Caring for older patients: coaching, legal issues, and professional behaviors

Patient coaching

The medical assistant must keep in mind the sensorimotor changes that accompany aging and also must consider respectful patient communication when conducting patient education with older patients. Remember, the aging process does not affect a person’s ability to learn; it just may take longer for the older patient to process the information, and the material may need to be repeated for understanding. Showing sensitivity to the needs of aging learners ensures successful patient education and improves compliance with prescribed treatment plans. The current aging population generally is respectful toward authority; therefore, if the medical assistant cannot gain the patient’s cooperation, the provider may be able to provide authoritative reinforcement of the material. Here are some general guidelines for effective patient education with older adults:

• The patient may have short-term memory loss, so you may need to repeat the information using different words.
• The patient may be distracted more easily, so learning in a group may be difficult.
• The patient may take longer to process information, so teach at a pace that matches the patient’s needs.
• Provide the patient with handouts that have large print and block letters for reviewing information at home.
• Involve family members as needed for continuity of care; supply provider-approved websites for reference.

Legal and ethical issues

One legal issue in the care of aging patients is the possibility of elder abuse, neglect, and exploitation. Mistreatment of aging people occurs at all social, racial, and economic levels. The abuse may be physical, mental, sexual, material, or financial; it may involve neglect or failure to provide adequate care, or it may involve self-neglect when aging people are unable or refuse to care for themselves. Abuse, neglect, and exploitation of elders by their caregivers may be difficult to identify. The aging victim could feel embarrassed, guilty, or afraid to report the abuse. Here are some indications that a patient may be the victim of elder abuse, neglect, or exploitation:

• Poor general appearance and poor hygiene
• Pattern of changing doctors and frequent emergency department visits
• Skin lesions, signs of dehydration, bruises (signs of new and old bruising together), abrasions, welts, burns, or pressure sores
• Recurrent injuries caused by accidents
• Signs of malnutrition and weight loss without related illness
• Any injury that does not fit the given history

If abuse, neglect, or exploitation is suspected, interviewing the caregiver and questioning the demands of care and self-reported perceptions of stress levels may help the provider detect the problem. Many states now have laws that require reporting of suspected elder abuse, neglect, or exploitation. Check your state laws to determine the requirements for healthcare workers.

Patient-centered care

When working with this patient population, it is important to include the patient and that individual’s support system in the decision-making process. Although many geriatric patients are still making their own healthcare decisions, there are some who have others involved in the process. It might be a partner, family member, or a trusted friend. The medical assistant needs to be aware of HIPAA concerns about privacy and confidentiality. This means making sure that the patient has signed all of the appropriate forms regarding who can receive information about the patient’s healthcare status. The disclosure authorization form will allow the healthcare facility to provide information to the designated representative. An advance directive will name the person who will make decisions for the patient when she or he is no longer able to.

Some patients just want another set of ears listening to what the provider says and any directions for care that may be given. The medical assistant will ask if the patient is comfortable with someone else being in the room, and when verbal consent is given, the visit can proceed. It can be comforting for patients to know they have someone they trust hearing the information. This person or persons may provide their opinion about the treatment but the patient will ultimately make the decision, unless the advance directive has been activated.

For certain situations, a meeting with the provider may need to be scheduled in a conference room setting to accommodate all that may need to attend. It is important to remember that we treat the whole patient, not just the patient’s medical condition.

End of life and grief

A patient facing a terminal diagnosis, and that patient’s family, will often experience grief. Grief isn’t limited to older adults or to dying patients - it’s a common response to any major loss, including a disabling condition or the death of a loved one.

Elisabeth Kübler-Ross described grief as unfolding in five stages, presented in this order: denial (“This can’t be happening”), anger (often directed at family members or office staff), bargaining (trying to make a deal for more time), depression (sadness and withdrawal as the loss becomes real), and acceptance (coming to terms with the loss). Kübler-Ross presented the stages in this sequence as a general model, but grief doesn’t always follow a fixed script - not everyone experiences every stage, and a grieving person may skip stages or move back and forth between them rather than passing through each one once in strict order.

The medical assistant plays an important supporting role with a grieving patient or family member: listen and allow them to express their feelings; accept expressions of anger without taking them personally; avoid false reassurance and clichés such as “everything will be fine”; respect cultural and religious practices surrounding death and dying; and know the resources the office can offer or refer to, such as hospice and palliative care referrals, bereavement support groups and counseling, and passing on requests to the provider.

Professional behaviors

Your future employers will expect you to use problem-solving techniques, including recognizing and defining a problem, analyzing the issue, and developing a plan of action. Older adult patients typically have multiple health problems that are frequently complicated by physical, psychological, and environmental factors. To provide quality care for these individuals, you must look at their health issues in a holistic way, taking into consideration all the factors that affect their eventual ability to follow treatment plans and improve their health status. Part of the process involves identifying resources that might help the aging person be better equipped to take care of himself or herself. Consistently using community and online resources may mean the difference between an aging person being able to stay in the home or having to go to a long-term care facility. The professional medical assistant can play a crucial role in providing assistance to aging clients.