The purposes of this study were to explore and describe communication patterns between nurses and elderly patients during nursing admission interviews in hospital settings and to apply a sociolinguistic model to identify factors related to communicative competence during admission interviews with the elderly. These research questions were addressed: (1) What kind of communication problems typically occur in nurse-elderly patient interactions during admission interviews in hospital settings when the patient is over 65 years of age, and (2) How do nurses respond to these communication problems?.

The methodological framework was sociolinguistic microanalysis that included analysis of recorded interactions in a natural setting and a replay of key segments during interviews with participants. The sociolinguistic model for analyzing communicative competence included six dimensions: acoustics, phonology and syntax, lexicon, conceptions, intent and credence. The sample consisted of 20 hospitalized elderly and 20 registered nurses who conducted the nursing admission interviews and consented to audio and videorecording. Verbatim transcripts of these dyad interactions, transcripts of investigator conducted individual interviews with each participant of the admission interview, and review of nurse subject documentation material in the patient record were analyzed.

Results indicated instances of both effective communication and miscommunication in the dyad interactions in all six areas of communicative competence. Findings indicated elderly individuals typically do not express needs and concerns overtly, but disclosure tends to be through long, narrative discourse. The elderly often were vague in describing health history and symptoms which created problems when direct responses were needed for the initial data base for nursing care. Factors that contributed to miscommunication occurred in all six areas: acoustics (hearing deficits and environmental noise), phonology and syntax (vague, ambiguous statements), lexicon (abbreviated words), conceptions (vague statements, inattentive listening), intent (lack of explanation of purpose, indirect manner of expressing emotions), and credence (inaccurate messages). Misperception of speech events represented an important source of conflict in the dyad relationship. Task-oriented communication approaches most often resulted in failure to explore and identify psychosocial needs of elderly subjects. Communicative competence during the admission interview is essential to the provision of effective health care of the elderly.