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A drug education program for the well elderly
A Drug Education Program A model that's been tested and can be a ELIZABETH DONAHUE KAREN GIRTON JEAN BAUMLER BARBARA MOERHLIN LESLIE STRAYER Elderly people comprise about 10 percent of our population but consume approximately 25 percent of all drugs used in this country(I). Each medicine may have a beneficial purpose, but poor understanding of drug side effects and misuse of drugs can contribute significantly to the health problems of older adults. Adverse drug reactions occur more frequently among the aged due to many factors. Among these are altered physiological responses caused by the aging process, the greater number of drugs taken, the effects of existing disease, selfmedication with nonprescription drugs, and the concurrent use of several drugs. Drug-induced illnesses may elude detection when their symptoms mimic such characteristics of old age as forgetfulness, weakness, confusion, tremor, anorexia, and anxiety. We designed a community-based education program to increase the ability of older adults to use OTC and prescribed drugs safely. The target group was the over-60 population of a large county in CaliforElizabeth Donahue, R.N., is assistant director at the Senior Socialization Center of Catholic Social Service in San Jose, Calif.; Karen Girton, R.N., M.S., lectures in the baccalaureate nursing program of San Jose University, Calif.; Jean Baumler, R.N., is a staff nurse at a Veterans Administration Intermediate Care Facility in Palo Alto, Calif.; Barbara Moehrlin, R.N., M.S., is a public health nurse coordinator with the Senior Health Promotion Project of the Santa Clara County Health Project Dept.; and Leslie Strayer. R.N., has been a teacher's assistant in a convalescent setting in Santa Clara County, Calif.
140 Geriatric Nursing March/April 1981
nia. The program was first presented to the residents of a retirement home and later repeated several times for groups of about 30 people at nutrition sites and senior centers. The retirement residence had 216 units, each housing one or two persons over the age of 62; the me-
dian age was 75. Sixty-three percent of the residents were women and the majority lived alone. Drug education was presented as part of an established weekly health program in the conference room of the seniors' apartment complex. The clients who attended the weekly health program were alert,
THE PROGRAM I. INTRODUCTION The content is planned to answer five questions: What is a medicine? In what forms are medicines dispensed? Why are m ed ici nes used? What information is needed to take medicines safely? What are the available resources? II. TEXT (30 MINUTES) What is a medicine and in what forms are medicines dispensed? 1) A medicin e is a substance or mix ture of substances. 2) Medicine comes in many forms, the most common are • Li quids (Nyquil, Maalox) • Pills (tetracycline [Achrornycin], Contac, aspirin) • Suppositories (Preparation -H) • Powders (Desenex, baking soda) • Creams (Solarcaine) • Aerosol (Bactine» 3) There are two ca tegories of medicine. Prescription • Obtained o nly by a prescription gi ven by a doctor. • Bought at a drugstore an d filled by a pharmacist (example: digoxin (Lanoxin) . Over-the-counter medicines • No pres c ript io n is needed . • You sele ct it from the shelf . • Y ou buy it at a dru g store, sometimes at a groce ry store (ex am ple : Ma alox) . Why do we take m ed icine ? In order to c ure, tre at, or prevent illness, or simply to fee l bett er. What do you need to kno w ab out takin g medicine s safely?
1) Medicines are potentially hazardous if not taken properly. 2) If you are taking more than three or four medicines in one day, you are increasing your chances of experiencing side effects . 3) If you are only taking medicines prescribed by one doctor, he has taken into consideration the potential side ef fects wh ich may be hazardous to y o u. 4) If you are taking prescribed medicine with OTC medicine or if you are taking me dicine prescribed by more than one doctor without t he doctor knowing what other medicines you are taking, yo u are inc rea si ng your chances for experiencing side effects. 5) When you are taking medicines to gether yo u may: • Make them work too well. • Make them work less well than they are sup po sed to . • Ma k e th em stop working altogether (examp le: tetracycline and iron). 6) Th e most common side effects you may experience are nausea, vom it ing, diar rhea or cons t ipation , rashes, and weakness . You may also experience nightmares, fe e lings of co nfusion or depr ession. You should know the fo llowing: • Th e name of the me dicine you are t aking. • Th e reason you are taking it. • How to take the medicine. • The side effect s of the medic ine. • The expiration date of the pre scription. • The precautions for taking the me dicine. • W here you should keep the drug.
