Communication barriers between older women and physicians

Communication barriers between health care providers and older women are multifaceted and complex. The acute care, hospital-based orientation of the health care system tends to bypass the characteristic problems of older women who need services. Breakdown in communication originates both with the provider and the recipient. Some inherent changes of aging due to sensory loss may be a major factor. Decline in vision, hearing, and touch make communication difficult for both parties. Other deficits may occur due to disease processes such as diabetes and hypertension. A frequently ignored problem is that of the language barrier between laywomen and physicians. Use of jargon and a nonempathic interviewing style by the doctor tend to discourage free exchange of information. A third consideration is the many psychosocial factors which affect the behavior of older women and their relationship with providers. One element is the belief in negative stereotypes of women in general, and older women in particular. Fear of being labeled a "hypochondriac," a "nuisance," or a "crabby old woman" inhibits accurate reporting by patients. Attitudes toward doctors, especially male doctors, make some older women timid and fearful. Physician and patient alike may accept signs and symptoms of disease as a normal part of aging and may cause medically treatable problems to be overlooked. Finally, patient and physician priorities may differ widely. The belief by either party that wellness, prevention, and health promotion are not realistic goals for the older women may push the individual patient into premature frailty and disability which could otherwise be postponed.