all effective tools a caregiver can use to help better manage their expenses

They vary in how accessible they are and what exactly they do, however there is an option that can be best suited for any caregivers situation

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Some government programs pay family or friends of people with disabilities to help with daily activities including personal care, giving medicine, cooking, cleaning, and more.

State Medicaid programs

If someone with a disability already receives Medicaid, their state may allow a family member or friend to become a paid caregiver.

Many states call this a consumer-directed personal assistance program. Each state has different requirements and rules. Contact your state's Medicaid office for more information.

Long-term care insurance

Some long-term care insurance policies allow family members to get paid as caregivers. Contact your insurance agent and ask for a written confirmation of benefits.

Veterans programs

There are two programs available for veterans:

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Get paid as a caregiver for a family member | USAGov

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Some government programs pay family or friends of people with disabilities to help with daily activities including personal care, giving medicine, cooking, cleaning, and more.

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Georgia Department of Human Services Division of Aging Services

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Georgia Department of Human Services Division of Aging Services

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State Organization

Provides a variety of resources for caregivers like assistances, educations, reporting abuse, and more

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If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware.

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Financial, African Americans struggle the most and have the lowest overall income​

African American caregivers struggle significantly more than other racial groups when it comes to finances, overworked, and low support

All caregivers are overlooked and under-paid​

Most of the time, caregivers are not paid, and they must take time off their paying job to be a caregiver​

There needs to be raised awareness and implementation of financial assistance programs for caregivers

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During the week after Sam, a 60-year-old, African American former client of mine, was diagnosed with a recurrence of colon cancer, his wife and two adult daughters quickly changed their work schedules to drive him to the hospital for the multiple rounds of chemotherapy he'd need. Sam's three nephews stopped by to watch football with him and cheer him up. A group of congregants from the family's church came by the house after Sunday services to pray with him. Neighbors dropped off meals.

I've seen other families and communities rally around an ill friend or family member, especially in the early stages before fatigue sets in and they drift back to their own lives. But Sam's network of support stuck with him over months that stretched into years as his cancer spread. He didn't have a lot of money but was rich with caring people. They surely felt tested at times by Sam's caregiving needs and glum moods, but most hung in there, proceeding in workmanlike fashion without complaint as if linked in the belief that "this is what kin do."

According to an AARP/National Alliance for Caregiving May 2020 fact sheet on " The 'Typical' African American Caregiver," based on research conducted for the Caregiving in the U.S. 2020 report, African Americans often have more burdensome caregiving situations than their non-Hispanic white or Asian caregiver counterparts. They also tend to be younger, are often unmarried, have poorer health, and frequently have to balance caregiving with full-time jobs.

This profile would suggest that African American caregivers should be highly stressed. But other research over the past 20 years has found they cope better with caregiving than white caregivers. For instance, a 2020 metanalysis by Liu, Badana and others, published in the journal The Gerontologist, found that African American dementia caregivers had somewhat better psychological well-being than white dementia caregivers. The authors offered several possible reasons, including the expectation among African Americans that family and community members will look out for one another and their relatively greater commitment to religious practices and values.

Research is about generalities; there are many individual African American caregivers who are struggling and many white ones who are thriving. But, on the occasion of Black History Month, it is still worth reflecting whether there are lessons to be learned from Sam, his family and community members, and others that could help family caregivers of all races and cultures. As a white former caregiver, I'm an outside observer who is no expert on the African American community. Here are a couple ideas, though, to at least consider:

It takes a village

Many caregivers are hard pressed to keep together even a small team of immediate family members who are agreeable to contributing. When those few later disappear, the entire crushing weight lands on the primary caregivers' shoulders. How does it happen then that, for many African American caregivers, that load is lightened through sharing it with immediate family and beyond to extended family and community members?

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Why African Americans Cope Better as Family Caregivers

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Studies show that many feel a greater sense of purpose, community and commitment to religious values than their white caregiver counterparts

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Stakeholders can be program staff, participants, funders, and policy makers​

In a study that was done, they found that the more stakeholders were involved in a program, the more successful the program was

If stakeholder are not very involved in programs, even if it is just one group, then it will negatively impact the program

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Stakeholder engagement to inform evidence-based treatment implementation for children’s mental health: a scoping review

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There is a pervasive mental health treatment gap for children across the globe. Engaging stakeholders in child mental health evidence-based treatment (EBT) implementation projects may increase the likelihood of successful EBT implementation, thereby…

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There are many different, unexpected situations a caregiver could face

It's impossible to prepare for every situation that might be faced, so having an open mind is important​

Any kind of help is better than no help!

Be able to think logically in times of crisis

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Join support groups​: allow a caregiver to relate to other people in similar situations​ and surrounds a caregiver with a group of people that understand​

Family and loved ones: provides a different level of comfort & security​ and can help caregiver better manage personal life ​

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FCA facilitates and sponsors several types of support groups, both in person and online.

Caregiver Online Support Group

This is an unmoderated group for families, partners, and other caregivers who want a safe place to discuss the stresses, challenges, and rewards of providing care for adults with disorders such as Alzheimer's, stroke, brain injury, and other chronic debilitating health conditions.
Solicitations and advertisements of ANY kind; academic, commercial, journalistic, or any other reason, are STRICTLY PROHIBITED.
Are you conducting a Research study or Clinical trial? Please click here.

This group is in e-mail format. Participants send and receive e-mail to take part in discussions. You can receive your posts all together, in one delivery each day, or you can receive them one-by-one, as they are sent. The choice is yours. It's fun, easy, and available 24 hours a day, 7 days a week. To subscribe to Caregiver Online Support Group, complete the form below and click the submit button.

