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Improving Pharmacy Consultations For Older People With Disabilities
Published by: By Pfizer Staff
Date of publishing: 17th Jan 2018
Older people are at risk of multiple long-term conditions, frailty and polypharmacy. However, they also belong to a section of society who value their health, independence and well-being.1 Old age may lead to a decline in health, physical or cognitive abilities.1
Medicines Optimisation is central to good pharmaceutical care of people with multi-morbidity and disabilities in their old age, as detailed in a recent review in the Journal of Medicines Optimisation by Professor Nina Barnett1, a consultant pharmacist specialising in the care of older people. Barnett described some strategies to assist HCPs in optimising communication with older people who may face physical or cognitive challenges.1
In the pharmacy setting, optimal support may be provided through the PETAL plan, i.e. considering the patient’s requirements for Patience, Environment, Time, Attention and Language1 as follows:
Patience, Empathy and Compassion – Get in the right frame of mind to focus on the patient. Focus on empathising instead of sympathising. Keep personal experiences out of the conversation and focus on how you can optimise their health.
Environment – Ask the patient how you can make them feel comfortable and what would be an appropriate environment for them. Consider what would work well for a patient with hearing or cognitive impairment or issues with mobility.
Time-More consultation time may be needed for older patients especially those with cognitive impairment or slow mobility.
Attention- Give undivided attention to the patient. Ask open questions and wait for the answer. Use clarifying questions to better understand the patient’s point of view.
Language-Where appropriate use simple language, sentences and words to help maintain focus for the conversation. Where memory or comprehension is a challenge, use a picture, diagram or words to help with the consultation.
When structuring a consultation, Barnett recommends that the 5 A’s1 may also provide a useful framework for short and focussed conversations with older people:
Ask the patient what they want from the consultation. Don’t assume to know what they want.
Acknowledge the patient’s situation. Don’t judge them if they express an opinion you don’t agree with.
Address the issues at hand and work towards a solution together by asking for the patient’s ideas so that you can suggest, signpost and support as appropriate. Include health promotions opportunities as an option.
Accept the patient’s decision. If they have made a decision you don’t agree with, ensure that they have understood the risk/benefit but be careful not to judge them. This ‘leaves the open door’ for future conversations.
Agree Actions byasking the patient what they are going to do and how they will put it in place and what you have agreed to do. Agree a specific follow-up plan and how this will be communicated to other healthcare professionals and actions to take if problems arise before scheduled follow-up.
Barnett concluded that pharmacists play a key role in identifying the needs of older people with disabilities through interactions in individualised consultations that can help to optimise patient health and wellbeing.1
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