Posts Tagged ‘caregivers caregiving’

Patience Is a Waste of Time

03/17/2010 , 1:47 PM by Victor Imbimbo

When I came up with this phrase years ago, it unfortunately accurately reflected my attitude about having little appreciation for patience and very little belief that patience is a virtue. My self-indulgent quip usually would get a laugh or maybe a quizzical expression from those within earshot. The sad thing, however, is that I really believed it.

It wasn’t until I became a family caregiver that I realized the ridiculous nature of this way of thinking. I’ve found patience to be an essential ingredient for delivering quality care for a loved one. More so, I have found it to be a necessity in preventing me from beating myself up during the most trying of times; the self-inflicted negative effect of a lack of patience on my personal well being had become a real problem.

I don’t know about you, but as a caregiver I quickly found out that there were many things I had to deal with that were completely out of my control. Though rarely catastrophic scenarios, I found many to be overwhelming simply because of my lack of patience that resulted in my not giving myself a break. Given my impatience, especially with myself, a sense of stress and anxiety became my near-constant emotional state. I didn’t allow myself to be receptive to joyful experiences or to appreciate the many good and satisfying parts of my life.

So what brought about my understanding of the need for patience? Oddly, it was my having to experience one of my most impatient times. For whatever reason, right in the center of a self-imposed emotional storm, the words of a flight instructor of mine from over 30 years ago popped into my head: “Sometimes, when you are flying through turbulence, the best way to handle it is to just relax and not hold onto the yoke (wheel) too tightly. “Let time and the conditions help you. Make sure you have done all you can do, just give it time, and don’t fight every little bump.” Eureka!

These words have had a lot more meaning and benefit for me on the ground than they ever did in the sky. They’ve made me a better caregiver for others, more understanding of those around me, and allowed me to be at greater peace with myself. I hope they do the same for you.

About Victor. Victor Imbimbo is a family caregiver and has been working with other caregivers for over ten years.

Traveling the country and speaking with caregivers Victor hears one central theme: “I don’t have time to worry about myself.” Although understandable it is simply not acceptable. We hope that you find something in Victor’s blog that rings true for you. Caregiver to caregiver dialogue is helpful and supportive so please sound off. Help yourself. Help others!

a Pictogram-Based Intervention to Reduce Dosing Errors and Improve Adherence Among Caregivers of Young Children

09/02/2008 , 9:47 AM by Alex Sicre

Today’s medication adherence related abstract comes from the Annals of Pediatrics & Adolescent Medicine.

See my COMMENTS at the end.

Objective: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children.

Design: Randomized controlled trial.

Setting: Urban public hospital pediatric emergency department.

Participants: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or “as needed”).

Intervention: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling.

Outcome Measures: Medication knowledge and practice, dosing accuracy, and adherence.

Results: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed.

Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]).

Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications.

Conclusion: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department.

MY COMMENTS
I recently attended a webinar hosted by a medical education company. They write their brochures and outreach materials for a 5th grade reading level. The average for healthcare related educational materials is geared towards an 8th grade reading level, but they are now going lower. To me that is quite scary for patients whose caregivers might not understand their medical regime and the medications they administer. Glad to see there is a study that has proven the efficacy of “dumbing down” medication instructions.

Exelon Follow-Up

11/01/2007 , 11:36 AM by Alex Sicre

October 23rd 2007 was the first day that the Exelon transdermal patch, the first and only skin patch for the symptomatic treatment of mild to moderately severe Alzheimer’s dementia, is available in the UK market. Here’s some info on it from ITNews.com, no author given:

A clinical study of 1,195 people with Alzheimer’s dementia demonstrated that the rivastigmine patch improves cognitive function (assessed using a tool that includes measures of orientation, memory and language), as well as a patient’s ability to perform everyday activities compared to placebo. The study also showed that the 9.5mg/24h patch is as effective as the maximum titrated dose of rivastigmine oral capsules.

Applied once a day (replaced every 24 hours), the rivastigmine patch provides smooth and continuous delivery of rivastigmine through the skin, which reduces nausea and vomiting caused by peaks in medication levels when the drug is taken orally.
Dr Peter Connelly, Consultant in Old Age Psychiatry, Perth, Scotland comments, “The Exelon patch represents a valuable advance in the treatment of Alzheimer’s disease. This formulation offers patients and their carers an effective, well-tolerated and convenient therapy option. I expect a significant proportion of carers will find the patch easier to use compared to the conventional formulation.”

Family cargivers are the backbone of long-term care to Alzheimer’s disease patients, frequently responsible for administering and managing patient medication. A survey conducted in over 1,000 caregivers showed that more than 70 per cent preferred the patch as a method of drug delivery compared to oral capsules(3). The most common reasons for preferring the patch were ease of following the schedule and ease of use.

The rivastigmine patch can be applied to the upper arm, chest or back(4). The patch may allow those caring for Alzheimer’s disease patients to monitor treatment compliance because it provides visual reassurance that the medication has been taken. Compliance with prescribed medication regimens represents a challenge for most patients but may be particularly difficult for older people due to: the extent to which drug regimens interfere with daily living; lack of understanding or misinterpretation of instructions; complex and complicated drug regimens; and forgetfulness(6). 75% of older people are believed to not comply with their treatment regimens.

“Caring for a relative with Alzheimer’s is very time-consuming and sometimes overwhelming. There’s a lot to think about and sufferers are often on a number of medications,” comments carer Lisa, who used to look after her sister at home. “People with the disease can find it difficult to take oral medication and to comply with a strict routine. A patch that provides 24 hour cover could help keep track of when medication has been taken.”

COMMENTS
I’m all for anything to improve patient medication adherence. Once again my hope is that patients remember they have the patch on and rmember to change them as well. To celebrate National Caregivers Month – here’s to Novartis!

November is National Caregiver’s Month

, 11:35 AM by Alex Sicre

To celebrate, go care for someone or give a caregiver the day off!