Age, Disability, and Dementia-Friendly Communicating

If you are a legal professional, you likely interact with a number of older adults, people living with disabilities, or people living with dementia in the course of your practice.

Having an age, disability, and dementia-friendly practice can help your clients feel more comfortable, be more willing to use your services, and make your services more user friendly for all people, regardless of age or ability.

An age-, dementia-, and disability-friendly practice covers a range of practice considerations, including knowledge, in-person interactions, written materials, and the physical environment. Such a practice will facilitate more effective communication between practitioner and client. The following strategies are also useful for substitute decision-makers in fulfilling the decision-maker’s duty to consult with the adult when making a decision that impacts the older adult.

Duty to Consult

All types of substitute decision makers have a duty to consult with the adult. The exact responsibilities differ, however, depending on the type of decision maker. Effective communicating strategies are important for substitute decision-makers to effectively fulfill their duty to consult.

The Representation Agreement Act allows an adult to choose who will make health care, personal care, or routine financial decisions for the adult when the adult is incapable. Under this Act, a representative must consult with the adult as much as possible. A representative must comply with the adult’s wishes if it is reasonable to do so.

The Power of Attorney Act allows an adult to choose a person to make financial decisions for the adult, either after incapacity or before and after incapacity. An attorney must encourage the adult’s involvement in decision-making and must take into account the adult’s current wishes. There is, however, no duty to comply with these wishes if the adult does not have decision-making capacity.

For both a Representation Agreement and a Power of Attorney, if the adult still has decision-making capacity for the decision at issue, the representative or attorney cannot override the wishes of the adult. The adult is presumed capable and has a right to make whatever decision the adult wishes, even if it would seem risky. It is only when the adult does not have decision-making capacity that the representative or attorney may be able to override the current wishes of the adult, depending on the specific circumstances, the requirements in the legislation, and the provisions of the agreement. The decision-maker must still comply with prior expressed wishes the adult made when capable.

Under the Health Care (Consent) and Care Facility (Admission) Act, if the adult does not have decision-making capacity for the health care decision and does not have a representative, the medical professional can obtain substitute consent from a person on a hierarchical list of possible temporary substitute decision-makers (TSDMs). A TSDM must consult with the adult as much as possible.

There is no duty to comply with the adult’s current wishes, but the TSDM must comply with the adult’s wishes expressed when the adult still had decision-making capacity.

Under the Patients Property Act, if the adult does not have decision making capacity and does not have a representative or attorney appointed, the Court can appoint a committee [comm-it-tay]. The committee has a duty to encourage the adult’s involvement in decision-making.

Knowledge and Language

There is significant social stigma around aging, disability, and dementia. To have an age- and disability-friendly practice, you must avoid stereotypes.

To avoid perpetuating stereotypes:

avoid ageist language, including the terms aged and elderly;
avoid being patronizing or protectionist as older adults know what is best for themselves;
recognize older adults are active participants in society;
recognize older adults have a wide range of abilities, roles, and interests; and
recognize older adults have unique values and lived experiences.

Language can have a harmful impact on people and contributes to stigma and discrimination. The language around dementia and disability is often negative, focusing on what has been lost and reducing people to labels. Language should be people-first, such as “person living with dementia.” Be alert to what language you are using as it can promote dignity and autonomy. Keep in mind the term dementia is not universal. You may need to learn what term is appropriate for the cultural group with which you are interacting.

In-Person Interactions

How you interact with clients, how you conduct meetings, and what language you use can have a big impact on a person with communicating challenges or dementia. This section will outline strategies you can take when meeting with clients in person, over the phone, or using video technology.

When scheduling meetings, choose a time of day that works best for the client. People living with dementia may have times of day that are better for them to take in information. That is most often earlier in the day, but it will differ from person to person. If possible, schedule extra time for the meeting so you can give the client more time to process information, ask questions, and have a break. Hold meetings in a quiet location with few distractions

Other Ways to Maximize Client Capacity and Decision-making

Allow the client to bring a supporter to help the client take in information and communicate wishes, unless this person may be abusing or mistreating the client.
Make sure your client has any assistive devices needed, such as mobility aids, hearing aids, or memory assistive technology.
Sit close to the client and avoid sitting across a table.
Give the client plain-language written information summarizing what you have discussed.
Break down information into small, meaningful chunks.
Be flexible and patient.
Allow the client time to ask follow-up questions.
Give the client extra time to make decisions.

The language you use can impact the ability of a person with reduced capacity to understand information. These are some strategies to increase comprehension, improve interactions, and be respectful and inclusive in the way you communicate.

Use plain language and avoid jargon.
Use informal speech.
Avoid sarcasm.
Avoid abbreviations.
Summarize what you have told your client and allow the client time to correct anything.
Rephrase information if the client does not understand.
Maintain eye contact.
Pay attention to non-verbal cues; people use gestures, body language, and action to express themselves.

Written Material

When writing material for both print and online, it is important to know your audience. If the materials are for other professionals, you may use professional language and be very detailed. If you are writing for a client, especially a client who may be older or have a disability, it is important to write in an accessible manner.

The following tips can help ensure your material is accessible to anyone, no matter the person’s education or abilities:

Write in plain language.
Minimize technical or professional language, terms, or jargon.
Limit the number of key points you are making.
Put your key points first.
Write in a direct manner.
Write in an active voice.
Write in short words, sentences, and paragraphs.
Use real-life examples, but use examples sparingly and thoughtfully.
Use person-centred language, such as person living with dementia, person who uses a wheelchair. The way you design and present a document can make it more readable and understandable.
Use a larger font of at least 12 points.
Avoid italics, underlining, and capitalizing full words as much as possible.
Use headings.
Break material into smaller sections.
Space out paragraphs.

The way you design and present a document can make it more readable and understandable.

Use a larger font of at least 12 points.
Avoid italics, underlining, and capitalizing full words as much as possible.
Use headings.
Break material into smaller sections.
Space out paragraphs.
Make use of blank space on the page.
Make paragraphs flush to the left and ragged on the right.
Use visuals to illustrate your point, but be sparing and use a simple design. Websites should be designed so they are accessible for all people, regardless of ability.

Tips for Making Websites More Accessible.

Make text easy to enlarge.
Use high-contrast colours.
Have information available in multiple formats, including text, audio, and visual formats.
Leave a lot of space around clickable targets.

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Sara Pon is a Canadian Centre for Elder Law Legal Research Assistant.

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References:

The resources below are the sources used for this article. See the resources for additional information on age-and disability-friendly communication:

Public Health Agency of Canada, Age-Friendly Communication – Facts, Tips and Ideas, Catalogue No HP 25-11/2010E-PDF (Ottawa: Public Health Agency of Canada, 2010)
World Health Organization, “Global Age-friendly Cities: A Guide” (2007)
Alzheimer Society of Canada, “Meaningful Engagement of People with Dementia: A Resource Guide” (2015)
Alzheimer Society of Canada, “First Responder Handbook” (2015) • Alzheimer Society of Canada, “Person-Centred Language Guidelines” (2017)
Kevin Smith, “Elder Law Toolkit” (Paper delivered at the Canadian Elder law Conference, Vancouver, 15 November 2019) [unpublished]

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