Table 1 Principles of care for older adults
From: Perspectives on optimizing care of patients in multidisciplinary chronic kidney disease clinics
| Barrier | Identification | Strategies |
|---|---|---|
| Sensory deficits | Screening for visual acuity and hearing loss formally, informally | -Referral for aids (glasses, hearing aids) |
| -Optimize the learning environment (adequate lighting, minimize glare, limit background noise) | ||
| -Written instructions with large font sizing and multimodal information (visual and verbal through writing, pictogram, hands-on experience, videos, web-links, online) | ||
| -Appropriate voice intensity, pitch, pacing, eye level, direct visualization to allow for lip reading | ||
| Cognitive impairment | Screening with MMSE, MoCA, clock drawing, cognitive battery testing | -Breakdown information into small units (focus on only 3–5 issues or ess per session, <15 minutes per session) |
| -Explain each element separately | ||
| -Direct, actional, concrete language (“take one tablet in the morning and one at night” not “take twice a day”) | ||
| -Individualized, tailored educational sessions | ||
| -“Right branching” (“take a seat and you won’t miss the session” not “if you don’t want to miss the session, take a seat”) | ||
| -Teach-back technique | ||
| -Involvement of caregiver | ||
| -Refer for treatment as indicated | ||
| Mood disorders | Screening formally, informally | -Reassurance |
| -Simplify | ||
| -Pacing | ||
| -Refer for treatment as indicated (medications, CBT) | ||
| Health literacy | Assuming baseline limited health literacy vs. screening | -Limiting language complexity |
| -The use of appropriate terminology in all forms and venues of communications (“high blood pressure” not “hypertension”) | ||
| Adherence | “How many times have you missed (behavior) in the last week?” | -Simplify |
| -Explain (indications, consequences, prioritization) | ||
| -Reinforce | ||
| -Checking/rechecking understanding | ||
| -Address feasibility, acceptability | ||
| -Involvement of caregiver |