Aging results in normal changes in cognition.
Three specific changes are reduced processing speed, greater tendency to be
distracted, and reduced capacity to process and remember new information at the
same timewhich is called "working memory." The nature of these changes
often leads to negative stereotypes about older adults, but in fact the changes
are expected and are not signs of "cognitive impairment." Nevertheless, fast
presentation of materials, frequent change of focus, and a background of
distractions and intrusions will reduce understanding and recall of information
for older persons.1,2
Other factors that reduce cognition and health
- Vision and hearing problems.
Aging often includes more time spent on
health-related matters. Many adults manage multiple medical conditions for
themselves and others. These conditions can increase a person's chances of
being distracted and forgetful, meaning he or she may miss appointments, forget
to take medicine, or leave the stove on by accident. In addition, the same
factors that affect memory can also affect "executive function." Executive
function is a term for the ability to develop, carry out, and make necessary
changes to goal-related plans. Executive capabilities are essential to a
person's health literacy and health self-management.1,3
An important consideration for communicating
health information is to make sure specific details and time-related actions
are understood. Poor comprehension of such information can result in decisions
and actions based on only a general or "gist-based" understanding. For example,
the specific order and time to use ice or heat on a muscle sprain is important.
For swelling to be reduced, a person must know the time-related context of that
information. When it is poorly presented and a person's working memory is
challenged, that person often remembers and acts only on the last part of
"step-by-step" information. A poor understanding of the order of actions can
result in poor executive function.1
Another important consideration is to avoid mixing
positive and negative information. Doing so may cause people to remember
messages incorrectly, especially when the information is new. For example, you
may repeatedly remind a patient, "Do not to take this pill with food." But that
patient may actually remember the instruction as, "Take this pill with food."
Also, frequent repetition of information as "not true" may result in that
information being remembered as "true." Older adults are more likely to
interpret the increasing familiarity of a message as truthfulness.1,4,5
What You Can
- Repeating information several times may
help people with memory problems.
- When writing, be specific and repeat your
points. Use pronouns such as "it," "this," and "that" sparingly because they
are indefinite in meaning.
Focus on important details.
- When communicating, stay focused on
important details. Personalize information when possible and minimize
- Be sure details such as timing and the
order of health-related actions are understood.
Emphasize desired actions.
- Communicate directions and advice that
older adults need to follow, not actions they should avoid.
This helps boost memory for appropriate action and reduces confusion. Be aware
that familiarity may be interpreted as truthfulness.
- Avoid using a "myth vs. fact" format.
Use plain language.
- Writing and speaking in plain language
boosts understanding for people with health literacy problems.
- Organize your information with the most
important points first.
- Break information into chunks.
- Use simple words and active voice.
- If you need to use a difficult word,
Consider the effects of stress and
- Know that the stress that comes with
illness and self-care can make anyone tired.
- Understand that mistakes in judgment,
errors, and depressed mood may result more from sickness than cognitive
- If managing technology or a medical
device is important to a person's health, be sure that person can use the
technology or device when tired and stressed.
- Ask stressed older adults to bring family
or friends with them to appointments.
- When possible, communicate important
information during times of low stress.
Be aware of the effects of illness
- Illness, or recovery from treatments such
as chemotherapy and surgery, can temporarily reduce cognitive function. A
person's ability to self-manage treatment or recovery can be compromised under
- Some medical conditions can result in
permanent changes in executive function.
Be sensitive to individual
- Not every older adult is the same, and
not every older adult will experience significant mental decline. Some just
need help in specific areas, so look for ways to clarify those needs.
Provide adequate time for
- A slower pace may be needed when working
with older adults. Factor in extra time so you can adjust the pace with which
you deliver instructions.
References for this table: 1,6,7,8,9
PlainLanguage.gov is a Federal Web site that
includes a large amount of information and resources on plain language. Visit
the site at www.plainlanguage.gov.
- Information included here
with the expert guidance of Elias JW, University of California, Davis.
- Levitt T, Fugelsang J,
Crossley M. Processing speed, attentional capacity, and age-related memory
change. Experimental Aging Research. 2006;32:263295.
- Barrington L, Yoder-Wise
PS. Executive control function: a clinically practical assessment. Journal
of Gerontological Nursing. 2006;32(2):2834.
- Park D. Consumer Fraud and
the Aging Mind. Scientific Testimony Presented to the Senate Special Committee
on Aging. July 27, 2005. Available at
Accessed July 2007.
- Skurnik I, Yoon C, Park DC,
Schwarz, N. How warnings about false claims become recommendations: Paradoxical
effects of warnings on beliefs of older consumers. Journal of Consumer
- U.S. Department of Health and
Human Services, Office of Disease Prevention and Health Promotion. Quick
Guide to Health Literacy. Available at
Accessed July 2007.
- Stableford S, Mettger W.
Plain Language: A Strategic Response to the Health Literacy Challenge.
Journal of Public Health Policy. 2007;28:7193.
- Royall DR. Précis of
executive dyscontrol as a cause of problem behavior in dementia.
Experimental Aging Research. 1994;20,7394.
- Elias JW, Treland JT.
Executive function in Parkinson's disease and subcortical disorders. Seminars
in Clinical Neuropsychiatry. 1999;4(1):3440.