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1 Introduction

Effective communication between designers and older people is perhaps one of the most critical elements of interview. Communication with older people can be made more challenging as a result of age-related impairments. These age-related changes in hearing, vision, cognitive and physical abilities make face-to-face communication even more demanding [1]. The results of numerous surveys indicate that age-related cognitive and sensory impairments highly affect communication. Many older people with a vision, hearing impairment experience frequent communication breakdowns [2]. Between 30–50 % of 70 year-olds have a hearing loss that is sufficient to interfere with conversations [3]. About 20 % of adults older than 65 years of age experience visual difficulties that can limit clarity of a person’s face at a conversational distance [4]. About 6 % of adults older than 65 years of age exhibit combined hearing and vision impairments (dual sensory loss) [5].

Older people-related communication barriers have been reported in design literature. Communication with users having speech or hearing problems can be difficult [6]. Interaction with older users often presents particular communication challenges for designers. In many cases, designers are forced to rely on their own experience or intuition to guide their assumptions about user characteristics, which may have little relevance to the real situation [7].

In addition, designers with young minds and attitudes are often fashion lovers: they pay more attention to trendy ideas, rather than the knowledge on older people. Very few designers have had training or education in communicating with older people.

This paper presents a first stage of study that seeks to develop a framework, which can help designers learn skills that will enhance their effectiveness in communicating with older people with cognitive and sensory impairments. This study is organized as follows: 1. To identify age-related cognitive and sensory impairments which are relevant to communication; 2. To categorise key aspects of communication that can help designers identify key factors for interacting with older people; 3. To develop a framework to aid communication.

This framework of effective communication was developed based on the transactional model of communication (Fig. 1). The model indicates each communicator is both “the sender” as well as “the receiver” simultaneously. It takes into account “noise” and the factors in communication. Noise is anything that interferes with the intended communication. Time shows that communication changes over time as a result of what happens between people. The outer lines of the model indicate that communication happens within systems that both communicators share their personal systems. It also considers changes that take place in the communicators’ fields of personal and common experiences.

Fig. 1.
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The transactional model of communication (Source: Adapted from [8])

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2 The Three Levels of Effective Communication

The most common deficiency in interviewing with older people remains a failure to demonstrate empathic listening and responding. Empathy is the ability to see things from the other person’s perspective. Developing empathic listening is particularly necessary for understanding the deficits that impede communication with older people.

Empathic listening, according to Stephen (1989), is listening with intent to understand. This kind of listening is not skill-based. It should not truncate from character and relationships. This means seeking first to understand, to really understand.

“The essence of empathic listening is not that you agree with someone; it’s that you fully, deeply, understand that person, emotionally as well as intellectually. Empathic listening involves much more than registering, reflecting, or even understanding the words that are said. Communications experts estimate, in fact, that only 10 % of our communication is represented by the words we say. Another 30 % is represented by our sounds, and 60 % by our body language. In empathic listening, you listen with your ears, but you also, and more importantly, listen with your eyes and with your heart” [9].

However, sometimes we thought we have fully understood what people said, but we did not. An ideal communication requires people to eliminate their personal prejudice. But it is rare and difficult, because we often cannot interact with people without our personal view all the time.

Some people have extraordinary talent in empathic communication, but everyone can learn to become a competent communicator. There are three levels of communication (Fig. 2): acceptable communication, empathic communication and ideal communication. It is possible to learn the skills to conduct acceptable communication and empathic communication (the gray parts in Fig. 2). The framework to be developed later also addresses these two levels of effective communication.

Fig. 2.
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The three levels of effective communication

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3 Age-Related Impairments with Communication

Aging process is not a simple process of declining [10]. It is important to consider that individual differences of communication skills do exist throughout the life span. But, we should be aware that much remains unchanged along the aging process. For example, there is no evidence of decline in most aspects of language abilities among older adults, including the use of language sounds, meaningful combination of words, and verbal comprehension [11]. When communicative differences between older and young adults have been observed, those differences have revealed that in some areas the older perform better than the young [10].

However, communication with older people can be challenging as a result of age-related cognitive and sensory impairments. Some age-related conditions such as hearing loss, and diseases such as dementia and stroke, directly affect individuals’ ability to produce and process language, making communication itself problematic [12, 13]. For instance, cognitive impairments can affect the quality and quantity of linguistic capability; visual impairments will affect the ability to read, and to interpret lip movements. They also affect the ability to detect and interpret other non-verbal communications that accompany speech; hearing impairments can cause difficulties with understanding verbal communication, and also generating speech [14].

