The document discusses effective communication between dental teams and elderly patients. It identifies three stages of aging: entering old age, transitional phase, and frail old age. Communication is important considering the diversity of the elderly population and conditions they may have. Effective communication can be two-way (dyadic) or three-way (triadic) and requires training. The Calgary-Cambridge Guide identifies four themes to medical communication: gathering information, biomedical perspective of disease, patient perspective of illness, and background information.

1. 372 Dental Nursing October 2016
DENTAL NURSING ESSENTIALS
The power of three
Why is communication between the elderly
and the dental team significant? It is readily
documented that we are living in a society
that is ageing; people are living longer; there
is a reduction in mortality and a reduction in
birth rates (Department of Health, 2008, p. 1).
It has been suggested that by 2020, the elderly
population will have increased to 18.9% of
the general population. In 2003, it was 15.7%
(BDA, 2003, p4). This will influence and have an
impact on primary care across all health care
provision.
Why is communication in
dentistry so important?
For the purpose of this article, it was necessary
to define the term ‘elderly’, as the elderly
population is a diverse section of society. The
Department of Health (DH) has established
a classification of the term elderly based
upon physical health and ability, rather
than chronological age. The three specified
categories are ‘entering old age’, ‘transitional
phase’ and ‘frail old age’ (DH, 2001, p. 3).
Therefore, considering how diverse
the elderly population is and incoperating the
vast array of physical, emotional or nurological
conditions that potentailly is presented to the
dental team on a daily basis. I would suggest
that elderly specific communication training
would be an essential aspect for the dental
team, especially when we consider the legal
requirement for infomed consent. (Table 1).
It is not within the scope of this article
to examine all the potentail physical, emotional
or nurological conditions that the dental team
may need to effectively interact with. But I will
Trudie Dawson considers the skills for the dental team with an ageing society, revealing the three stages
of ageing and that, very often, there is three-way communication
Trudie Dawson BSc (Hons) RDN OHE is General
and HR Manager for Antwerp Dental Group,
Cambridge.
Table 1
‘The aim of this regulation is to make sure that all people using the service, and those lawfully
acting on their behalf, have given consent before any care or treatment is provided. Providers
must make sure that they obtain the consent lawfully and that the person who obtains the
consent has the necessary knowledge and understanding of the care and/or treatment that
they are asking consent for.
Consent is an important aspect of providing care and treatment, but in some cases, acting
strictly in accordance with consent will mean that some of the other regulations cannot be
met. For example, this might apply with regard to nutrition and person-centred care. However,
providers must not provide unsafe or inappropriate care just because someone has consented
to care or treatment that would be unsafe’. www.cqc.org.uk
endeaver to give an overview to the ageing
process and effective communication.
Background information
The general process of ageing is extremely
variable and individual, and this includes
the ability to cope psychologically with this
transitional phase in life (Patil and Patil, 2009,
p.73). To establish empathy with an older
person requires an understanding of an older
adult’s personal and social history, and the
ability to communicate this understanding
back to the patient in a helpful way. The
communication process requires that both
parties want to communicate (Evans, and
Evans, 1991), and it also helps if the dental
professional is not perceived with general
negativity from the onset (Borreani et al., 2010).
An effective communication
tool
The Calgary-Cambridge Guide has been
widely used in the education of healthcare
professionals (Silverman, Kurtz, and Draper,
2005, p. 16).
This process recognised four themes
to the process of communication within a
medical communication (Silverman, Kurtz, and
Draper, 2005, p. 14-20). Table 2.
Gathering information
Communication is a multi-faceted process,
which involves verbal and non-verbal
communication, of which non-verbal
communication consists of 55%-97% of
the conveyed message. Kings Theory, a
conceptual framework for nursing, articulates
that communication is a two-way process
and involves the ‘perceptions’ of both the
‘sender and receiver’. Consequently, when
a ‘transaction’ occurs, the significance
of that information remains, even if the
sender attempts to modify the previous
communication (Evans and Evans, 1991,
p.11). The significance for this initial stage
in a medical interview is to establish
the patient’s personal requirements,
capabilities and expectations. This can be
established by ascertaining the patient’s
narrative; using attentive listening; picking
up cues and appropriate use of language.
Although, this may be complicated further
depending on whether this communication
is being conducted via a dyadic (two-
person conversation) or triadic (three-
person communication) interaction. Triad
communication comes under this identified
theme of information gathering, as this
represents the processing and clarification of
information via others (Silverman, Kurtz, and
Draper, 2005, p. 20).
The biomedical perspective –
disease
One aspect that that can influence
Table 1. The Care Quality Commission Regulation 11: The Need for Consent.

2. October 2016 Dental Nursing 373
DENTAL NURSING ESSENTIALS
DoH.
