Older Adult Sensitivity Training

Older Adult Sensitivity Training Helping to Improve Care for an Aging Population Resource Guide The Older Adult Sensitivity Training Resource Guide...
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Older Adult Sensitivity Training Helping to Improve Care for an Aging Population

Resource Guide

The Older Adult Sensitivity Training Resource Guide   To enhance your ability to use the Older Adult Sensitivity Training (OAST) workshop techniques, key concepts are summarized in the Resource Guide. Descriptions of helpful Web site links and recommended readings supplement the workshop presentations.

  The Older Adult Sensitivity Training Module Effective Communications Skills: the Basics Good communication is the foundation of a successful relationship between health care professionals and older adults. All forms of communication—verbal, nonverbal, and written—are critical. Verbal Communication Assess the health literacy of each patient individually and frame your discussion with words that are understandable and familiar to the patient (and his/her family). Avoid complicated language, medical jargon, and abbreviations. When a patient doesn’t understand the jargon, quality of care may be jeopardized and comprehension of the health care professional’s message is diminished.1 Take the time to check that the patient understands what you are saying. Nonverbal Communication Facial expression, body movements and posture, eye contact, gestures, touch, and tone of voice are all important nonverbal cues, especially with older adults who have experienced losses in hearing and cognitive function. Positive nonverbal cues can contribute to development of trust and rapport and to the establishment and maintenance of close interpersonal relationships between health care professionals and older adults.2 Written Communication There are some special considerations when developing written materials for older adults. Changes in learning and memory may affect an older reader’s ability to absorb content; thus, the information should be presented in a way that accommodates both the cognitive and physical changes that are often associated with aging.3 Another suggestion is to repeat key points multiple times.3 Additional written communication strategies can be found in the Improving the Health Literacy of Older Adults section below. Strategies to Address Common Sensory, Cognitive, and Mobility Changes in Older Adults Hearing Loss in Older Adults Hearing loss is one of the most common conditions affecting older adults. In people aged 85 years and older, approximately 60% report hearing loss.4 Look for clues of misunderstanding when assessing hearing impairment. Recognizing these behaviors can help you identify situations in which hearing loss may be causing a communication problem. Examples of behaviors exhibited include the following:

 

• • • •

Indicators of Impaired Hearing5 Turns up the radio • Appears inattentive Habitually turns head to one • Complains that speakers don’t side while listening speak clearly Frequently misunderstands • Frequently asks speakers to repeat what is said what they said Gives inappropriate answers to • Has difficulty distinguishing words questions 

Strategies to enhance communications with older adults who are hearing impaired are listed below. Enhancing Communications With Older Adults Who Are Hearing Impaired5 • Don’t cover your mouth • Ask if the person if he/she can • Use visual aids (eg, diagrams) hear you • Provide time to respond • Use low tones—don’t shout • Try rewording a message • Speak distinctly • Provide good lighting directed at • Talk face-to-face the speaker (helps with lip reading) • Eliminate or reduce background noise Visual Impairment in Older Adults The risk of vision loss and blindness increases significantly later in life. An estimated 10% of people aged 65 to 75 years and 27% of those 85 years and older experience functional limitation because of visual impairment.5 A number of strategies can be used to enhance communication with older adults who have a visual impairment. Enhancing Communications With Older Adults Who Have a Visual Impairment5 • Offer assistance—but don’t insist on • Announce your presence helping • State what you are going to do • Use the person’s remaining senses • Keep objects in the same place • Know how to be a sighted guide • Talk directly to the person • Have relevant low-vision aids • Orient person to a new available environment Learning and Cognitive Changes in Older Adults There are a variety of age-related changes in learning and memory that can affect communications with older adults. These include6 • • • • •

Decline in “channel capacity,” the ability to process information from 2 or more sources at once Increased likelihood of being distracted from learning and remembering Increased time required to learn new information Slower retrieval of stored information Decreased performance in tasks requiring speed and fine coordination

There are also changes in cognition and memory with age that may be related to Alzheimer’s disease (a form of dementia). An estimated 5.4 million Americans of all ages have Alzheimer’s 2   

 

disease in 2011; 5.2 million of these people are aged 65 and older. In the overall population aged 65 and older, 13% have Alzheimer’s disease.7 As dementia progresses, a person’s way of communicating will change. As a result, you will need to change your expectations of and how you communicate with people with dementia. Experts suggest the following tips for improving communications with older adults with dementia.

