Dispensing to the Elderly Patient

Question 1

Identify barriers to effective communication with the elderly

Answer 1

• Stereotyping
• Depersonalizing
• Control or loss of control
• Reluctance or inability to communicate by the patient
• Physiologic barriers to communication: visual, hearing, cognitive impairment

Question 2

Stereotyping

Answer 2

• Dismissing problems as a normal part of aging
• “Older people may evoke negative images”
• “Old people are lonely”
• “Old people are confused”

Question 3

What are solutions to stereotyping?

Answer 3

• Identify our stereotypes and work to overcome them

* Appreciate the heterogeneity of the older population

Question 4

Depersonalizing attitudes

Answer 4

• Talking to the caregiver instead of the patient
• Failure to personalize the interview
• Using a scripted monologue

Question 5

What are solutions to depersonalizing attitudes?

Answer 5

• Address the patient directly
• Display empathy and concern
• Encourage dialogue
• Use respectful language: “Mr.”, “Mrs.”, etc

Question 6

Controlling behavior

Answer 6

• Pharmacists discourage active participation by using exclusively closed-ended questions, rushing
through the interview or using an authoritarian style
• As a result, the older patient may feel vulnerable and helpless, true problems can be missed and poor compliance may occur

Question 7

What are solutions to controlling behavior?

Answer 7

• Attempt to make the patient an active participant

* Identifying your behaviors and make changes.

Question 8

What are solutions to reluctance or inability to communicate by the patient?

Answer 8

Pharmacist should be proactive and encourage the patient to participate

Question 9

Communication Issues in the Elderly

Answer 9

• Verbal communication
• Non-verbal communication
• Hearing issues
• Cognitive issues

Question 10

Summarize aspects of verbal communication

Answer 10

• Use of appropriate language
• Awareness of cultural differences
• Awareness of health belief differences
• Tone and loudness of voice
• Empathy
• Respect
• Genuineness

Question 11

Summarize aspects of non-verbal communication

Answer 11

• Stance
• Eye contact
• Listening
• Expressions
• Distractions
• Empathy

Question 12

What are solutions to vision impairment?

Answer 12

• Ensure adequate lighting
• Glasses
• Large type on Rx label without glossy tape
• Supplemental information should be in large type and non-glare finish
• Write out instruction in larger print. Offer to read the labels for the patient. Use pictograms
• Color codes
• Divided pillboxes

Question 13

What are solutions to hearing impairment?

Answer 13

• Speak slowly and clearly with pauses
• Do not shout. Speak clearly with a slightly increased volume. Avoid talking in a higher pitch
• Face the patient directly making sure they can see your mouth to read you lips
• Minimize background noise
• Use written supplements, gestures or diagrams
• Incorporate family members

Question 14

Hearing impairment

Answer 14

• Common amongst the elderly but not universal

* Clues to hearing impairment: inattentive, request repetition, speaks loudly or does not respond to questions.

Question 15

Cognitive impairment

Answer 15

• Memory and learning do decline > age 70 due to a slowing of the cognitive process
• Older people may need more time to process new information and answer questions
• Older people may not be able to perform multiple task
• If the patient is profoundly impaired be sure a caregiver is present.

Question 16

What are solutions to cognitive impairment?

Answer 16

• Talk directly to the patient even if the caregiver is present
• Use simple, direct wording and short sentences
• Slow down, take your time
• Accommodate for accompanying visual or hearing loss.
• Orient the patient to what you are doing
• Do not overload the patient
• Be organized
• Be supportive and reassuring

Question 17

List factors that influence medication compliance in the older patient

Answer 17

– Age (?) 
– Cost of medications 
– Insurance coverage 
– Dosage form 
– Memory deficit
– Functional disabilities 
– Number of medications and complex dosage schedules 
– Side effects 
– Transportation problems 
– Lack of proper patient education 
– Health belief model 
– Health literacy

Question 18

Construct strategies to improve medication compliance in the older population

Answer 18

• Simplify dosing regimen
• Overcome functional disabilities
• Overcome financial barriers
• Overcome patient education barriers
• Assistive aids
• Monitoring
• Educating the Care-Giver

Question 19

Simplifying dosing regimen

Answer 19

– Decrease the number of total medications and total doses per day to a minimum
– Medications which can be taken twice daily should be recommended
– Tailor the dosing schedule and select appropriate dosage forms to meet the patients life style
• Design schedule to fit patients schedule
• Avoid if possible changing the patients schedule to fit the medication schedule
– Individualize dosing regimen to each patient and their characteristics (cues)

Question 20

Overcoming functional disabilities

Answer 20

– Hearing aids
– Cataract removal or glasses for visual impairment or change labeling (large letters, color code)
– PT and OT for patients with arthritis or change packaging

Question 21

Overcoming financial barriers

Answer 21

– Prescribe generically
– Minimize number of medications
– Employ social service agencies to assess patient qualifications for financial assistance programs
– Pharmaceutical company assistance programs

Question 22

Overcoming patient education barriers

Answer 22

– Provide clear information utilizing good communication skills
– Provide written information to complement the spoken word (not replace it)
– Establish a longitudinal relationship which builds trust and enhances communication
– Assess literacy

Question 23

Assistive aids

Answer 23

– Labeling considerations (larger font, color codes - retain a master schedule for interpretation)
– Calendars
– Packaging; Medication organizers
– Watches
– Phone alarms
– Electronic caps with alarms or signals
– Refill reminder services

Question 24

Monitoring

Answer 24

– Pill counts 
– Therapeutic effect 
– Refill records 
– Microelectronic monitoring devices 
– Involvement of family or caregivers as monitors