Make your office elderly friendly

For many ophthalmic practices, the elderly make up a large portion of the patient base. Ensuring that your office is elderly friendly keeps these older patients more comfortable during their visits and more likely to return as well as to refer others.

The majority of my patients are Medicare recipients, and I’ve found that tailoring my office to their needs increases their comfort level. A comfortable patient is more relaxed, and the examination goes much more smoothly with a relaxed patient.

Most of the suggestions I offer here to improve your practice for the elderly are simply common sense.

Office design

From the moment your older patients arrive, they should feel welcome.

Ensure that you have enough clearly marked handicapped parking spaces. Your walkways should be wide enough to accommodate walkers and wheelchairs. Sidewalks and parking lots must be well lit.

All doorways, exterior and interior, should be wide enough for walkers and wheelchairs. Install handrails in the bathrooms.

Reception

Be sure the height of your reception desk isn’t too high for patients in wheelchairs. Tack down the edges of carpeting and avoid loose rugs to keep safe patients using walkers or crutches.

Aim to schedule the elderly earlier in the day when your office may not be as busy. Plus, many older people are early risers and will appreciate an earlier time slot.

When designing exam forms, allow enough room for old hands to enter information and be sure the type is large enough for old eyes to clearly read.

Be mindful that elderly patients move more slowly than their younger counterparts. No need to rush them-they already know that they are slow. Simply saying, “Please don’t rush, there’s no hurry and we have plenty of time,” can be comforting to elderly patients. Staff should also be alert if a patient is not steady on her feet and may need help sitting, standing, or walking from room to room.

Be sure bathrooms are well stocked with toilet paper. Many older people take diuretic medications, requiring frequent trips to the restroom.

In the exam room

When preparing patients for the examination, remember that elderly patients frequently have hearing problems. I suggest talking low and slow-high registers in hearing are lost as people age. Women have higher pitched voices, and voices tend to go higher when speaking quickly. Speaking slower and in a consciously lower tone-think the bottom of your voice-helps to enhance communication. Low and slow can replace loud, which is exhausting for the doctor or staffer speaking with the patient and irritating for others to hear. In addition, speaking loudly may cause patients to think you are yelling at them, which in fact you are.

When communicating with elderly patients, use correct terminology, then use terms to better explain what you’re trying to say. Try using models or charts during your conversation to visually convey concepts. Printed summaries are another good idea, provided that the font is large enough for the patients to read. Also, sit facing elderly patients when speaking to them. This allows them to “see” what you are saying as well as hear you.

Prior to the exam, describe the steps of the exam so the patient knows what to expect. The doctor should narrate the steps of the exam as well as he or she goes through the process. Many times patients don’t know that the doctor just examined the patient’s crystalline lens to determine what type of cataract she has, for example. A short sentence or two will help patients understand what’s happening-and understand the value of the exam as well.

Try to keep distractions out of the exam room. Music, interruptions, noise from the hallway, extra people add clutter to the process.

Allow the doctor enough time to examine elderly patients without interruption. During the exam, staff or doctor should encourage the patient, especially during refraction. For example, say “Great job on that!” or “We’re about  halfway through, and you’re doing a great job.”

In the optical

Your best move when helping older patients while in the optical is to keep things simple. During frame selection, offer a few choices similar to what the patient is currently wearing, then try to gauge what she might like. Keep in mind that just because a patient is 85 years old doesn’t mean she might not want a frame with color or bling, which is on trend today.

Don’t neglect discussion of second pairs. Plus, I’ve found that an amber tint greatly helps to cut glare and enhance contrast, especially if the patient has cataracts. A tint can continue to help even after intraocular lens (IOL) implantation.

People skills

Listen to what patients are saying to you. Take the time to slow down and pay attention to what they say.

Smile. Make eye contact frequently with patients. Meet patients’ needs without them feeling like they’re a bother to you or you don’t have time for them.

Above all, our office mantra is to be kind. Treat patients how you would like to be treated.