• • • • •

Communicating With Memory-Impaired Older Adults8 Introduce yourself • Emphasize key words • Provide visual cues Call the person by name Speak slowly and use simple, • Write things down direct wording • Be aware of your tone of voice Ask one question at a time and • Pay special attention to your body patiently wait for a response language Repeat information or questions

Older adults with dementia frequently present challenging behaviors. When dealing with persons with dementia, the following points should be kept in mind9: • • • • • •

Difficult behavior is not willful The impaired person is always right, from their point of view The impaired person loses the ability to learn and to record information In patients with dementia, the past becomes more real than the present Emotions and feelings remain intact in patients with dementia The memory-impaired person cannot change

Strategies for dealing with challenging behavior include9 • • •

Connecting, not correcting Focusing on feelings, not facts Using distraction

For additional information on dealing with behavioral issues in older adults see Addressing Behavioral Challenges in the Senior Care Setting in the second module of this document. Mobility and Dexterity Issues and the Older Adult Older adults frequently demonstrate limitation of mobility and dexterity due to both the normal aging process and the progression of disease outcomes. When dealing with older adults with limitations of mobility, specific strategies should be adopted.

• • • •

Strategies for Assisting With Mobility and Dexterity Problems in Older Adults9-11 Move at the person’s pace • Encourage physical activity12 Be patient • Recognize fear of falling11 • Encourage the use of assistance Ask if assistance is needed—but don’t insist on helping 10 devices10 11 Address physical limitations

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The office in which older adults are seen should make them feel comfortable, secure, and able to function as independently as possible.13 Be sure to correct any environmental obstacles (eg, blocked access, poor lighting). Lack of mobility also contributes to the risk of falling. Patients at risk of falling should be identified and closely monitored.

• • • • •

Common Risk Factors for Falling14 Prior history of falling • Frailty (eg, weakness) Age > 80 years old • Need for assistive devices Conditions that limit mobility (eg, • Visual deficits arthritis) • Urinary or fecal urgency Balance and gait problems Cognitive impairment

Psychosocial Issues and the Older Adult Older adults frequently experience multiple losses and life transitions, events that can diminish psychosocial well-being. Social engagement, such as social interaction and involvement in social activities, may limit psychosocial decline. The positive effects of social engagement include15 • • • •

Providing a dynamic environment that stimulates cognitive faculties Supporting commitment to community and family Providing a health-promoting sense of purpose and fulfillment Offering emotional support from relatives and friends

Depression in older adults often goes untreated because many people think that depression is a normal reaction to the chronic illness, loss, and social transition often associated with aging.16  Distinguishing between cognitive deficits seen in depression and dementia is difficult but can be facilitated by neuropsychological evaluation.17 Late-life depression increases risk of medical illness and cognitive decline and, if unrecognized and untreated, can have fatal consequences.17 If depression is identified and treated, the prognosis is good.16 Psychosocial treatment plays an essential role in the care of older patients who have difficulty dealing with their life situations.16

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Strategies to Support Telephonic and In-Office Encounters With Older Adults Improving Telephone Communications With Older Adults Communicating by telephone can be a source of confusion and frustration for older adults. This is especially true for older adults who have hearing, vision, or memory problems. A variety of simple steps will improve telephone conversations with older adults.

Strategies to Enhance Telephone Conversations With Older Adults Ask if the caller can hear you • Repeat and rephrase your key points clearly • Alert the caller when changing subjects Be friendly and respectful • Summarize key points to help ensure Use a formal term of address understanding Don’t shout; speak directly into • Allow time for questions the mouthpiece • If possible, send reminders before calls Ask the caller to eliminate and follow-up notes highlighting key background noises points from the call



• • • •

Sometimes problems arise despite your best efforts. In these instances, reassure the caller that you want to solve their problem. Remain calm, courteous, and sympathetic. Allow the caller to speak to a supervisor if they wish. Improving the In-Office Encounter With Older Adults Encouraging older adults to prepare for their medical visits is beneficial for all participants because it minimizes anxiety for the older adult and helps ensure that the visit will go smoothly. Encourage the older adult to take the following steps18: • • • • • •

Be prepared: make a list of concerns Bring information regarding your insurance and medications with you Make sure you can see and hear as well as possible Consider bringing a family member or friend Find an interpreter if you know you will need one Plan to update the doctor on what has happened since your last visit

Improving the Health Literacy of Older Adults Older adults are more likely to have low health literacy,19 and individuals with limited health literacy are more likely to have chronic conditions and to be less able to manage said conditions effectively.19 It may be useful for a caregiver to attend appointments with the patient. Caregivers can help older adults overcome low health literacy by improving the usefulness of health information.

