Communication and informed consent in clinical geriatrics

Obtaining a valid informed consent from an elderly person, especially with possible senile dementia of the Alzheimer's type (SDAT), first may involve solving the practical problems of effective communication. Perceptual constraints that frequently occur in the elderly and that may interfere with communication, i.e., the sharing of information, are auditory and/or visual. The most common auditory obstacle, presbycusis (the hearing loss for pure tones due to normal aging) and other hearing impairments, may make the communication of any information about a proposed research project difficult, if not impossible, when not suspected and successfully overcome. Speech and language impediments, whether as a result of stroke or SDAT, are also common and need to be addressed if the person is to communicate his or her concerns and questions effectively with the researcher. Included in such constraints are the misunderstandings that arise from the use of confusing vocabulary, especially "medicalese." Presbyopia, cataract, and glaucoma are some of the visual constraints that may play an important role in making it difficult for the person to read the informed consent form. This article discusses these and other impediments to effective communication with SDAT elderly and makes suggestions how to obviate them.