LGBTQ+ Community Support: Caregiving for our Families and Friends

This online support group LGBTQ+ Community Support Caregiving for our Families and Friends offers a place for lesbian, gay, bisexual, and transgender caregivers of adults with chronic health problems to discuss the unique issues of caring for their loved ones.
Solicitations and advertisements of ANY kind; academic, commercial, journalistic, or any other reason, are STRICTLY PROHIBITED.
Are you conducting a Research study or Clinical trial? Please click here.

This group is in e-mail format. Participants send and receive e-mail to take part in discussions. You can receive your posts all together, in one delivery each day, or you can receive them one-by-one, as they are sent. The choice is yours. It's fun, easy, and available 24 hours a day, 7 days a week. To subscribe to LGBTQ+ Community Online Support Group, complete the form below and click the submit button.

LGBTQ Caregiver Support Group

We welcome a diverse group of LGBTQ caregivers for a new monthly support group! Join us via Zoom as we discuss the stresses, challenges, and variety of experiences that come with providing care in our community. This group is for caregivers of those with a variety of illnesses, disorders, and challenges. If you are caring for someone with dementia-specific challenges, we encourage you to check out the LGBTQ Caregivers of Those With Dementia support group.

For San Francisco Bay Area or California caregivers of older adults or those with adult-onset cognitive or neurological conditions like dementia, stroke, or Parkinson's.

For more information or to register, contact Adriana Sanchez: asanchez@caregiver.org.
In partnership with Openhouse
When: 3rd Wednesdays of the month, 4 to 5:30 p.m. (PT), via Zoom

Young Adult Caregivers Support Group

Designed for family caregivers under the age of 40 who are caring for someone who is:

60 or older with any diagnosis, or

between the ages of 18-59 with an adult-onset cognitive or neurological impairment.

Meets online via Zoom twice monthly. Participants should live in the San Francisco Bay Area (Alameda, Contra Costa, Marin, San Francisco, San Mateo, or Santa Clara counties).

To register, contact Intake at (415) 434-3388 x331; bayareaintake@caregiver.org.

East Bay Support Group (FULL)

This is a monthly group serves caregivers who are caring for someone who is:

60 or older with any diagnosis, or

between the ages of 18-59 with an adult-onset cognitive or neurological impairment.

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Support Groups - Family Caregiver Alliance

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FCA facilitates and sponsors several types of support groups, both in person and online. This is an unmoderated group for families, partners, and other caregivers who want a safe place to discuss the stresses, challenges, and rewards of providing care for adults with disorders such as Alzheimer's, stroke, brain injury, and other chronic debilitating health conditions.

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River Valley Regional Commission Area on Aging

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River Valley Regional Commission Area on Aging

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Local Caregiving Agency to Sumter County

Are partnered with many other programs like Habitat for Humanity. All Ways Caring Homecare, and more

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Home - River Valley Area Agency on Aging

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The River Valley Area Agency on Aging is dedicated to improving the quality of life for seniors and people with disabilities. Through a variety of…

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Taking your time with research is important to get the most effective results with less attempts at repeating the evidence-based systemic cycle.

If the time is taken to make sure that there is substantial research in one ways favor, then it will be more effective.​

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Evidence-Based Practice and Nursing Research

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Evidence-based practice is now widely recognized as the key to improving healthcare quality and patient outcomes. Although the purposes of nursing research (conducting research to generate new knowledge) and evidence-based nursing practice (utilizing best evidence as basis of nursing practice) seem quite different, an increasing number of research studies have been conducted with the goal of translating evidence effectively into practice. Clearly, evidence from research (effective innovation) must be accompanied by effective implementation, and an enabling context to achieve significant outcomes.

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Be more involved in actively advocating consistently​

Send more letter to government official, be persistent​

Support groups​

Signing petitions​

Utilize social media

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Resources

Technical Difficulties?

Send comments about the Find Your Representative service to the webmaster. Please note that messages for a specific representative sent to the webmaster will not be forwarded to the representative.

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Send comments about the Find Your Representative service to the webmaster. Please note that messages for a specific representative sent to the webmaster will not be forwarded to the representative.

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Rosalynn Carter Institute for Caregivers

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Rosalynn Carter Institute for Caregivers

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Based out of Americus, GA​ and was founded 35 years ago by the Former First Lady Rosalynn Carter​

Offer caregiving support, advocacy, and strategic initiatives research

Provides a crisis help line and a course on managing your stress as a caregiver to help promote health, strength, and resilience in caregivers​

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Rosalynn Carter Institute - Rosalynn Carter Institute for Caregivers

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Former First Lady Rosalynn Carter understood that even on the days when caregiving provides joy and fulfillment, it is hard work. That's why she founded the Rosalynn Carter Institute for Caregivers 35 years ago. Today, we are continuing her work promoting caregivers' health, strength, and resilience.

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Communication is huge because if there is no communication, there is no program

Programs rely heavily on effective communication because if there is effective communication, the program is most likely doing well

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Research

Open access

Published:

BMC Health Services Research 23, Article number: 886 (2023) Cite this article

33k Accesses

8 Citations

Metrics

Abstract

Background

Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.

Methods

Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like "effective communication," "elderly," and "well-being." Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool.

Results

The search strategy yielded seven studies. Five studies were qualitative (two phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, and one was an experimental study. The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes.

Conclusion

Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.