• • •

Strategies for Improving the Utility of Health Information Ensure that the materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended user19 Keep the message simple; limit the number of messages to the minimum amount of information that is needed by the user19 Speak and listen to the patient carefully and check for understanding19

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Consideration of age-related changes in vision is particularly important when developing printed educational materials for older adults. The National Institute on Aging offers the following guidelines3: • • • • • • • •

Use larger print (12 to 14 point) Allow for white space Use easy-to-read fonts and limit the use of italics, underlines, and bold for emphasis Double space text where possible Align text to the left margin Create contrast between print and background Limit line length Select matte-finish paper rather than glossy

Strategies for Supporting Caregivers Approximately 43.5 million adult caregivers provide unpaid care to someone aged 50 years or older, usually a family member.20 Many caregivers are older adults themselves and are often faced with competing demands from various aspects of their lives.20 Health care professionals can support the caregiver in a number of ways. • • •



Making time to speak with caregivers Giving caregivers permission to take care of themselves Providing appropriate referrals to caregivers – In-home services – Respite care Encouraging use of community resources

Role of the Pharmacist in the Management of Older Adults Practical Solutions to Pharmacy-Related Problems for Older Adults Clinical pharmacists have assumed an increasingly larger role in counseling and educating patients about their medications. Pharmacists can also offer practical solutions. These include

• • • •

Supplying drugs in easy-to-open containers Providing liquid medication instead of pills Printing drug labels in larger fonts or encouraging the use of magnifiers to increase label legibility Educating older adults on strategies for remembering how many pills to take

Strategies to Improve Drug Adherence in Older Adults Pharmacists can use a variety of strategies to improve adherence to medication in older adults. Nonadherence is a complex phenomenon and may be driven by issues related to the treatment regimen (eg, cost), to the health care provider (eg, failure to provide clear instructions), or to the patient (eg, failure to believe that the benefit of treatment outweighs the consequences).21 Health care professionals must be able to identify the nature of the issue and respond appropriately to optimize likelihood of adherence.

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Behavioral Reinforcements to Improve Treatment Adherence in Older Adults22 • Teach patients skill building • Simplify the dosing schedule • Use reminders and technology to assist • Use rewards and reinforcement to older adults with medication regimens encourage treatment adherence Creating an Older Adult–Friendly Pharmacy Environment Pharmacies are often intimidating places for older adults. Pharmacies can be modified in several simple ways to help older adults be safer and to make them feel at ease. • • • • • •

Use signs that are large enough to be easily read Provide clear information about waiting times Avoid shiny floor surfaces that produce glare Place commonly used items on mid-level shelves; offer assistance as needed Provide a quiet, private counseling area with seating Use verbal and nonverbal communication strategies to communicate with older adults

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Older Adult Sensitivity Training for the Senior Care Setting Module The Growing Need for Senior Care In 2008, 4.1% of the United States (US) population aged 65 years and older lived in institutional settings, such as nursing homes. An additional 2.4% of the total elderly population lived in senior housing. The proportion of elderly people in nursing homes increases dramatically with age, from 1.3% for persons 65 to 74 years old to 15.4% for persons 85 and older.23 According to government statistics, 43% of people who reach age 65 will eventually enter a nursing home.24 Addressing Mobility, Falls, and Safety in the Senior Care Setting Falls are a major risk for older adults in senior care settings. Recognizing patients with a risk of falling (see Mobility and Dexterity Issues in the Older Adult above) and environmental issues that contribute to the risk of falls is important. All institutions should develop a plan for fall risk reduction. The care goal of such a plan is to prevent both initial and recurrent falls.14 Strategies for Fall Prevention Fall Risks and Actions to Prevent Falls14 Problem Solution Prior history of a fall Identify cause(s) and create an action plan Unfamiliar environment Accompany resident Postural hypotension, dizziness Slowly transition to sitting from lying and to standing from sitting positions Visual impairment Schedule eye exam, keep glasses clean, place objects in close range Malfunctioning emergency call Test for reliability system Ill-fitting or unsafe footwear Provide shoes that fit well and are slip-proof Inadequate assistive devices Provide and teach use of appropriate devices Use of full-length side bed rails Use partial side rails Lack of grab bars in bathroom Install safety grab bars Loose carpets or flooring Ensure even, nonskid floor surface Wet or slippery floor Identify and promptly eliminate hazards Clutter Maintain a clear path between bed and bathroom Poor lighting Ensure that working nightlights are available Bed height Adjust height or change bed Tripping hazards Get rid of cords, throw rugs, small footstools

