Interviewing the Elderly – Factors to Consider

Bennett Blum, M.D.

The following is a list of situational and interviewer characteristics that have been shown to improve the quality of interviews with the elderly. This is not an exhaustive list. Please feel free to contact me if any items are unclear, or if you have questions.

Environment

1. Conduct the interview in a location that is well known to the elder and is comfortable for him/her.
2. The room should have good lighting, minimizing glare.  Minimize extraneous noise by turning off all radios, televisions, and machinery (if possible). Shut doors and windows to minimize noise from outside the room.
3. If the interview is not conducted in the elder’s home, amenities should be available for the elder’s comfort. These include:
   1. Adequate handicap and regular parking. Easy access into the building, elevators, waiting area, and office/conference room/courtroom chambers.
   2. Comfortable waiting area. In courthouses, elders should have a separate waiting area. This reduces their anxiety (Consider: Would you want your grandmother to sit on a hard bench for several hours, in the same waiting area as gang members, drug dealers, rapists, thieves, and killers?)  In all settings, many elders fee more relaxed if they can watch soap operas or game shows while waiting.
   3. If possible, adjust the temperature to be comfortable for the elder.
   4. Water, juices, and sodas should be available, as well as sugar, candy, and low-salt and regular crackers. In addition to feeling thirsty, elders may need to take medications, quell upset stomachs, and treat hypoglycemic episodes. Elders may not be able to drink out of bottles, or may not be comfortable with that practice. Have disposable cups available.
   5. There should be a clock. It should have large numbers and be easily visible.
   6. Nearby bathroom with sufficient access for wheel chairs or walkers, good lighting, and handrails.
4. The interviewer’s face should be well lighted. He should never have a major source of light behind him, placing his face in shadow. Do not turn away while speaking.
5. The Interviewer should be 3-6 feet away from the elder during the interview.
6. The interviewer should be at eye level with the elder.
7. The interviewer should sit directly in front of the elder, if possible.
8. Extra lighting is necessary if the elder is expected to read documents.
9. Make paper and pens/pencils available for the elder.
10. Conduct the interview at a time when the elder is usually the most alert. Cognitive abilities may fluctuate based on the time of day, meals, medication, and activity level.

Printed Material

1. Print size should be 14-point or larger. The document is printed in 14-point.
2. Font should be simple and without seraphs.
3. There should be high contrast between the printed material and backgrounds. Example: Black ink on white paper may be more easily seen and read than red ink on a black background.
4. Anticipate that an elder may require more time to read a document. Do not rush.
5. Make duplicate copies available for the elder.

Audiences

1. If possible, interview the elder without others present.
2. If others must be present, minimize the number of spectators, and position them so they are not in the direct line of sigh of the elder. Maintain eye contract with the elder, unless specifically speaking to others in the room. There should be no interruptions from other when speaking to the elder. Because that is not always possible, or reasonable, keep such interruptions to a minimum. “Interruptions” includes both verbal and non-verbal communication.

The Interviewer

1. Be prepared to spend a lot of time listening to the elder. Displaying impatience is more like to cause the elder to withdraw and not provide important information.
2. Maintain a calm and professional manner at all times.
3. Notice the elder’s environment and use that information as appropriate. For example, in one case the interviewer noticed family photographs covering the walls in an elder’s home, yet the elder claimed to have no family. The photographs belonged to an abuser who had all by physically moved the elder out of her home against her will.
4. Be aware of the elder’s nonverbal communication. Watch for signs of distress, nervousness, fear, confusion, etc.
5. Be away of your nonverbal communication. Signal interest and attentiveness.
6. Establish eye contact before speaking.
7. Be sure the elder can see your face clearly. Many elders have hearing loss and cover up impairments by lip reading. Female interviewers should consider wearing lipstick, as this helps the elder’s ability to lip read. Similarly, do not cover your mouth, chew gum, eat, or smoke while speaking.
8. Do not use patronizing terms such as “dear,” “honey,” or “sweetheart.” Do not condescend.
9. Speak directly to the elder unless directed to do otherwise. If speaking to others in the room, include the elder in the conversation.
10. Do not yet.
11. Speak clearly and in short sentences. Expect to repeat yourself.
12. Ask one question at a time. No compound questions.
13. Ask open-ended questions. Avoid questions that may be answered “yes” or “no”.
14. Use written materials as needed to supplement verbal information.
15. Periodically, ask the elder to summarize the discussion.

Special circumstances

1. 1. If using an interpreter:
      1. Use professional interpreters.
      2. Instruct the interpreter to translate comments exactly as they are said. You want to know if the elder adds unwarranted or unusual comments.
      3. Speak directly to the elder, not to the interpreter.
   2. If the elder is blind or otherwise visually impaired:
      1. Do not touch or speak to a guide dog without the elder’s permission.
      2. Use the elder’s name frequently.
      3. When guiding the elder to a seat, place his/her hand on the back of the chair to indicate where to sit.
   3. If the elder has difficulty hearing:
      1. Speak slightly louder than normal and do not try to over-articulate.
      2. Speak at a normal speed.
      3. Yelling, over-articulating, or speaking too quickly distorts sound. Do not speak into someone’s ear.
      4. Consider using visual aids and written material.
      5. Consider using sign language or a professional sign language interpreter.
   4. If the elder has a speech impediment:
      1. Allow more time for responses.
      2. Consider having the elder write responses or indicate responses by behavior. Example: Following a motor vehicle accident, a man was bedridden, unable to speak, and almost completely paralyzed below the neck. He was able to blink and could move his right thumb slightly. In preparation for conservatorship and guardianship hearings, the man communicated with the interviewer by an agreed upon series of eye blinks and thumb movements. By doing do, the injured man knowingly participated and gave important information to the Court.
      3. Consider using sign language or a professional sign language interpreter.
   5. If the elder has had a stroke:
      1. Strokes may affect physical movement, cognitive abilities, and/or emotional control. Because of this, the elder may require more time than normal to complete tasks. The elder also may need frequent breaks during the interview, or may need to prolong the interview over several days.
      2. Because of impaired emotional control, elders who have had a stroke may become more anxious than the situation apparently warrants.
   6. If the elder is intellectually impaired (due to stroke/injury, disease, or developmental disability):
      1. Minimize use of abstract terms or concepts. Use clear, unambiguous, concrete language whenever possible.
      2. Use short sentences.
      3. Have the elder frequently summarize what the interviewer said.
      4. Take frequent breaks.

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