My assigned patient for the week is JC, an at-risk 86-year-old Asian male. The case description provides plenty of contextual information that would guide my initial interaction with the patient. The first key revelation is that JC is physically and financially dependent on his daughter, who is herself a single mother. Furthermore, it appears that JC feels he has become a burden to his daughter, and that she “has little time or money for her father’s needs.” I would be curious to understand where this sentiment arises from. It is common for older patients to develop such feelings as they grow older and become more dependent on their families for their sustenance and to help them with activities of daily living (Shorey & Chan, 2021). I would consider involving JC’s daughter in the patient’s long-term treatment plan, and I would prioritize ascertaining whether she is indeed struggling to attend to his needs while also fulfilling her own motherly obligations. The patient’s daughter may also be more reliable as a source of information on his health, and may be useful for seeking follow up information on the progression of his health after he is discharged (Ko & Berkman, 2010). In addition, JC’s daughter may be a useful intermediary or translator that helps the attending practitioner to communicate more effectively with the patient.
Depending on the specific culture from which JC and his daughter hail, it may be normal for Asian families to assume responsibility for caring for the older members of their families. For example, in traditional Chinese culture, parents often move in with their children’s families after retirement (Ko & Berkman, 2010). Beyond these issues, the patient presents with several chronic conditions, and is on a medication regimen that requires consistent conformity. I would want to determine whether JC is capable of managing his medication alone, and if not, I would work with him and his daughter to find a viable solution that will ensure he takes his medication on time and in the required quantity. In the absence of a caregiver, technological solutions like smartphone-based reminders can help older patients adhere to complicated medication plans that they cannot manage on their own.
When interviewing an older patient, it is important to remain civil, respectful, and patient. The appearance of condescension or a patronizing attitude may put off a patient and prevent him from interacting positively with the practitioner (Koskenniemi, et al., 2018). As such, I would remain respectful, acknowledge JC’s concerns and preferences, and solicit his input on the relevant aspects of his treatment that he can contribute to. Assuming that I succeed in securing the involvement of his daughter, I would also encourage her to reassure JC and alleviate any fears that he may have become a burden to her. The geriatric depression scale (GDS) would be a useful assessment instrument for determining whether JC is depressed, and consequently incorporating therapy into his care plan.
I would prioritize the following questions in my initial interaction with the patient:
1. How is your overall health? Which particular health issues trouble you the most?
2. When was your last hospital visit?
3. Do you have difficulties taking your medication as prescribed? Or how often do you miss taking your medication?
4. What are your beliefs about healthcare?
5. How is your relationship with your daughter?
Ko, E., & Berkman, C. S. (2010). Role of children in end-of-life treatment planning among Korean American older adults. Journal of social work in end-of-life & palliative care, 6(3-4), 164-184. https://doi.org/10.1080/15524256.2010.529019
Koskenniemi, J., Leino‐Kilpi, H., Puukka, P., Stolt, M., & Suhonen, R. (2018). Being respected by nurses: Measuring older patients’ perceptions. International Journal of Older People Nursing, 13(3), e12197. https://doi.org/10.1111/opn.12197
Shorey, S., & Chan, V. (2021). The experiences and needs of Asian older adults who are socially isolated and lonely: A qualitative systematic review. Archives of gerontology and geriatrics, 92, 104254. https://doi.org/10.1016/j.archger.2020.104254