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Incontinence Assessment and Management in the Senior Care Setting Consequences and Impact of Incontinence Incontinence is the involuntary loss of either urine or feces. Urinary incontinence is one of the most common conditions among residents of long-term care facilities, affecting about 55% of this population.25 Although the prevalence of urinary incontinence increases with age, it is not a normal consequence of aging.25 Incontinence can have a devastating effect on people’s lives in a number of ways. Potential consequences of incontinence include25 • • • • •

Falls Embarrassment Loss of dignity and self-esteem Social isolation Depression

Individualized Approach to Address Incontinence Urinary incontinence can result from a variety of causes. Management, and sometimes even reversal, can be accomplished, even in frail older adults and individuals with dementia who reside in long-term care facilities. Correction of underlying illnesses and drug side effects may help to control incontinence.25 Interventions to Address Incontinence Although long-term care staff are typically not responsible for determining treatment of either urinary or fecal incontinence, their role in assisting residents with toileting, monitoring, and in preparation of treatment plans is very important. The following table contains some actions to consider. Helping Residents With Incontinence • • • • • • • • •

Document observations and any changes25 Provide access to toilets Implement scheduled toileting programs Assist with bladder retraining or pelvic muscle exercises25 Adjust diet/fluids (eg, restrict fluids at bedtime) Empathize with resident26 Focus on resident’s schedule Use resident’s vocabulary Provide privacy27 and don’t rush28

Pain Assessment and Management in the Senior Care Setting Common Myths About Pain Pain is not a normal part of aging and can often be treated successfully once it is identified. Ideally, pain medication should ease discomfort and allow the treated person to be alert enough to enjoy life and activities. Despite these considerations, a number of myths regarding pain in older adults are commonly considered to be facts. Some of these include the following29:

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• • • • • • •

Pain is an unavoidable part of aging Elderly/cognitively impaired individuals have higher tolerance for pain Pain cannot be accurately assessed in elderly/cognitively impaired residents Residents say they are in pain to get attention Older adults are likely to become addicted to pain medications Complaining of pain is a sign of personal weakness Acknowledging pain will result in intrusive and painful tests and/or loss of independence

Assessing Pain in the Senior Care Setting Any one or a combination of behaviors may indicate the presence of pain in elderly adults.29 • • • • • • • • • •

Change in gait or mobility Loss of function; decreased activity level Bracing, guarding, or rubbing Fidgeting, restlessness Frowning, grimacing, or grinding teeth Change in behavior (eg, refusing food or beginning to wander) Striking out; increased or recurrent agitation Eating or sleeping poorly Vocalizations (eg, sighing, groaning, crying, breathing heavily) Becoming more confused, irritable, or depressed

Intervention Strategies to Address Pain A clinician may prescribe medication to treat pain, but there are also nonpharmaceutical interventions that can help ease discomfort. Studies have shown that many activities help contribute to comfort, relaxation, and peace of mind. Examples of Nonpharmaceutical Pain Management Techniques29

• •

Reassuring words and touch A back rub, hot or cold compresses, whirlpool bath, or shower Simple exercises Repositioning Relaxation techniques

• • •

• • • • •

Comforting music Listening to patients discuss their pain Distraction Deep breathing The services of a chaplain counselor

Addressing Behavioral Challenges in the Senior Care Setting Triggers for Wandering Behavior Wandering behavior may consist of pacing, roaming, or attempting to leave or actually leaving a facility. Such behavior is seldom aimless. When considering the trigger for this behavior, ask the following questions8: • • • • • •

Does the person normally use walking to relieve stress? Is the person bored? Is there somewhere the person wants to go? Is the person looking for something? Was the person trying to get away from someone or from an unfamiliar or uncomfortable situation? Was the person attracted by activity or noise? 10 

 

 

• •

Is the person searching for a sense of security and comfort? Is the person in pain?

Responding to Challenging Behavior Some general guidelines should be kept in mind when responding to any challenging behavior displayed by an older adult. • • • • • •

Conduct an assessment of the behavior before responding30 Maintain a philosophy of compassionate care31 Communicate effectively, both verbally and nonverbally30 Maintain a calm atmosphere8 Connect, don’t correct8 Distract or redirect the person’s attention8