7. Ekdahl, A.E., Andersson, L., Friedrichsen,
M. (2010) “They do what they think is best
for me”: frail elderly patients’ preferences
for participation in their care during
hospitalisation. Patient Education and
Counselling. Volume 80. 2010. pp. 233-
240.
8. Evans, C.L., Evans, S. (1991) Imogene
King: A Conceptual Framework for
Nursing. London. SAGE Publications. Inc.
9. Finch, H., Keegan, J., Ward, K., Sanyal-
San, B. (1988) Barriers to dental care. A
qualitative study. Social and Community
Planning Research. London. 1988. British
Dental Association.
10. Regulation11: Need for consent Care
Quality Commission [Internet] 2016,
Available from: <www.cqc.org.uk>
[Accessed 19 August 2016].
11. Ryan, E.B., Giles, H., Bartolucci, G.,
Henwood, K. (1986) Psycholinguistic
and social psychological components of
communication by and with the elderly.
Language and Communication. Volume
6. No.1/2. Pp. 1-24.
12. Patil, M.S., Patil, S.B. (2009) Geriatric
patients — psychological and emotional
considerations during dental treatment.
Gerodontology. Volume 26. pp. 72-77.
13. Silverman, J., Kurtz, S., Draper, J. (2005)
Skills for Communicating with Patients.
2nd ed. Oxon. Radcliffe Publishing Ltd.
Key points
 The onset of frail older age appears to coincide, for some older adults, with less
confidence and a reduced ability to cope with complex experiences.
 The generic process of aging is highly variable and individual, and this includes the
ability to cope psychologically with this transitional phase in life.
 To establish empathy with an older person requires an understanding of an
older adult’s personal and social history, and the ability to communicate this
understanding back to the patient in a positive way.
communication – and the building of
rapport – is the patient’s health (Ekdahl,
Andersson and Freidrichsen, 2010). Ryan
et al. (1986) propose that there is a strong
relationship between health and the ability
to communicate effectively for some older
adults. Numerous medical conditions
may compromise communication and the
provision of dental treatment. It may be that
you would engage with the patient and their
partner or main carer (once the patients
consent for this has been obtained) to be
involved with the discussion of treatment
options to act as an aid for both the patients
pnd yourself.
The patient perspective –
illness
The onset of frail older age appears to
coincide, for some older adults, with less
confidence and a reduced ability to cope
with complex experiences (Ryan et al., 1986)
considered that the natural ageing process
alone might not be solely responsible for the
reduction in the confidence of older people
during a medical encounter. The older
adult’s negativity, either directed towards
the health care provider (Chant et al., 2002)
or perceived from the health care provider
(Borreani et al., 2008; Borreani et al., 2010),
during the medical interaction may prove
to undermine an older person’s confidence
when interacting with the health care
provider.
Background information
The generic process of ageing is highly
variable and individual, and this includes
the ability to cope psychologically with this
transitional phase in life (Patil and Patil,
2009, p.73). To establish empathy with an
older person requires an understanding
of an older adult’s personal and social
history, and the ability to communicate
this understanding back to the patient in a
positive way.
Conclusion
Effective communication with this diverse
section of society can be complicated and
requires the dental professional to engage
with each patient from a care-centred
perspective. Essentially, tailoring the
communication to each specific patient.
Be that in the form of dyadic (two-way)
or triadic (three-way) conversation. This
level of communication takes training and
confidence. Using the Calgary-Cambridge
Guide as a training tool would enable the
dental team to develop their commination
skills with this diverse group of patient.
References
1. Borreani, E., Wright, D., Scambler, S.,
Gallagher, J.E. (2008) Minimising barriers
to dental care in older people. BioMed
Central [Internet] 2008, (7) Available
from: <http://www.biomedcentral.
com> [Accessed 13 July 2010].
2. Borreani, E., Jones, K., Scrambler, S.,
Gallagher, J.E. (2010) Informing the
debate on oral health for older peoples
views on oral health and oral health
care. Gerontology. Volume 27. Pp.11-18.
3. British Dental Association. (2003) Oral
Healthcare for Older people 2020 Vision.
BDA. Key issues policy paper.
4. Chant, R., Jenkinson, T., Randle, J.,
Russell, G. (2002) Communication skills:
some problems in nursing education
and practice. Journal of Clinical Nursing.
Volume 11. Pp. 12-21.
5. Department of Health. (2001) National
Service Framework for Older People.
London. DoH.
6. Department of Health. (2008) Health
and Care Services for Older People:
Overview Report on Research
to Support the National Service
Framework for Older People. London.
Table 2
 Gathering information
 The biomedical perspective-disease.
 The patient’s perspective-illness
 Background information
Table 2. Four themes to the process of communication within a medical communication (Silverman, Kurtz,
and Draper, 2005, p. 14-20).