Communication between Older Patients and Their Physicians老年患者和他们的医生之间的沟通.pptVIP

* * * * * * Multiple chronic illness – involves more time and more work Atypical presentation of disease - angina, no walking, SOB, - it takes longer to diagnose Polypharmacy – takes longer to review and list meds Multiple MDs – coordination of care who is doing what and integrating care – involves phone calls and organizing the focus Team - realize that MD cannot do it all if you don’t work in an academic practice with a social worker, you need to develop informal relationships with professionals in the community. when VNS calls, you answer * Hearing – presbycusis, decreased hearing of high frequency sounds incidence of sensory neural loss increases each decade. By 7th-8th decade, 70-80% of PTs are affected. Vision – after 65 decrease in visual acuity, contrast sensitivity, glare intolerance and visual fields Because of prevalence, must be addressed in medical visit Cognitive issues – daunting task, involves family members, PTs skills vary with type of dementia and over the course of the disease MDs must use a range of strategies to optimize the exchange of information and shepherd the relationship with the demented PT dementia-ism – writing off * Utilizing other health professionals to help with psychological and social needs Knowing that Losses – friends, function Caregiving – who is going to care for them concerns about being a burden Spiritual issues – goals of care advanced directives end of life care * Elder abuse example Is the 3rd person an advocate, an opportunist or an underminer of the MD-older PT relationship? Who is the 3rd person? How are the dynamics of the interaction changed from dyadic to triadic encounters? Will be talking more about this * * * May need more than a single visit. Let PT know that it may take several vis