Peer Review reports

Introduction

Excellent communication is critical for all health professionals [ 1, 2]. It affects the quality of healthcare output, impacts the patient's health and satisfaction, and benefits both patients and providers [ 3]. Communication is a critical clinical competence because it establishes trust between providers and patients, creating a therapeutic relationship [ 4]. Physician-patient communication plays several functions, including making decisions, exchanging information, improving the physician-patient relationship, managing the patient's doubts, addressing emotions, and enhancing self-management [ 5]. Features of effective or quality communication include involving patients in decisions, allowing patients to speak without interruptions, encouraging a patient to ask questions and answering the questions, using a language that the patient understands, paying attention to the patient and discussing the next steps [ 5]. This communication also includes listening, developing a good interpersonal relationship, and making patient-centred management plans.

The quality of patient-physician communication influences various patient-centred outcomes [ 6]. In this review, patient-centred outcomes refer to all the outcomes that contribute to the recovery or indicate the recovery of patients, as well as suggest positive experiences with the care process. For instance, effective communication is associated with enhanced patient satisfaction, regulating emotions, and increasing compliance, leading to improved health and better outcomes [ 7, 8]. According to [ 9], quality communication enhances patients' trust in their providers, making patients more satisfied with the treatment. A trusting provider-patient relationship causes individuals to believe they receive better care [ 10]. For instance, [ 11] report that effective provider-patient communication improves social, somatic, and psychological health. During communication, the provider may enhance positive motivations and involve the individual in treatment decisions. Communication helps patients to acknowledge their illnesses, the associated risks, and the advantages of consistent treatment [ 5]. note that mutual communication between providers and patients stimulates or strengthens patients' perception of control over their health, the knowledge to discern symptoms and self-care and identify changes in their condition. Effective communication leads to improved perceived quality of health care [ 12]. report that physician-patient communication influences the perceived quality of healthcare services. All these outcomes that suggest or contribute to patient's positive experiences or imply a positive recovery journey, such as shorter hospital stays, are considered patient-centred outcomes.

This rapid review aims to review studies that have previously investigated the influence of quality communication on patient-centred outcomes among older adults, such as psychological well-being, quality of health care, emotional well-being, cognitive well-being, individualised care, health status, patient satisfaction, and quality of life. The specific objectives include (a) exploring the strategies used to ensure quality and effective communication with older patients in various healthcare settings, (b) exploring the patient-centred health outcomes reported by previous studies investigating quality communication between providers and older patients, and (c) to link quality communication strategies with older patients to patient-centred health outcomes among older patients.

The primary rationale for conducting this rapid review is that although many studies have examined the relationship between quality communication and various patient-centred outcomes, few studies have used older patients as their participants. It is a significant research gap because older adults have unique communication needs, which, if not considered, their communication with healthcare providers could be ineffective [ 13]. For example, older adults experience age-related changes in cognition, perception, and sensation, which can interfere with the communication process [ 14]. As a result, more research is needed to the specific quality communication strategies that could improve patient-centred outcomes among older adults. To my knowledge, no systematic review has focused on this topic. Therefore, this is the first rapid review to explore quality communication and its impact on patient-centred health outcomes among older patients in various healthcare settings.

This rapid review's findings could inform practitioners of the quality communication strategies they can use to improve patient-reported outcomes. Besides, the rapid review evaluates the quality of studies investigating this matter and makes informed recommendations for future research to advance knowledge on this subject.

Methods

This rapid review was conducted in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 15]. The main difference between a systematic review and a rapid review is that the former strictly conforms to the PRISMA protocol, whereas the latter can miss a few elements of a typical systematic review. A rapid review was suitable because a single reviewer was involved in the study selection process, whereas at least two independent reviewers are recommended in typical systematic reviews [ 16].

Eligibility criteria

Table 1 below summarises the inclusion and exclusion criteria used to guide study selection in this rapid review. Also, justification is provided for each inclusion/exclusion criteria. The inclusion/exclusion criteria were drafted based on the target population, the intervention, the outcomes, year of publication, article language, and geographical location. This approach corresponds with the PICO (P - population, I - intervention, C - comparison, and O - outcomes) framework [ 17].

Information sources

Four academic databases were searched: PubMed, Scopus, CINAHL, and PsycINFO. These databases were used as sources of information because they publish studies in healthcare sciences on a wide range of topics, including communication and the health outcomes of various interventions. Additionally, Google Scholar was searched to supplement the databases because it indexes academic journal articles in all disciplines, including healthcare. Combining Google Scholar with these databases has been recommended for an optimal search strategy [ 18].

Search strategy

Various search terms related to the critical variables of this rapid review, namely quality communication, patient-centred health outcomes, and older patients, were combined using Boolean connectors (AND & OR). Regarding quality communication, some of the keywords that were used include "quality communication," "effective communication," "doctor-patient communication," and "patient-centred communication." The keywords that were used for patient-centred outcomes included "well-being," "patient satisfaction," "quality of care," "health status," and "quality of life." The search terms related to older patients included "nursing home residents," "older," and "elderly." Additionally, since most older patients are institutionalised, search terms like "nursing homes" and "assisted living facilities" were used in the search strategy. Table 2 below presents a sample search strategy executed on PubMed between September 2022 and July 2023. As shown in Table 2, Mesh terms were used alongside regular keywords. Truncations on the three keywords, namely elderly, nursing homes, and geriatric were used to allow more of their variations to be captured in the search. The use of Mesh terms was only performed on PubMed - Mesh terms are only supported on PubMed and MEDLINE. The rest of the sources of information were searched using the search terms without specifying whether they are Mesh terms or not.