A framework for understanding, assessing, and finding solutions to reducing challenging behaviors is the A-B-C model. This model assumes that an activator (A) or trigger stimulates the problematic behavior (B), which leads to the resultant consequences (C). This approach is based on the theory that identifying and changing what happens immediately before or after a disruptive behavior occurs can be used to alter or reduce the frequency of the behavior.32 Once you have clearly defined the behavior and its activators and consequences, the next step is to develop a plan to change behavior. The key is changing or adjusting the activators and/or consequences that are contributing to the behavior.33 This involves determining what you are going to do differently to reduce the behavior. Team Approach to Developing an Action Plan • Brainstorm. What you can do to change the activators and/or consequences of behavioral problems?33 • Write. Record the best ideas.32 • Implement. Initiate one or more changes. Set realistic, achievable goals.32 Ensure that everyone uses the same approach; inconsistency can make a problem worse. • Evaluate. How well did the plan work? Did the changes make the behavior better or worse?32 • Refine. Modify the plan as needed.32

• •

Principles for Dealing With Challenging Behavior8 Recognize that difficult behavior is not • Look at the behavior as deliberate reflecting a need, not just as a problem Define the behavior, not the person, as the problem

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Older Adult Sensitivity Training in the Oncology Setting Module Enhancing Management of the Older Adult Through Patient Assessment It is important to know as much as possible about a patient who has cancer. A comprehensive assessment of the older patient with cancer can • Help to determine the kinds and levels of support required34 • Help to assess the presence or absence of geriatric syndromes and their likely impact on cancer symptoms and cancer treatment35 • Help to manage problems/side effects associated with cancer treatment36 The Comprehensive Geriatric Assessment (CGA) is an important tool for the assessment of the older adult. The CGA considers a number of domains, or parameters, such as functional status, comorbidity, and cognition/mental status. These domains are then evaluated with several measurements or tools. For example, functional status is assessed in terms of the number of activities of daily living or instrumental activities of daily living the patient is able to perform.35,37 Sample components of a CGA are shown below. Parameter Assessed35,37 Comorbidities, risk factors Functional assessment Cognitive/emotional assessment Social assessment Pharmacy assessment Nutritional assessment

Elements of the Assessment35,38 Medical examination and history, Cumulative Index Rating Scale-Geriatric Activities of daily living, exercise capacity, gait, balance Mental status, mood/depression tests; Folstein Minimental status Geriatric Depression Scale Living conditions, availability of family/peer support system Number and appropriateness of medications (over-the-counter, prescription, supplement) Mininutritional Assessment

Clinical Implication37 Life expectancy, likely benefit of medical intervention Functional dependence, stress tolerance Life expectancy, dependence, motivation for treatment Implications for survival and psychological state Reduced risk of drug/drug interactions Amelioration of poor nutrition

Treatment Issues in the Older Adult With Cancer Pain Assessment in the Older Adult With Cancer Some older adults may not use the word pain. Instead, they may describe how they are feeling by using descriptive words. It may be useful to ask about pain in a different way, such as • • • •

Is any part of your body hurting? Where? How does it feel when I touch this spot? Does it hurt when you move? Where? Can you tell me what’s hurting you? What does it feel like?

It is important to assess pain continually and to determine the appropriate solution/response to deal with each individual’s pain.29

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Cognitive Defects Associated With Cancer Treatment in the Older Adult Chemotherapy used for cancer treatment can have a detrimental effect on cognitive function in older adults. • •

Dementia may decrease the ability to communicate about pain.39 Systemic cancer treatment may result in a cluster of potentially long-lasting cognitive defects associated that may worsen symptoms of dementia40 Dementia and cognitive defects associated with cancer therapy, as well as normal, agerelated neurocognitive changes, may reduce the patient’s ability to adhere to cancer therapy5

Depression and Psychosocial Issues in the Older Patient With Cancer  • In a study of 215 older (≥ 60 years) cancer patients, 18% were diagnosed with major depression and an additional 33% with dysthymia.41 Among older cancer survivors, approximately one-third report anxieties and depression about recurrence or second malignancies42 • Making appropriate referrals for older adults with mental health issues has tremendous importance. In cases of moderate to severe depression, people get the best results by combining psychotherapy with antidepressant medications43 Caregiver Support Caregivers are an important component of health care support for older adults with cancer. Almost 43.5 million adult caregivers provide unpaid care to someone aged 50 or older, most often a family member.20 Thirty percent of caregivers consider their situation to be highly stressful; an additional 22% report moderate stress.20 As the health care system changes, responsibility for patient care may be shifted from the clinic and hospital to the home environment. Outreach from health care professionals to family members providing care for older patients with cancer is essential. The health care system can facilitate positive outcomes by embracing the family caregiver as a partner in the health care team and by providing instruction and guidance to the caregiver.44 The Creativity, Optimism, Planning, and Expert Information (COPE) problem-solving model has been developed to teach caregivers coping skills and problem-solving techniques. The goals of the COPE model include maximizing the caregiver’s sense of effectiveness and satisfaction in the caregiving role. The components of the COPE model are • • • •

