Clinical Encounters with Older Adults: Reframing the Conversation
Holly Hosford-Dunn
September 5, 2017

Barbara Weinstein PhD

Barbara Weinstein’s “Downstream Consequences of Aging” appears bi-monthly at


It is now well accepted that life expectancy is improving, the population of older individuals is increasing, the length of time spent as an older adult is on the rise and prevalence of multimorbidity is growing (Cha, Seo, & Sok, 2012). These demographic shifts have given rise to several important initiatives within the field of geriatrics which should inform our work with older adults.

One innovation is the decision to reframe the language used by the public and policy makers when discussing aging, focusing on promoting healthy aging, optimizing function and quality of life (Martin et al, 2015; Lundebjerg et al, 2017).  No longer considered an inevitable consequence of aging, senile dementia is now recognized as a public health problem for which treatments are available that may delay onset or reduce prevalence (Livingston et al. 2017).

These changes are of relevance to audiologists because older adults represent the bulk of our caseloads and while still considered an invisible condition, the burden of age related hearing loss is considerable. Importantly, our capacity to reduce the burden of hearing loss through our multifaceted interventions is considerable (Wilson et al. 2017). But we too must reframe the conversation!


Reframing the Conversation


As part of their reframing efforts, The American Geriatrics Society (AGS)   partnered with several agencies including the FrameWorks Institute (2017) to begin to spread the word regarding “best language practices” as relates to older persons.  To this end, the AGS published a quick start guide (see Table 1) suggesting language to be used by professionals when writing about “older people.”

This reflects an effort on the part of multiple aging organizations to dispel myths and public perceptions regarding aging as synonymous with decline, deterioration, dependence and as a personal rather than a societal challenge (Lundebjerg et al. (2017).  In their effort to encourage productive practices and policies and to help adapt society to focus on the needs of the aging population, adoption of the language displayed in Table 1 has been recommended (FrameWorks Institute, 2017).

Inspired by VISION 2020, Wilson, and colleagues (2017) suggest that the landscape may be ripe for a HEARING 2020 initiative underscoring the fact that age related hearing loss must cease to be a silent epidemic given the devastating consequences and the potential for personal amplification systems and smartphone technologies to remediate the effects of untreated hearing loss. In short, audiologists must begin to reframe the language surrounding age related hearing loss (ARHL) dispelling the many myths associated with hearing loss and hearing aid use.

Table 1. Language to Be Used When Discussing Aging from the FrameWorks Communication Toolkit (FrameWorks Institute, 2017)




Talk affirmatively about changing demographics – “as Americans live longer and healthier lives.”

Avoid using words such as tsunami or tidal wave when referring to growing population

Emphasize how to improve social contexts and help people thrive as they age.

Use words such as choice or planning when discussing outcomes

Use neutral (older people) and inclusive (we and us) terms

Use stereotypic terms such as seniors, elderly or aging dependents

Refer to aging as a dynamic process leading to new abilities and knowledge; creativity does not dim with aging


Do not use conflict oriented words such as struggle or battle to describe aging experiences




Cha N, Seo E & Sok S. (2012). Factors influencing the successful aging of older Korean adults. Contemporary Nurse, 41, 78–87.

FrameWorks Institute (2017). Gaining Momentum: A FrameWorks Communications Toolkit (available on line). Accessed July 25, 2017.

Livingston, G., Sommerlad, A., Orgeta, V., et al. (2017). Dementia prevention, intervention, and care. Lancet published online July 20.

Lundebjerg N et al. (2017). When it comes to older adults, language matters: Journal of the American Geriatrics Society adopts modified American Medical Association style. JAGS. 65; 1386-1388.

Martin P et al.,(2015). Defining successful aging: A tangible or elusive concept? The Gerontologist, 55, 14–25.

Wilson B et al. (2017). Global hearing health care: new findings and perspectives. The Lancet. July 10 2017.


Barbara E. Weinstein, Ph.D. earned her doctorate from Columbia University, where she continued on as a faculty member and developed the Hearing Handicap Inventory with her mentor, Dr. Ira Ventry. Dr. Weinstein’s research interests range from screening, quantification of psychosocial effects of hearing loss, senile dementia, and patient reported outcomes assessment. Her passion is educating health professionals and the public about the trajectory of untreated age-related hearing loss and the importance of referral and management. The author of both editions of Geriatric Audiology, Dr. Weinstein has written numerous manuscripts and spoken worldwide on hearing loss in the elderly.  Dr. Weinstein is the founding Executive Officer of Health Sciences Doctoral Programs at the Graduate Center, CUNY which included doctoral programs in public health, audiology, nursing sciences and physical therapy. She was the first Executive Officer the CUNY AuD program and is a Professor in the Doctor of Audiology program and the Ph.D. program in Speech, Language and Hearing Sciences at the Graduate Center, CUNY.

feature photo courtesy of shannon christy

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