NOV 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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November 2012 Providing better treatment to elderly patients by Vanessa Caceres EyeWorld Contributing Writer Patients aren't just "older adults" C onsider yourself a gate- keeper for the graying population. Ophthalmolo- gists are at the forefront of treating the booming elderly patient group. One reason: The first crop of baby boomers turned 65 in 2011—part of the so-called silver tsunami that will cause the elderly population to double by 2030. This is mirrored by an upswing in the "extreme elderly," patients who are 85 and older, said Hilary Beaver, M.D., associate professor of clinical ophthalmology, Weill Cornell Medical College, The Methodist Hospital System, Houston. The U.S. Census Bureau predicts that the U.S. population age 85 and over will reach 19 million by 2050, compared to only 5.7 million in 2008. Exacerbating the elderly tsunami in eyecare is the fact that ophthalmology's most commonly treated conditions are connected with age. "All four major disorders are age-related—diabetic retinopa- thy, cataract, glaucoma, and age- related macular degeneration," said Andrew Lee, M.D., chairman, Department of Ophthalmology, The Methodist Hospital, Houston. Drs. Beaver and Lee are co-authors of the book Geriatric Ophthalmology: A Competency-based Approach. Yet another reason ophthalmol- ogists will increasingly treat the 65+ crowd is because vision has powerful connections with other age-related health problems. For example, vi- sion problems affect a patient's risk for falls. Cognitive problems in the elderly may actually be exacerbated by decreased vision and may ini- tially present as a vision problem. "The aging population will affect all specialties, but ophthalmology disproportionately," said Dr. Lee. Finally, when patients live longer, they carry their chronic health problems for longer time periods, Dr. Beaver said. An example of this is obesity and the associated conditions of diabetes and hyperten- sion. Ophthalmologists will be seeing more diabetic-related eye problems with more type 2 diabetes, Dr. Beaver said. This doesn't mean ophthalmic practices can merely tweak what Health Literacy Month promotes the importance of understandable health information Source: Helen Osborne, M.Ed., OTR/L they do with their younger or mid- dle-aged adult patients to accommo- date elderly patients. "It's like they say in pediatric ophthalmology: Pediatric patients are not just little adults, and older people are not just older adults," Dr. Lee said. "They have different needs, responses, and co-morbidities." Below are some other common issues to consider as you treat the ever-expanding elderly patient group. The role of caregivers When you assess older patients, involve caregivers who bring them to appointments to get a better sense of the patient's daily visual challenges, said Barbara Resnick, Ph.D., Sonya Ziporkin Gershowitz Chair in Gerontology, University of Maryland School of Nursing, Balti- more, and chair, Board of Directors, American Geriatric Society. "You sometimes have to ask the same question five different ways," she said. "You might ask patients if they are able to get their groceries on their own, and they say it's no problem. Yet the caregiver will tell you the patient hasn't gone alone for 6 years." Involving caregivers will also help give a clearer picture of the patient's problem. While baby boomers are typically thought of as reaching out for help, those in the generations preceding baby boomers tend to stay mum about their health problems. "They may not under- stand their symptoms, or they don't want to worry their families. There is also a lot of denial," said rheumatol- ogist Roy D. Altman, M.D., UCLA Rheumatology, Los Angeles. Dr. Beaver finds it helpful with these patients and their caregivers to discuss the wide variety of medica- tions now available and to empha- size the importance of accessing healthcare when necessary. It helps to contrast the options that they have compared to the health system available to their patients. Another common challenge in the older age group is polyphar- macy. "The average 80-year-old takes 5-10 drugs. This can inadvertently cause an interaction," Dr. Lee said. Caregivers can work with patients to manage medication use and main- tain compliance. Caregivers can also help risk- proof the patient's living environ- ment to prevent falls, Dr. Lee said. This might include moving electrical cords, removing throw rugs, and providing handrails near toilets. Patient education Vision, hearing, and cognition problems can all affect an elderly patient's ability to understand pa- tient education, said Helen Osborne, M.Ed., OTR/L, founder and presi- dent, Health Literacy Consulting, Natick, Mass. Ms. Osborne wrote the book Health Literacy from A to Z. Elderly patients also may experience declining literacy skills, increased pain levels, and independ- ence issues—all factors that can im- pede their ability to understand and manage their visual problems, she added. "It's not just about under- standing a brochure," Ms. Osborne said. "The patient has to learn, act on, and internalize information." Education for older patients should be a team effort, Dr. Resnick said. Appoint technicians or other staff members to help fill in the extra chair time these patients may require, she recommended. When explaining eye diseases or providing instructions on how to take medications, share that infor- mation with everyone involved with patient care. This might include family members, home health staff, physical or occupational therapists, and other health professionals. To further reinforce what you want patients to learn, use brochures, visuals, audio and video, online resources, or even manipula- tives such as a model of the eye. continued on page 24 Website resources American Geriatrics Society www.americangeriatrics.org Health Literacy Consulting: Helen Osborne's website featuring various articles and podcasts about better patient communication and education healthliteracy.com and www.healthliteracyoutloud.com Number of Older Americans: Contains a number of facts and figures on the elderly population growth in the U.S. www.agingstats.gov/Main_Site/Data/2010 _Documents/Population.aspx EW NEWS & OPINION 23

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