Study selection process

One reviewer (the author) was involved in screening the studies. The reviewer screened each record at least twice for confirmation purposes. Afterwards, an automation tool called ASReview which relies on machine learning to screen textual data was used as a second confirmation [ 19]. Research has shown that combining a machine learning tool and a single reviewer can significantly reduce the risk of missing relevant records [ 20]. This decision was reached based on previous research that has also demonstrated the good sensitivity of ASReview as a study selection tool in systematic reviews [ 19]. The software was trained on the eligibility criteria and the broader context of this study before it was used to screen the studies and confirm the reviewer's decision. Therefore, if a record were retrieved, the author would screen for its eligibility the first time and confirm it the second time. For the third time confirmation, ASReview was employed. In case of disagreement between the author's first and second attempts, a third attempt could be made to resolve it. In case of disagreement between the author's first/second/third attempts and ASReview, a fourth attempt was made to resolve it.

Data collection process

One reviewer (the author) extracted data from the qualifying records. The reviewer could collect data from a given study in the first round, record them, and confirm them in the second round. In case of disagreement between the first and second rounds, the author would extract data from the record for the third time to resolve it. The data points on which data extraction was based include the country where the study was conducted, the study's research design (if reported), the population and setting of the study, the characteristics of the intervention (communication), and outcomes. Also, the author remained keen to identify ways the studies defined quality or effective communication in the context of older patient care. Regarding the characteristics of the intervention, some of the data sought included the type of communication (e.g., verbal or non-verbal) and the specific communicative strategies, such as touch and active listening.

Regarding outcomes, 'patient-centred outcomes' was used as an umbrella term for several variables that relate to the patient's subjective well-being. Such variables include perceptions of quality of care, quality of life, symptom management, physical health, mental health, health literacy, patient satisfaction, individualised care, and overall well-being, including social processes, self-actualisation, self-esteem, life satisfaction, and psychosocial well-being. If studies reported on the acceptance and usability of communicative strategies, it was also included as a patient-centred outcome because the patient accepts a specific intervention and acknowledges its usability.

Study quality assessment

The study quality assessment in this rapid review entailed the risk of bias and certainty assessments. Risk of bias assessment formed an essential aspect of certainty assessment. The risk of bias in qualitative studies was evaluated using the Critical Appraisal Skills Program (CASP) Qualitative Checklist [ 21]; the Cochrane Risk of Bias (RoB) tool was used for randomised studies [ 22]; and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) was used for cross-sectional observational studies [ 23]. The Grading for Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for all study designs [ 24]. The risk of bias in each study design and its corresponding assessment tool was calculated as a percentage of the total points possible. For example, the CASP Qualitative Checklist has ten items; each awarded one point. If a study scored seven out of 10 possible points, its risk of bias would be rated as 70%. The GRADE Tool has five domains, namely risk of bias, inconsistency, indirectness, imprecision, and publication bias. The first domain, risk of bias, was populated using the findings of risk of bias assessment using the stated tools. The overall quality of a study was based upon all five domains of the GRADE Tool.

Synthesis methods

Both qualitative and quantitative studies were included in this review. The studies were highly heterogeneous in their research designs hence statistical methods like a meta-analysis synthesis were impossible [ 25]. Besides, the studies also had substantial heterogeneity in the study settings (some were conducted in primary care settings, but a majority were conducted in long-term care facilities/nursing homes) and outcomes. The studies measured different outcomes under the umbrella variable of patient-centred outcomes. As such, a narrative synthesis approach was considered the most suitable [ 26]. The narrative synthesis guidance by [ 27] was used. The first step based on the guidelines should be developing a theoretical model of how the interventions work, why, and for whom.

This rapid review's explanation of how effective or quality communication leads to improved patient-centred outcomes in the introduction section formed the theoretical basis, that is, effective communication facilitates informational exchange between the patient and provider, leading to better decision-making, which positively influences patient outcomes The second step of a narrative synthesis entails organising findings from the included studies to describe patterns across the studies based on the direction of the effect size or effects [ 27]. The third step is to explore the relationship in the data by identifying the reasons for the direction of effects or effect size. This rapid review's reasons were based on the theoretical notions outlined above in this paragraph. The final step is to provide insights into the generalizability of the findings to other populations, which, in the process, further research gaps can be outlined. The results are stated below.

Results

Study selection

After running the search strategy, 40 articles were identified from PubMed, 13 from Google Scholar (records identified from websites (Fig. 1)), 24 from Scopus, 18 from CINHAL, and 10 from PsycINFO based on the relevance of the titles. It was discovered that 26 were duplicated records between databases and Google Scholar, which reduced the number of identified records to 79. Further, the automation tool (ASReview) marked five records as ineligible based on their title considering the inclusion and exclusion criteria. These articles were excluded because the author confirmed in the fourth round that they were ineligible. After realising they did not focus on older adults, the author excluded three more records. Therefore, 71 records were screened using their abstracts with the help of ASReview (64 records from databases and 7 records from Google Scholar), whereby 44 were excluded (40 records from databases and 4 records from Google Scholar) for various reasons, such as being expert opinions and professional development based on field experiences (e.g., [ 28]) and did not have a methodology. The remaining 27 records (24 records from databases and 3 records from Google Scholar) were sought for retrieval, whereby one was excluded because its full text was inaccessible. The remaining 26 articles (23 records from databases and 3 records from Google Scholar) were assessed for eligibility with the help of ASReview, whereby eight records were excluded because they did not report their methodologies (e.g., [ 29]), another eight were secondary studies (e.g., [ 30]), and three were non-peer-reviewed preprints. Therefore, seven studies met the eligibility criteria for this rapid review.

