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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
  1. MMSE Mini Mental Status Examination, MoCA Montreal cognitive assessment, CBT cognitive behavioral therapy