Effective communication with these older people requires designers to have a thorough understanding of older people’s capabilities and communicative difficulties (Table 1). Designers may learn techniques to adapt to communication deficits of older people with cognitive and sensory impairments. Developing empathy is particularly necessary for understanding the physical deficits of older people that impede communication.

Table 1. Age-related cognitive and sensory capabilities and communication
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Cognitive changes in older adults are highly variable from one person to another [11]. Dementia adversely affects people’s receptive and expressive communication. Older people with memory loss have some difficulty with recall of recent activities or events.

Vision is important for understanding non-verbal communication cues. Gestures, lip reading, contextual cues, facial expressions and eye gaze are important non-verbal elements to communication that may be missed by an older person with vision impairment [2].

Hearing loss makes it difficult for older adults to understand and remember speech in the presence of background noise, especially multiple competing conversations [11]. Older adults with age-related hearing loss often try to compensate by reading the speaker’s lips. This is possible only if the older adult can see the speaker’s lips, preferably at face level [11].

4 The Factors of Effective Communication with Older People

Effectiveness involves achieving the goals we have for specific interactions [8]. Effective communication is vital for the designer and the older people in obtaining a successful and positive relationship, and allow them to have a satisfied interaction. Here, within the design context, the term “communication” is narrowly defined, referring only to designer-user face to face interactions within a work setting.

Assumptions are often made that because someone has chosen to design for older people as a project, so they will have empathy when interacting with older people. Sometimes this is not the case. Some designers appear to have the innate ability to be empathetic; others may never have had these traits or with little respect and recognition of the needs of older people. Even though we speak to older people with empathy, sometimes even regarding older people as grandparents, we may recognize that we still need to combine specific techniques, especially with those older people who have cognitive and sensory impairments.

Therefore, designers need to learn how they transmit information and how to be sensitive to those messages expressed by older people. We have to look for an acceptable and efficient approach to achieve this goal by combining techniques and empathy. Meanwhile, we need to remember to eliminate our prejudice as much as possible. It should also be highlighted that listening is more important than speaking, although communication is a two-way process.

First, we need to understand the designer-older people communication system presented in Fig. 3, which is developed based on the transactional model of communication [8]. As we know, effective communication is an activity that depends on clear expression and full comprehension of both sides. But in the interview, it is often the designer who remains in control [20] because he/she collects data from the older respondent. Therefore, it is the designer’s responsibility for choosing an appropriate means for communication which can work well for both sides.

Fig. 3.
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The designer-older people transactional model of communication

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Designers’ interviewing older people is a conversation (speaking channel) that has a structure and a purpose determined by designers. It is a research professional interaction, which goes beyond the spontaneous exchange of views as in everyday conversations, and becomes a careful questioning and listening approach with the purpose of obtaining thoroughly tested knowledge about [21]. Ethical issues go through the entire process of an interview investigation, and potential ethical concern should be taken into consideration from the very start of an investigation and up to the final report [21].

A designer/an older person encodes messages (verbal/nonverbal), and then transmits the message via a speaking channel to the other side, and then decodes the message (verbal/nonverbal). The message may encounter noises, which interferes with the decoding of messages sent over a speaking channel by an encoder (e.g., any physical environment, psychological, physiological distraction or interference), which could prevent the message from being received or fully understood as the sender intended. The shared field of experience shows how communication becomes more difficult when designers and older people have less in common.

From the Fig. 3 we can see designers could achieve effective communications mainly through three means: i.e., 1. Increasing shared field experience; 2. Encoding/decoding messages correctly; 3. Decreasing “noises”.

4.1 Increasing Shared Field Experience

Shared field experience is a common ground between a designer and an older person. To share a common experience is helpful to understand each other, and can create trust and security. Before interview, it is useful to gather preliminary data on user background; at the beginning of the interaction, engaging with older people in a brief dialogue may help the designer to understand the culture background, personal experience of the older person. They can also assess the level of sensory impairments of the older person.

4.2 Encoding/Decoding Messages Correctly

The designer encodes messages by using verbal/non-verbal ideas and thoughts to process the information. The purpose for decoding is for the designer to be able to comprehend the older person’s messages to his/her best of understanding. To encode/decode messages correctly requires designers to be more attentive to both verbal (i.e., words spoken) and nonverbal cues (i.e., the ability to express and interpret facial expressions, body posture and movements, and vocal tones). This process should not be conceived as a one-size-fits-all sets of procedures. It requires the designer to take into account the diversities of older people. Every old person is special; designers need to listen and respond to each one on an individual basis.