PRISMA Flowchart summarising the study selection process

Study characteristics

Out of the seven studies, one was an experimental study [ 31], one was a cross-sectional observational study [ 32], and five were qualitative studies [ 33, 34, 35, 36, 37]. As shown in Table 3, most of the studies (n = 4) were conducted in the United States. The following countries produced one study each: Australia, Cameroon, the Netherlands, and Hungary. Although all the studies utilised a sample of older patients, the characteristics of the patients differed from one study to another. The studies ranged from primary care settings [ 36] and adult medical wards [ 37] to long-term care facilities like nursing homes. Apart from [ 36], the rest of the studies investigated various non-verbal communication strategies with older adults and their impact on various types of patient-centred outcomes, ranging from health-related outcomes (e.g., smoking cessation) to patient-reported outcomes, such as patient satisfaction, self-esteem, and life satisfaction. These outcomes are within the broader umbrella category of patient-centred m outcomes.

Further, the studies used different types of communicative strategies that can be used to enhance or promote patient-centred outcomes. In this rapid review, they were categorised into seven, namely (a) touching, (b) smiling, (c) gaze, head nod, and eyebrow movement, (d) active listening, (e) close physical distance, and (f) use of visual aids, and (g) telephone communication. Table 4 summarises the various ways in which each study described its interventions.

Quality assessment findings

All seven studies were of high quality based on the GRADE Tool-based Assessment. However, [ 31] conducted an experimental study, but they did not provide any details indicating whether there was concealment in participant allocation and blinding of participants and outcome assessors. Therefore, it has a high likelihood of risk of bias. However, they scored excellently in the other domains of the GRADE Tool. All five qualitative studies and the cross-sectional observational study also scored excellently in the domains of the GRADE Tool, apart from the imprecision domain where they could not be scored because none of them reported effect sizes (Table 5).

Results of individual studies

[ 31] was the only experimental study used in this rapid review investigating the effect of comfort touch on older patients' perceptions of well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. The authors did not report the effect sizes but indicated that comforting touch had a statistically significant effect on each of the five variables. In summary, the authors suggested that comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on the various patient-centred outcomes reported in their study. For each variable, the authors used three groups, the first and second control groups and the third experimental group. After delivering the intervention, they investigated whether the scores of these variables changed between three-time points in each of the three groups. The first time point was the baseline data collected before intervention was initiated; the second was two weeks after baseline data; and the third was four weeks after baseline data. The authors found that in each of the five variables, the scores remained almost the same in the three-time points for the two control groups, but there were significant improvements in the experimental group (the one that received the intervention). For example, the self-esteem variable was measured using Rosenberg's Self-Esteem Scale, with the highest attainable score of 40. In the first control group, the score remained 27.00, 27.27, and 27.13 for Time 1 (baseline), Time 2 (after two weeks), and Time 3 (after four weeks), respectively. The same trend was observed in the second control group. However, in the experimental group, the score improved from 29.17 at baseline to 36.00 at Time 2 and 37.47 at Time 3. These findings suggest that comfort touch was highly effective in improving self-esteem among older patients. The same significant improvements were evident for all the other variables (p.184).

While all the other studies focused on nonverbal communication cues, [ 36] focused on telephone communication. They aimed to investigate the effect of a tailored intervention on health behaviour change in older adults delivered through telephone communication. Therefore, the primary rationale for selecting this study for review is that it used a specific communicative strategy (telephone) to deliver the intervention, which is the primary purpose of effective communication in most healthcare settings. The older patients used as participants in this study lived with COPD. The nurses trained to administer the intervention made regular phone calls over 12 months. The intervention was delivered to 90 participants. Of these, 65 were invited for interviews at the end of 12 months. One of the most important outcomes relevant to this rapid review is that the participants reported "being listened to by a caring health professional." It means that regular telephone communication improved the patient's perceptions of the quality of care. Other critical patient-centred outcomes that improved due to this intervention include many participants quitting smoking and increased awareness of COPD effects.

[ 34] also conducted a qualitative study but needed to specify the specific research design, which was generally non-experimental. The authors used formative evaluation and a participatory approach to develop a communicative intervention for older adults with limited health literacy. In other words, apart from literature reviews, the authors involved the target population in developing a curated story to improve their health literacy. They developed photo and video-based stories by incorporating narrative and social learning theories. The most important finding of this study was that the authors found the developed communicative strategy appealing and understandable. Such observations imply that the participants' health literacy also likely improved even though the authors did not evaluate it.

Further, using a sample of 155 older patients, [ 32] investigated the relationship between the communication characteristics between nursing practitioners and the older patients and patients' proximal outcomes, namely patient satisfaction and intention to adhere to the NPs' recommendations, and patients' long-term outcomes (presenting problems and physical and mental health). The proximal outcomes (satisfaction and intention to adhere) were measured after visits, whereas the long-term outcomes (presenting problems, mental health, and physical health) were measured at four weeks. The communication and relationship components observed include various non-verbal communication strategies: smile, gaze, touch, eyebrow movement, head nod, and handshakes. The authors recorded videos during patient-provider interactions. These communicative strategies were measured using the Roter Interaction Analysis System (independent variable).

In contrast, the other outcomes (dependent variables) outlined above were each measured separately with a validated tool or single-item instruments [ 32]. For example, presenting problems were measured with a single-item instrument, whereas the physical and mental health changes at four weeks were measured using the SF-12 Version 2 Health Survey. The authors found that verbal and nonverbal communication strategies focused on providing patients with biomedical and psychosocial information and positive talk characterised by receptivity and trust were associated with better patient outcomes, such as significant improvements in mental and physical health at four weeks. Although the study did not report effect sizes, the findings agree that effective and quality communication can improve patient-centred outcomes like patient satisfaction.