Creativity: viewing the problem from multiple points of view (eg, caregiver, patient, health care professional) can generate alternative solutions45 Optimism: addressing the emotional and motivational aspects of problem-solving; staying positive, while being realistic43 Planning: systematic planning increases effectiveness and provides the caregiver with a sense of being in control45 Expert information: obtaining guidance; knowing what to ask and whom to ask can empower the caregiver45

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Supplemental Resources The Web sites listed in this Resource Guide are neither owned nor controlled by Pfizer. Pfizer is not responsible for the content or services provided by these sites.

Administration on Aging (AoA) AoA is developing a comprehensive, coordinated, and costeffective system of home and community-based services that helps elderly individuals maintain their health and independence in their homes and communities.

www.aoa.gov 1-202-619-0724

Alzheimer’s Association The Alzheimer’s Association is a leader in Alzheimer’s advocacy, research, and support.

www.alz.org 1-800-272-3900

American Association for Geriatric Psychiatry (AAGP) AAGP promotes the mental health and well-being of older people and improves the care of those with late-life mental disorders.

www.aagponline.org 1-301-654-7850

  American Association of Retired Persons (AARP) AARP is a nonprofit, nonpartisan organization with a membership that helps people over age 50 improve their lives.

www.aarp.org 1-888-687-2277

American Cancer Society (ACS) ACS is a nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem.

www.cancer.org 1-800-227-2345

American Foundation for the Blind (AFB) AFB is a national nonprofit that expands possibilities for people with vision loss in the US.

www.afb.org 1-800-232-5463

American Geriatrics Society (AGS) AGS seeks to improve the health, independence, and quality of life of all older people. American Geriatrics Society Foundation for Health in Aging (FHA) FHA is a national nonprofit organization that aims to build a bridge between the research and practice of geriatrics and to advocate on behalf of older adults and their special health care needs. American Society on Aging (ASA) ASA supports the commitment and enhances the knowledge and skills of those who seek to improve the quality of life of older adults and their families.

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www.americangeriatrics.org 1-212-308-1414 www.healthinaging.org 1-212-755-6810

www.asaging.org 1-800-537-9728

 

American Speech-Language-Hearing Association (ASHA) ASHA is a professional, scientific, and credentialing association for speech-language pathologists, audiologists, and speech, language, and hearing scientists in the US and internationally. Center to Advance Palliative Care (CAPC) CAPC provides health care professionals with the tools, training, and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.

www.capc.org 1-212-201-2670

Center for Healthy Aging The Center for Healthy Aging assists community-based organizations serving older adults in developing and implementing evidence-based health promotion/disease prevention programs.

www.healthyagingprograms.org 1-202-479-1200

Children of Aging Parents (CAPS) CAPS is a nonprofit, charitable organization that assists caregivers of the elderly or chronically ill with reliable information, referrals, and support.

www.caps4caregivers.org 1-800-227-7294

Eldercare Locator Eldercare Locator is a public service of the US Administration on Aging that connects older adults and their families to services.

www.eldercare.gov 1-800-677-1116

Family Caregiver Alliance (FCA) FCA is a community-based nonprofit organization that addresses the needs of families and friends providing longterm care at home.

www.caregiver.org 1-800-445-8106

Senior Citizens’ Resources Senior Citizens’ Resources is a government clearinghouse site of resources for seniors on money, housing, health, consumer protection, and more.

www.seniors.gov 1-800-433-4636

Hartford Institute for Geriatric Nursing (HIGN) HIGN seeks to improve the quality of health care of older adults through excellence in nursing practice

www.hartfordign.org 1-212-992-9416

Lighthouse International Lighthouse International fights vision loss through prevention, treatment, and empowerment.

www.lighthouse.org 1-800-829-0500

National Alliance for Caregiving (NAC) The NAC is a nonprofit coalition of national organizations that focuses on issues of family caregiving.

www.caregiving.org

National Association of Professional Geriatric Care Managers (NAPGCM) NAPGCM seeks to advance professional geriatric care management through education, collaboration, and leadership. 15   

www.asha.org 301-296-5700

www.caremanager.org 1-520-881-8008

 

National Cancer Institute (NCI) NCI is a branch of the National Institutes of Health (NIH) that supports and coordinates cancer research projects conducted by universities, hospitals, research foundations, and businesses. National Comprehensive Cancer Network (NCCN) NCCN seeks to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

www.nccn.org 215.690.0300

National Council on Aging (NCOA) NCOA brings together nonprofit organizations, businesses, and government agencies to develop creative solutions that improve the lives of all older adults.

