Dispensing to the Elderly Patient Flashcards
Identify barriers to effective communication with the elderly
- Stereotyping
- Depersonalizing
- Control or loss of control
- Reluctance or inability to communicate by the patient
- Physiologic barriers to communication: visual, hearing, cognitive impairment
Stereotyping
- Dismissing problems as a normal part of aging
- “Older people may evoke negative images”
- “Old people are lonely”
- “Old people are confused”
What are solutions to stereotyping?
- Identify our stereotypes and work to overcome them
* Appreciate the heterogeneity of the older population
Depersonalizing attitudes
- Talking to the caregiver instead of the patient
- Failure to personalize the interview
- Using a scripted monologue
What are solutions to depersonalizing attitudes?
- Address the patient directly
- Display empathy and concern
- Encourage dialogue
- Use respectful language: “Mr.”, “Mrs.”, etc
Controlling behavior
• 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
What are solutions to controlling behavior?
- Attempt to make the patient an active participant
* Identifying your behaviors and make changes.
What are solutions to reluctance or inability to communicate by the patient?
Pharmacist should be proactive and encourage the patient to participate
Communication Issues in the Elderly
- Verbal communication
- Non-verbal communication
- Hearing issues
- Cognitive issues
Summarize aspects of verbal communication
- Use of appropriate language
- Awareness of cultural differences
- Awareness of health belief differences
- Tone and loudness of voice
- Empathy
- Respect
- Genuineness
Summarize aspects of non-verbal communication
- Stance
- Eye contact
- Listening
- Expressions
- Distractions
- Empathy
What are solutions to vision impairment?
- 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
What are solutions to hearing impairment?
- 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
Hearing impairment
- Common amongst the elderly but not universal
* Clues to hearing impairment: inattentive, request repetition, speaks loudly or does not respond to questions.
Cognitive impairment
- 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.
What are solutions to cognitive impairment?
- 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
List factors that influence medication compliance in the older patient
– 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
Construct strategies to improve medication compliance in the older population
- Simplify dosing regimen
- Overcome functional disabilities
- Overcome financial barriers
- Overcome patient education barriers
- Assistive aids
- Monitoring
- Educating the Care-Giver
Simplifying dosing regimen
– 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)
Overcoming functional disabilities
– 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
Overcoming financial barriers
– Prescribe generically
– Minimize number of medications
– Employ social service agencies to assess patient qualifications for financial assistance programs
– Pharmaceutical company assistance programs
Overcoming patient education barriers
– 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
Assistive aids
– 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
Monitoring
– Pill counts – Therapeutic effect – Refill records – Microelectronic monitoring devices – Involvement of family or caregivers as monitors