[ 35] conducted a qualitative study with focus groups (eight focus groups with a range of three to nine participants) of 15 older adults in a nursing home. The study used an ethnographic qualitative design. The nonverbal communication strategies observed in this study included active listening (including verbal responses) and touching. The authors found that the characteristics of the communication strategies that make communication quality and effective include mutual respect, equity, and addressing conflict. The patients perceived that their nursing aides gave them better-individualised care if their relationship and communication were characterised by mutual respect. Portraying mutual respect includes showing the patients that they are being listened to and heard, which can include calling them by their names and showing signs of active listening. Some residents (older patients) complained that some nursing aides had favouritism, whereby they liked some patients and not others. When such a perception emerges, the patients could perceive the treatment as unjust, compromising individualised care quality. Also, nursing aides must equip themselves with communicative strategies to address conflict rather than avoid it. For example, knowing about the patient's history can help nursing aides understand their behaviour in the facility, improving prospects of providing better personalised or individualised care.

[ 33] also conducted a qualitative study utilising a sample of 17 older adults in nursing homes and assisted living facilities in the United States. They aimed to identify the types and examples of nurse-aide-initiated communication with long-term care residents during mealtime assistance in the context of the residents' responses. Using a naturalistic approach, the researchers observed communicative interactions between the nurse aides and the residents during mealtime assistance. Videos were recorded and transcribed and analysed using the grounded theory approach. They found that apart from emotional support, nonverbal communication strategies were used by nurse aides to address the residents, initiate and maintain personal conversations, and check-in. Although the authors did not provide statistical proof that these communication strategies improved well-being, their findings can inform future studies.

Finally, [ 37] conducted a qualitative, grounded theory study to develop a model for effective non-verbal communication between nurses and older patients. The authors conducted overt observations of patient-nurse interactions using a sample of eight older patients. They found that the nature of nonverbal communication to be employed depends on the context or environment, and certain external factors influence it. The factors influencing nonverbal communication include the nurses' intrinsic factors, positive views of older adults, awareness of nonverbal communication, and possession of nonverbal communication skills. Patient factors that can also influence the effectiveness of nonverbal communication include positive moods, financial situations, and non-critical medical conditions. The model developed also emphasised that non-verbal communication, if carried out correctly considering context and environment, can lead to positive outcomes, such as increased adherence to providers' recommendations, improved quality of care, and shorter hospital stays.

Results of syntheses

Four themes emerged from the narrative synthesis: nonverbal communication, verbal communication, communication strategies, and patient-centred outcomes. Table 6 summarises the subthemes that emerged under each theme. They are discussed below.

Nonverbal communication

Nonverbal communication was a critical theme that emerged in several studies. Five out of the seven studies investigated the effectiveness of touch on various patient-centred outcomes [ 31]. found that nonverbal communication strategies such as comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on patient-centred outcomes, such as well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility [ 31]. implemented comfort touch exclusively without combining it with other nonverbal communication strategies. It means that comfort touch on its own can be effective in improving various patient-centred outcomes. As such, it can be hypothesised that if comfort touch is combined with other nonverbal communication strategies, such as active listening, eye gazing, smiling, maintaining a close distance, eyebrow movement, and nodding/shaking of the head can lead to even better results regarding patient-centred outcomes [ 32, 33, 35, 37]. [ 35] identified active listening and touching as important nonverbal communication strategies that make communication quality and effective [ 33]. found that nurse-aide-initiated communication during mealtime assistance using nonverbal communication strategies, such as emotional support, smiling, laughing, touching, eye gazing, shaking hands, head nodding, leaning forward, and a soft tone were crucial in addressing the residents, initiating (and maintaining) personal conversations, and checking in. Finally, [ 37] developed a model that emphasised the importance of effective nonverbal communication in forming effective therapeutic relationships, promoting patient satisfaction, and improving the quality of care. An exhaustive list of the nonverbal communication approaches is shown in Table 6.

In general, most studies, especially the qualitative ones, supported the utilisation of multiple non-verbal communication strategies in a single communicative episode. The studies also implied that it is the responsibility of healthcare providers to initiate and maintain effective nonverbal communication cues, such as those detailed in Table 6. Additionally, it is important to note that it is only one study [ 31] that investigated the effectiveness of comfort touch on patient-centred outcomes. Therefore, the notion implied in qualitative studies that combining various nonverbal strategies could lead to a better improvement in patient-centred outcomes is subject to further empirical investigation. It was noted that there is a lack of empirical studies investigating how the combination of various non-verbal communication techniques or strategies can influence patient-centred outcomes, such as patient satisfaction and perceptions of quality of care.

Verbal communication

Four out of the seven studies implied that verbal communication improved patient-centred outcomes [ 32, 34, 35, 36]. Effective and quality verbal communication was found to impact patient satisfaction positively [ 32], increased awareness of COPD effects [ 36], improved health literacy [ 34], presented problems [ 32], and mental and physical health [ 32]. It is worth noting that [ 32] used a cross-sectional survey approach and used regression analyses to investigate the relationship between communication and various patient-centred outcomes, such as patient satisfaction and mental and physical health. Also, it is important noting that the authors combined both verbal (e.g., more positive talk, greater trust, and receptivity) and non-verbal (e.g., smile, gazing, eyebrow movements, and interpersonal touches) in their study. Therefore, it can be a bit challenging to directly conclude that effective verbal communication alone without non-verbal communication is effective on its own in improving patient-centred outcomes. Similarly, [ 34] combined both narrative-based and picture-based communication strategies to give patients education about health literacy. Therefore, it can be challenging to know whether narratives comprising of verbal communication (and often non-verbal communication) can improve patient-centred outcomes on their own. The rest of the studies were qualitative [ 35, 36], which means that their findings generally reflected the subjective experiences or opinions of their participants. Therefore, it can be said that although all the four studies supported verbal communication can effectively improve patient-centred outcomes, there is a need for future research to experimentally test its effectiveness without being combined with non-verbal communication strategies.