www.ncoa.org 1-202-479-1200

National Institute on Aging (NIA) NIA is an institute of the NIH that supports and conducts research related to the aging process, diseases and conditions associated with aging, and other special problems and needs of older Americans.

www.nia.nih.gov 1-301-496-1752

National Institute on Deafness and Other Communication Disorders (NIDCD) NIDCD is a branch of the NIH that supports research to help prevent, detect, diagnose, and treat disease and disability.

www.nidcd.nih.gov 1-301-496-7243

National Patient Safety Foundation (NPSF) NPSF is a resource for individuals and organizations committed to improving the safety of patients.

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www.cancer.gov 1-800-422-6237

www.npsf.org 1-617-391-9900

 

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10. 11. 12.

13. 14. 15. 16.

 

HealthCare and California Academy of Family Physicians. “I Hear You Talking, But I Don’t Understand You!”: Medical Jargon & Clear Communication. Familydocs.org Web site. http://www.familydocs.org/assets/Multicultural_Health/MedicalJargon.pdf. Published April 2004. Accessed December 17, 2011. Ambady N, Koo J, Winograd CH, Rosenthal R. Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Psychol Aging. 2002;17(3):443-452. National Institute on Aging. Making Your Printed Health Materials Senior Friendly: Tips From the National Institute on Aging. http://www.nia.nih.gov/health/publication/making-your-printed-health-materialssenior-friendly. Accessed December 17, 2011. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010. Key Indicators of Well-Being. Agingstats.gov Web site. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Do cs/OA_2010.pdf. Accessed December 16, 2011. Schmall VL. Sensory Changes in Later Life. Oregon State University Web site. http://ir.library.oregonstate.edu/xmlui/bitstream/handle/1957/15925/PNW196fromArchive.pdf?sequence=1. Accessed December 16, 2011. Schmall VL. Memory loss in later life: is it normal or is it Alzheimer’s? Hearing Rev. 1996;3(12):32-40. Alzheimer’s Association. Alzheimer’s Association Report: 2011 Alzheimer’s disease facts and figures. Alzheimer’s Dement. 2011;7(2):208-244. Alzheimer’s Association. Communication: best ways to interact with the person with dementia. http://www.alz.org/national/documents/brochure_communication.pdf. Published 2011. Accessed December 16, 2011. Schmall V, Bowman S, Cleland M. Helping Memory-Impaired Elders: A Guide For Caregivers. PNW 314. http://extension.oregonstate.edu/catalog/pdf/pnw/pnw314.pdf. Published 2000. Updated August 2005. Accessed December 16, 2011. Mobily PR, Skemp Kelley LS. Iatrogenesis in the elderly: factors of immobility. J Gerontol Nurs. 1991;17(9):5-10. Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility difficulties are not only a problem of old age. J Gen Intern Med. 2001;16(4):235-243. Cornell University. Falls and Hip Fractures Among Older Adults. Weill Medical College of Cornell University Web site. http://www.environmentalgeriatrics.com/home_safety/falls_fractures.html. Accessed December 16, 2011. Schmall VL. Is your office elder-friendly? The Hearing Professional. 2000;49(5):5-8. Notes From the AMDA Clinical Practice Guidelines for Certified Nursing Assistants. Falls and Fall Risk. American Medical Directors Association; 2010. Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med. 1999;131(3):165173. National Alliance on Mental Illness. Depression in Older Persons Fact Sheet. http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentMana

 

17. 18.

19.

20. 21. 22. 23.

24. 25. 26. 27. 28. 29. 30.

31.

32.

