Root M J
Division of Clinical Education, Oklahoma College of Osteopathic Medicine and Surgery, Tulsa.
Public Health Rep. 1987 Jul-Aug;102(4 Suppl):152-5.
Communication barriers between health care providers and older women are multifaceted and complex. The acute care, hospital-based orientation of the health care system tends to bypass the characteristic problems of older women who need services. Breakdown in communication originates both with the provider and the recipient. Some inherent changes of aging due to sensory loss may be a major factor. Decline in vision, hearing, and touch make communication difficult for both parties. Other deficits may occur due to disease processes such as diabetes and hypertension. A frequently ignored problem is that of the language barrier between laywomen and physicians. Use of jargon and a nonempathic interviewing style by the doctor tend to discourage free exchange of information. A third consideration is the many psychosocial factors which affect the behavior of older women and their relationship with providers. One element is the belief in negative stereotypes of women in general, and older women in particular. Fear of being labeled a "hypochondriac," a "nuisance," or a "crabby old woman" inhibits accurate reporting by patients. Attitudes toward doctors, especially male doctors, make some older women timid and fearful. Physician and patient alike may accept signs and symptoms of disease as a normal part of aging and may cause medically treatable problems to be overlooked. Finally, patient and physician priorities may differ widely. The belief by either party that wellness, prevention, and health promotion are not realistic goals for the older women may push the individual patient into premature frailty and disability which could otherwise be postponed.
医疗服务提供者与老年女性之间的沟通障碍是多方面且复杂的。医疗系统以急性病护理、医院为导向，往往会忽略需要服务的老年女性的特有问题。沟通障碍既源于医疗服务提供者，也源于接受服务者。衰老过程中因感官功能丧失而产生的一些内在变化可能是一个主要因素。视力、听力和触觉的衰退使双方的沟通变得困难。其他缺陷可能是由糖尿病和高血压等疾病过程导致的。一个经常被忽视的问题是外行女性与医生之间的语言障碍。医生使用行话以及采用缺乏同理心的问诊方式往往会阻碍信息的自由交流。第三个需要考虑的因素是许多社会心理因素，这些因素会影响老年女性的行为以及她们与医疗服务提供者的关系。其中一个因素是对女性，尤其是老年女性的负面刻板印象。害怕被贴上“疑病症患者”“讨厌鬼”或“脾气暴躁的老女人”的标签会抑制患者准确报告病情。对医生，尤其是男医生的态度使一些老年女性变得胆小和恐惧。医生和患者可能都将疾病的症状和体征视为衰老的正常组成部分，从而可能导致一些可通过医学治疗的问题被忽视。最后，患者和医生的优先事项可能有很大差异。任何一方认为健康、预防和健康促进对老年女性来说不是现实目标，这可能会使个体患者过早地陷入虚弱和残疾状态，而这些情况原本是可以推迟的。