Moreover, two of the four studies implied that some conditions must be met for verbal communication to be effective [ 32, 35]. some communication strategies, such as higher lifestyle discussion and rapport-building rates, were perceived as patronising and associated with poor outcomes [ 32]. Instead, the authors found that communication strategies like seeking and giving biomedical and psychosocial information were more effective in improving patient outcomes [ 32]. It implies that healthcare providers should be attentive and intentional of the topics they discuss with patients. Further, in their qualitative study, [ 35] found that effective verbal communication also requires mutual respect, equity, and addressing conflict. Indeed, it appears that certain communication strategies like lifestyle discussions can undermine the process of establishing trust, which is why they were associated with adverse patient outcomes. Also, unlike nonverbal communication, the studies that highlighted the effect of verbal communication on patient-centred outcomes did not provide rich descriptions of the specific verbal communication strategies that can be used in a face-to-face healthcare setting. The described strategies like using phone calls to regularly communicate with the patient without having to visit a healthcare facility and things to ensure when communicating with the older patient, such as mutual respect and avoiding too many discussions on lifestyle do not offer rich insights into the specific nature of the verbal communication strategies.

Communication strategies

In 3.5.2 above, it was shown that the sample of participants that [ 32] used in their study did not prefer discussions related with healthy lifestyles, which compromised patient-centred outcomes. Therefore, it was also important to determine the best approaches to formulate communication strategies that work. Two out of the seven studies implied how communication strategies can be formulated [ 34, 36] [ 36]. found that a tailored intervention delivered through telephone communication improved patient perceptions of the quality of care. In this regard, the authors first identified the needs of the patients to guide the development of the tailored intervention, from which they might have obtained insights into the patients' communication preferences [ 34]. found a participatory approach to developing a curated story that improves health literacy appealing and understandable. The findings emphasised the need for participatory approaches when developing communication interventions for patients with varied health and social needs. Although the studies did not compare or contrast the effectiveness of participatory-based communication strategies and non-participatory-based communication strategies, their findings provide useful insights into the significance of involving patients when developing them. From their findings, it can be anticipated that a participatory approach is more likely to yield better patient-centred outcomes than non-participatory-based communication strategies.

Patient-centred outcomes

All studies reviewed highlighted patient-centred outcomes as the goal of effective communication in older patients. Patient-centred outcomes included well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility (Butt, 2001), as well as patient satisfaction [ 32, 36], increased awareness of COPD effects [ 36], and improved health literacy [ 34]. Others included presenting problems, mental health, and physical health [ 32], as well as adherence to providers' recommendations, improved quality of care, and shorter hospital stays [ 37]. All seven studies indicated that the various verbal and nonverbal communication approaches could improve these patient-centred outcomes. The consistency observed between the experimental study by [ 31], the qualitative studies, and other quantitative study designs implies the need to pay greater attention to verbal and non-verbal communication strategies used by healthcare professionals as they can directly influence numerous patient-centred outcomes. This consistency further implies that effective communication is the anchor of high-quality care, and its absence will always compromise patient-centred outcomes, such as satisfaction and health outcomes.

Discussion and conclusion

Discussion of findings

In agreement with various studies and reviews conducted in younger populations [ 1, 2, 3], all the seven studies selected in this rapid review supported that effective communication is a cornerstone of improved patient-centred outcomes. Like [ 5, 11, 12], the studies reviewed in this rapid review also supported the idea that effective communication with older adults involves the combination of verbal and nonverbal communication cues. However, this rapid review went a step ahead to identify the specific conditions that must be present for effective verbal and nonverbal communication to take place, such as perceptions of equity, mutual respect, and addressing conflict instead of avoiding it. The qualitative studies used in this rapid review also offered rich descriptions of how providers use nonverbal communication strategies.

However, the main shortcoming of the seven studies reviewed is that none aimed to define or describe what constitutes effective communication with older adults, apart from [ 37], who described a model of nonverbal communication with older adults. The study was qualitative and only formed a theoretical basis of how effective nonverbal communication with older adults could be shaped. The theory developed needs to be tested in an experimental setting so that its effect size in improving patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and emotional and cognitive well-being, can be documented unbiasedly and validly. Therefore, as much as the reviewed studies agreed with younger populations regarding the positive effect of effective and quality communication on patient-centred outcomes [ 9, 10], the methodological rigour of studies with older patients needs to be improved.

Although the individual studies reviewed in this rapid review had low risk of bias apart from [ 31], the screening was based on the judgment of the individual research designs. Otherwise, if the assessment had been done from the perspective of the focus of this rapid review, the risk of bias in studies could have been high in predicting the influence of effective communication on patient-centred outcomes. First, apart from [ 31], none of the studies used a random sample. The qualitative studies used purposively obtained samples, which means the risk of bias from an interventional perspective was high. However, the studies provided in-depth insights into the characteristics and features of verbal and non-verbal communication strategies that can be used to form and maintain provider-patient relationships.