gement/ContentDisplay.cfm&ContentID=7515. Published October 2009. Accessed December 16, 2011. Lamberty GJ, Bieliauskas LA. Distinguishing between depression and dementia in the elderly: a review of neuropsychological findings. Arch Clin Neuropsychol. 1993;8:149-170. National Institute on Aging. Talking with your doctor: a guide for older people. National Institutes of Health Web site. http://www.nia.nih.gov/sites/default/files/TWYD_0521_web.pdf. Published August 2005. Updated April 2010. Accessed December 17, 2011. U.S. Department of Health and Human Services. Quick Guide to Health Literacy. Office of Disease Prevention and Health Promotion Web site. http://www.health.gov/communication/literacy/quickguide/Quickguide.pdf. Accessed December 16, 2011. National Alliance for Caregiving, AARP. Caregiving in the U.S. 2009. AARP Web site. http://assets.aarp.org/rgcenter/il/caregiving_09_fr.pdf. Published November 2009. Accessed December 16, 2011. Guise BJ, Nelinson D. Beyond the Prescription: Promoting Patient Compliance. New York: Impact Communications; 2001. Touchette DR, Shapiro l. Medication compliance, adherence, and persistence: current status of behavioral and educational interventions to improve outcomes. J Manag Care Pharm. 2008;14(suppl S-d):S2-S10. Department of Health and Human Services. A Profile of Older Americans: 2009. Administration on Aging Web site. http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2009/6.aspx. Updated January 2010. Accessed December 16, 2011. Agency for Healthcare Research and Quality. AHCPR research on long-term care. U.S. Department of Health & Human Services Web site. http://archive.ahrq.gov/research/longtrm1.htm. Accessed December 16, 2011. American Medical Directors Association. Urinary Incontinence: Clinical Practice Guideline. Columbia, MD. 2007. Long ML. Incontinence: defining the nursing role. J Gerontol Nurs. 1985;11(1):30-35. Hogstel MO, Nelson M. Anticipation and early detection can reduce bowel elimination complications. Geriatr Nurs. 1992;13(1):28-33. National Digestive Diseases Information Clearinghouse. Fecal Incontinence. US Department of Health and Human Services; July 2007. NIH Publication No 074866. American Medical Directors Association. Pain Management in the Long-term care setting. Notes From the AMDA Clinical Practice Guidelines for Certified Nursing Assistants. Columbia, MD; 2010. Smith M, Buckwalter K. Back to the A-B-C’s: Understanding and Responding to Behavioral Symptoms in Dementia: Supportive Materials. University of Iowa College of Nursing Web site. http://www.nursing.uiowa.edu/sites/default/files/documents/hartford/ABCSuppMat.pdf. Published 1993. Updated 2005. Accessed December 16, 2011. Snow T. Understanding dementia and symptoms: what is happening? & how to help! Estate & Elder Law Firm of Vandiver & Bryan Web site. http://www.vbfirm.com/docs/Is%20It%20Dementia.pdf. Accessed December 16, 2011. The University of Washington Alzheimer’s Disease Research Center. Behavior Management Techniques. ADRC Web site.

19   

 

33.

34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

http://depts.washington.edu/adrcweb/UnderstandingAD/BehavMang.shtml. Accessed December 16, 2011. Administration on Aging. Managing difficult behaviors: a standardized intervention to help family caregivers (STAR-C). Department of Health and Human Services Web site. http://aoa.gov/AoARoot/AoA_Programs/HPW/Alz_Grants/star-c.aspx. Updated October 2011. Accessed December 16, 2011. Pal SK, Katheria V, Hurria A. Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin. 2010;60:120-132. Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5(3):224-237. Dodd M, Janson S, Facione N, et al. Advancing the science of symptom management. J Adv Nurs. 2001;33:668-676. Carreca I, Balducci L, Extermann M. Cancer in the older person. Cancer Treat Rev. 2005;31(5):380-402. Wieland D, Hirth V. Comprehensive geriatric assessment. Cancer Control. 2003;10(6):454-462. Murdoch J, Larsen D. Assessing pain in cognitively impaired older adults. Nurs Stand. 2004;18(38):33-39. Dietrich J, Monje M, Wefel J, Meyers C. Clinical patterns and biological correlates of cognitive dysfunction associated with cancer therapy. Oncologist. 2008;13(12):1285-1295. Fann JR, Fan MY, Unützer J. Improving primary care for older adults with cancer and depression. J Gen Intern Med. 2009;24(suppl 2):S417-S424. Berger NA, Savvides P, Koroukian SM, et al. Cancer in the elderly. Trans Am Clin Climatol Assoc. 2006;117:147-156. MedlinePlus. Depression - elderly. U.S. National Library of Medicine Web site. http://www.nlm.nih.gov/medlineplus/ency/article/001521.htm. Updated December 2011. Accessed December 16, 2011. Given BA, Given CW, Kozachik S. Family support in advanced cancer. CA Cancer J Clin. 2001;51(4):213-231. Houts PS, Nezu AM, Nezu CM, Bucher JA. The prepared family caregiver: a problem-solving approach to family caregiver education. Patient Educ Counsel. 1996;27(1):63-73.

Pfizer, Inc. would like to acknowledge Vicki Schmall, PhD, and Anita Woods, PhD, for their contributions in developing this program

NPC01513H/426926-01

© 2012 Pfizer Inc.

All rights reserved.

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