There are very real and practical difficulties of communication with older cancer patients. Cancer increases in prevalence steadily as people get older and it occurs in many different body sites. Communication difficulties become compounded with older patients who have to deal with multiple deficits, including sensory losses and physical frailty. These issues become extremely challenging and frustrating when those older patients have cognitive deficits and begin losing, or have lost, aspects of their autonomy and independence. The challenge for oncology staff is to know how to communicate appropriately with patients in various circumstances. Physicians can work together with the elderly patient to improve the quality of communication during the medical encounter. This chapter reviews the small communication literature from the fields of geriatric psychiatry and cognitive disorders. It also looks at case studies and provides practical solutions for common problems that arise when communicating with the elderly who are cognitively impaired.