PATIENT COUNSELING Tips for Counseling Elderly Patients Because of the many barriers that can make counseling elderly patients difficult, pharmacists and other health professionals must be prepared to try a variety of approaches,accordingto Madeline Feinberg, director of the Elder-Health Program at the University of Maryland School of Pharmacy. Feinberg, who spoke at a recent conference sponsored by the National Council on Patient Information and Education (NCPIE), emphasized that many elderly people take multiple medications and risk becoming sicker if they are not properly
taught about them. "Our goal is to preserve patients' functional status and maintain or improve their quality of life," she said. Important questions to answer before being able to counsel effectively include: • Does the patient have a caregiver who is helpful? • What is the patient's cognitive status? • What is the patient's functional status? Can the patient administer medications unassisted-for example, swallow tablets or apply eyedrops? Can the patient read the directions? • What does the patient know about his or her conditions and medications? • What is the patient's nutritional status?
Irving Swartz counsels many his practice.
Facts About Drug Use in the Elderly The following statistics were presented at the Ninth National Conference on Prescription Medicine Information and Education, held May 6-7 in Washington, D.C.: • Approximately 90%, or 35.5 million, of Americans aged 60 and older are taking one or more medications. • The average elderly outpatient uses two to four different prescription dnlgs at one time. • Among people aged 65-84 who live in the community-not in hospitals or nursing homes61 % receive three or more different prescription drugs in a year, 37% get five or more, and 19% get seven or more. • Each year, more than nine million adverse drug reactions occur in older Americans. • Unwanted side effects of drugs are seven times more common in the elderly than in younger adults. In 1985, adverse reactions to drugs caused an estimated 243,000 adults aged 60 or older to be admitted to hospitals. • Nearly one-fourth of all nursing home admissions result from older people being unable to take their medicines properly. July 1993
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• What other health care providers is the patient seeing? What other pharmacies are being used, and what other medications are being taken? Attitudes constitute a barrier that can prevent COlllseling from being effective, Feinberg noted. For example, "ageism," or prejudice against the elderly, is an attitude providers may be unaware they hold. COlllters, lighting, and other physical barriers can also affect the quality of counseling, as can the patient's limitations, such as diminished hearing, poor eyesight, or a low literacy level. Making eye contact is very important when counseling the elderly, Feinberg said. Elderly patients also respond pOSitively to appropriate touching, such as a pat on the hand or arm. Being an empathetic listener and allowing elderly patients to share reminiscences from their life builds their confidence in the practitioner and may improve compliance. According to Feinberg, elderly patients absorb information best when practitioners draw upon two or more of the four channels of communication: auditory, visual, verbal, and tactile. Because the elderly are a very diverse group, with different needs, attitudes, and abilities, "there is no one approach that works best, " Feinberg said.
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Family Health Month. American Academy of Family Physicians, 8880 Ward Parkway, Kansas City, MO 64114. (800) 274-2237 or (816) 333-9700. National liver Awareness Month. American liver Foundation, 1425 Pompton Ave., Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. National Lupus Awareness Month. Lupus FOllldation of America, 4 Research Pl., Suite 180, Rockville, MD 20850. (800) 558-0121 or (301) 670-9292. National Spinal Health Month. American Chiropractic Association, 1701 Clarendon Blvd., Arlington, VA 22209. (703) 276-8800. 3-9, Mental Ulness Awareness Week. American Psychiatric Association, 1400 K St., NW, Suite 1050, Washington, DC 20005. (202) 682-6000.
National Cholesterol Education Month. National Cholesterol Education Program Information Center, P.O. Box 30105, Bethesda, MD 20824-0105. (301) 9513260. National Pediculosis Prevention Month. National Pediculosis Association, P.O. Box 149, Newton, MA 02161. (800) 446-4NPA or (617) 449-6487. National Sickle Cell Month. National Association for Sickle Cell Disease, 3345 Wilshire Blvd. , Suite 1106, Los Angeles, CA 90010-1880. (800) 421-8453 or (213) 7365455. National Spina Bifida Month. Spina Bifida Association of America, 4590 MacArthur Blvd. , NW, Slute 250, Washington, DC 20007. (800) 621-3141 or (202) 9443285. 12-18, Adult Dental Awareness Week. American Dental Association, 211 East Chicago Ave. , Chicago, IL 60611. (312) 440-2543.
4 Child Health Day. U.S. Department of Health and Human Services, Maternal and Child Health Bureau, Parklawn Bldg., Room 18A55, 5600 Fishers Lane, Rockville, MD 20857. (301) 443-3163. 17-23, National Infection Control Week. Association for Practitioners in Infection Control, 505 East Hawley St., Mundelein, IL 60060. (708) 949-6052. 24-30 National Pharmacy Week. American Pharmaceutical Association, c/o Trexco, 1251 Gordon Park Rd. , Augusta, GA 30901. (800) 950-7701. 24-30 National Adult Inununization Awareness Week. National Coalition for Adult Immlmization and National FOllldation for Infectious Diseases, 4733 Bethesda Ave., Suite 750, Bethesda, MD 20814. (301) 656-0003.
NEW DRUGS & DEVICES
Talk About Prescriptions Month. National Council on Patient Information and Education, 666 Eleventh St., NW, Suite 810, . Washington, DC 20001. (202) 347-6711. Child Health Month. American Academy of Pediatrics, 141 Northwest Point Blvd. , Elk Grove, IL 600090927. (800) 433-9016.
Lovenox for Preventing Blood Clots Enoxaparin (LovenoxRhone-Poulenc Rorer) is a low-molecular-weight heparin product recently approved by the Food and Drug Administration (FDA) for preventing deep-vein thrombosis following hip replacement surgery. FDA gave the drug alP rating, sig-
nifying a new molecular entity given a priority review. The development of blood clots is a potentially fatal complication following hip replacement surgery, especially if they lodge in the lung and form a pulmonary embolism. Most of the nearly 250,000 hip replacements in the United States each year are performed on elderly patients, who are particularAMERICAN PHARMACY