Recommendations for practice and future research

The main recommendation for practice is that nurses and providers serving older patients must be aware of their verbal and non-verbal communication strategies. Besides, they should engage in continuous professional development to enhance their verbal and non-verbal communication skills. Combining a wide range of nonverbal communication, such as touching the patient on the shoulder or arm or even handshaking can help create strong bonds and relationships, which are key in an effective therapeutic relationship. The qualitative studies reviewed showed that nurses and other providers combine a wide range of nonverbal communication in a single interaction instance, such as eye gazing, nodding, touching, and eyebrow movement. Although studies on verbal communication were rare in this rapid review, some lessons learned from the few studies included (e.g., [ 36]) is that using telephones to communicate with older patients regularly is potentially effective in improving patient-centred outcomes like better self-management. The information shared by the nurse should be tailored to serve the specific health needs of older patients. For example, for COPD patients, a nurse can make regular calls to old patients to educate them about the importance of quitting smoking and alcohol to improve their health condition and better self-management. However, as [ 32] indicated, the nurse should be cautious about how to present the information to the client and be able to detect patronising discussions quickly. For example, the sample of adults used by [ 32] found that many lifestyle and rapport-building discussions with the nurse were patronising in ways that may be detrimental to patient-centred outcomes. Some of the strategies providers can employ to ensure that communication is not perceived as patronising by older patients include ensuring mutual respect (e.g., active listening as a sign of mutual respect), creating perceptions of equity rather than favouritism when communicating with multiple patients at a time, and solving conflicts rather than avoiding them, which entails extra efforts, such as understanding the patient's behaviour in the past and present. Overall, although studies have not provided specific estimates of the effect sizes of effective communication on patient-centred outcomes among older adults, there is a general trend and consensus in studies that effective communication, nonverbal and verbal, is the cornerstone of high-quality healthcare.

Further, future research needs to address various gaps identified in this study. The first gap is that although [ 37] tried to develop a model of nonverbal communication with older adults, their study had some drawbacks that limited the comprehensiveness of the model. First, the authors used a sample of only eight older adults in two medical wards in Cameroon. Besides the small sample, the study was conducted in medical wards, which means its findings may not be generalisable to long-term care settings like nursing homes. More older adults who encounter healthcare professionals are admitted in long-term care facilities, calling for developing a more robust communication strategy. Second, [ 37] only focused on nonverbal communication, thereby providing limited practical applicability of the model since verbal and nonverbal communication co-exists in a single interactional instance. Therefore, there is a need to develop a model that provides a complete picture into what effective communication is like with older adults.

After developing a valid, reliable, and generalisable model for effective communication with older adults in various healthcare settings, future research should also focus on investigating the impact of such a model on patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and physical and mental health. More particularly, the developed model can be used to derive communication interventions, which can be applied and tested in various healthcare settings with older adults. That way, research on this subject matter will mature as more and more studies test the effectiveness of such a communication model in various settings and countries. All that is known in the literature is that effective verbal and nonverbal communication can help promote patient-centred outcomes among older adults.

Limitations

Although this rapid review was conducted rigorously by adhering to the PRISMA guidelines, the use of a single reviewer in the study selection process can undermine the quality of the review. When a single reviewer is involved, the probability of missing out relevant studies increases immensely. However, this limitation was mitigated in this review by using an automation tool in the study selection process. In was assumed that combining the automation tool with one independent reviewer could significantly reduce the probability of missing relevant studies.

Another possible limitation is that few studies have been conducted between 2000 and 2023 investigating the effect of effective communication on various patient-centred outcomes. Although the literature recognises the importance of effective communication, and there is a unanimous agreement between studies of various research designs that it is the cornerstone of quality of care, more studies need to be conducted examining how various communication strategies influence patient outcomes, both subjective and objective. For example, [ 31] investigated the effect of comfort touch. Other studies using empirical means (e.g., experiments) can also test the other strategies identified, such as eye gazing, head nodding, eyebrow movement, et cetera. In this way, a more specific and structured approach to communication in healthcare settings can be developed using the evidence base.

Moreover, I initially intended to review studies published within the past five years (2018-2023) but later learned there were insufficient studies meeting the eligibility criteria. Consequently, I adjusted the publication date to the past ten years (2013-2023). I also learned insufficient studies published within that period. Consequently, I chose the period of 2000-2023, which yielded seven studies. Thus, some of the studies included may not capture contemporary realities in healthcare settings, raising the need for more empirical studies on this topic.

Conclusion

This rapid review selected seven studies whose narrative synthesis demonstrated that effective verbal and non-verbal communication could improve patient-centred outcomes. However, the studies were mostly qualitative, and hence they only provided rich descriptions of how nurses and older patients communicate in various clinical settings. It is only one study (Butts, 2001) that was experimental. Still, its risk of bias was high since patients were not concealed to allocation, and participants and outcome assessors were not blinded. Future research needs to focus on deriving a valid, reliable, and generalisable communication model with older adults using a larger and more representative sample size of older patients. Such a model should encompass both verbal and nonverbal communication. After developing a robust model, the next phase of future studies is to derive interventions based on the model and then, through experimental research, test their effectiveness. In that way, a standard approach to communicating effectively and in quality will be achieved, which is yet to be achieved in the current studies.

Data Availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

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Acknowledgements

I thank my wife and children for their patience and the great opportunity to devote a lot of time to doing the article in the best possible way.

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Faculty of Graduate Studies, Arab American University, 13 Zababdeh, P.O Box 240, Jenin, Palestine

Samer H. Sharkiya

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I am the primary and sole author of this article. My contribution to this article is a full contribution.

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Correspondence to Samer H. Sharkiya.

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Sharkiya, S.H. Quality communication can improve patient-centred health outcomes among older patients: a rapid review. BMC Health Serv Res 23, 886 (2023). https://doi.org/10.1186/s12913-023-09869-8
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Quality communication can improve patient-centred health outcomes among older patients: a rapid review - BMC Health Services Research

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Background Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.

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