4.3 Decreasing “Noise”

Noise can be anything that prevents effective communication from happening.

  • To exclude the negative influences on context (physical environment and time)

    • Environment: eliminate visual and auditory distractions as much as possible. For example, provide adequate illumination; eliminate reflective glare; visual distractions; and reduce noise and echo in the room.

    • Time: to appoint an appropriate time and control the length of time. For example, hearing worsen later in the day, morning appointments are generally better for older people [22]; it is useful to consider their nap time and provide frequent washroom times if possible.

  • To isolate physiological noise

This requires an understanding of the capabilities of older people with cognitive and sensory impairments.

  • To isolate psychological noise

Real communication barriers exist beyond linguistic. Designers’ attitudes and behaviors can make older people unwilling to listen and talk. One of the most important things to remember is to avoid ageism. Designers should regard each older person as a unique individual with valuable experiences and treat them respectfully. Designers need to express respect nonverbally and verbally as this is the most powerful way to build a relationship. Moreover, if one wants to have a really effective interpersonal communication, one cannot do it with techniques alone. One has to build the skills of empathic listening on a base of one’s character that inspires openness and trust [9].

  • To avoid semantic noise

It exists when words themselves are not mutually understood. Sometimes the designer creates semantic noise by using jargon or unnecessary technical terms. It is better to use everyday language.

5 A Framework of Effective Communication

Any communication process can be divided into three stages: before, during, and after, the communication. In the Fig. 4, before the communication, the designer should collect the older person’s personal information, including cultural background, personal experience and capabilities. The designer also needs to be aware of the communication context, to choose appropriate environments and arrange proper time, such as providing adequate illumination, eliminating reflective glare and visual distractions, reducing the environment noise and echo. During the process of the communication, designers need to reasonably use verbal and nonverbal communication skills. At the same time, empathic listening and responding should be applied from the beginning to the end. After the communication, designers should summarize the feedback which is provided by older person. It will tell the designer how well they have decoded the message.

Fig. 4.
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A time process model of communication

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The designer must know how to use verbal and nonverbal skills effectively when he/she interviews older people with cognitive and sensory impairments. In the framework (Table 2), the typical causes of older people’s communication difficulties are listed in rows, and the verbal/nonverbal behaviors of designers are listed in columns.

Table 2. A framework of effective communication with older people
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The framework can be used either as a checklist or as an information collection tool:

  1. (1)

    A checklist: The framework as a checklist let designer consider what communication techniques should be focused on before an interview; If any communication barrier occur, designers can correct their behaviors immediately by checking the factor in the framework.

  2. (2)

    An information collection tool: After the interview, designers sum up all their communication experiences, using the framework provided. After accumulating enough experiences, designers can create a personal communication guidance. As a common framework, it offers flexibility to all designers, which could be shared, augmented and personalized over time.

For example, in preparing for an interview with a visually impaired older person, the designer can identify the important areas by mapping the links between communicative difficulties of vision and verbal/nonverbal behaviors. And then write down appropriate communication techniques in each area. After a number of interview practices, the designer will enrich this framework as a systematic guidance full of communication tips.

Meanwhile, the designer needs to be more attentive to both verbal and nonverbal cues of the older person. Designers could ask questions and paraphrase what the older people said to clarify meaning. Furthermore, as we know, cognitive and sensory impairments have considerable impacts on self-image and confidence. Many older people are reluctant to disclose their cognitive, visual and hearing impairments. Designers need to be sensitive to the behaviors that indicate the older person’s impairments. For example, if an older adult is turning his or her head to one side, it may be to adjust the visual distance or angle for improving vision to see you. If an older person often asks you to repeat what you have said, he/she may have a hearing impairment.

6 Conclusion

This paper is intended as a starting point for designers interested in understanding how age-related changes may influence communication and how to effectively communicate with older people with cognitive and sensory impairments. A framework provides an acceptable approach to help designers learn communication techniques. However it is not a panacea. Designers need to practice and find which strategies work best for them. Different older adults have different communication needs, which may require different techniques of communication. However, if we begin with this simple framework and if we train ourselves, we will find increased effectiveness and satisfaction, and will be able to communicate better with older people who have cognitive and sensory impairments.

The framework will be further developed with designers to ensure that the categorization is as useful as possible, and will be tested with designers to improve its usability and appropriateness.