for the Well Elderly guide in establishing your own workshop. mot ivated, and sufficiently mobile to com e to a group meet ing . Using a fam iliar room , time, and agency lent credence and authenticity, and encouraged acc ept ance by th e. elderly residents. . The changes th at many older adults experience calI for specific criteria in choosing a physical set-
ting for teaching. The elderly ha ve visua l difficulty discr iminating among blue, blue green, and violet ; smaII det ails are also a problem (2-3) . Aged clien ts also have lengthened reaction times and varying deg rees of memory fu nction(4). Motor loss due to pathological changes may prolong their per-
UTLINE • How many day 's supply you have on hand . You need to do the following: • Keep a list of the prescription and TC medicines you take. • Keep the list in a handy and visible place, like the medicine chest or refrigrator doo r. • Carry a wallet size card tha t lists your health problem(s) and the medicines you are taking . • Wear a Medic-Alert bracelet or necklace . • Always take the medicine at the prescribed times. You should never do the following: • Take an OTC medicine without first checking with your doctor or pharacist. • Take a medicine at othe r times than prescribed or suggested by the lael. • Take more or less of the medicine ithout first checking with your doctor (i f one pill is good, two are not necesarily better). 'hat resourc es are available? Only you can take responsibility for taking your medicines safely, but the following resources are available. he label If the label does not have the necesary information, ask your pharmacist for clarification . our doc tor 1) Take a list to your doctor of OTC nd prescription medicines you are currently taking (particularly when you ave more than one doctor). 2) Write down the health concerns you wa nt to discuss with your doctor so
you do not forget. 3) Whenever the doctor prescribes a new medicine for you, ask the following: • Name of the medicine • Reason for taking the medicine • How much, how often, and how long to take the medicine • Specific directions abo ut taking it or not taking it with meals, milk products, or fruit juices • Side effects you might have from taking the medicine and which side ef fects you should report immediately • Is the prescription safe to take with the common OTC medicines The pharmacist 1) He can tell you the difference be tween generic and brand names. 2) He can provide you with price lists or let you know if discounts are availabl e to seni ors . 3) He can keep a record of all your medicines and any drug allergies that you may have. 4) He can tell you about books avail able on medicines. Th e nurse 1) Explains how the medicines work and what possible side effects might be experienced. She clarifies the physician's directions. 2) Instructs in the proper storage of medicines. 3) Assists in keeping medicine rec ords. III. Program evaluation (5 minutes). IV. Question and answer period (20 minutes).
formance time(5). Thirty-three percent of our program participants had some degree of visual impairment and many had hearing deficits. The conference room and the 2 to 3 P.M. class hour met our criteria for the drug prog ram setting: convenient time of day for participants, adequate ventilation' and warmth, nonglare lighting, good acoustics, enough space for clie nt comfort but not too much distance between teachers and participants, familiar surroundings, privacy, room for canes, wheelchairs, and walkers, comfortable chairs, easy access by elevator or ramp, and tables for large displays . Th e drug prog ram was presented by two of us (K.G., B.M.) who are public health nurses with experience in education and group work with the elderly. We knew the district public health nurse who regularly conducted health education programs at the residence. We used an eclectic approach in teaching, combining elements of behaviorism, humanism, and cogn itivism. Behavioristic repetition and reinforcement are effective with the aged. Principles of cognitivism, such as perception, problem solving , information processing, and und erstanding, guided our choice of visual aids , ad vance organizers (handouts, comparisons, and flip charts), and the didactic teaching. A cognitive approach permits students to question specific areas of concern; humanism emphasizes self-paced instruction and a nonthreatening student-teacher relationship. Gribbin states, " Allowing people to proceed a t the ir own pac e, making task s meaningful, avo iding irrelevant information, keeping tasks as simple as possible, providing cues, etc., are very important factors to consider if one wishes to im-
Geriatric Nursing M archi April 1981 141
Our use of large, easily read visual aids encouraged participation and stimulated interaction.
prove the learning and memory performance of the elderly."(6) Hallburg listed numerous recommendations for teaching older adults. We adhered to the following Hallburg guidelines: • Select large easily seen visual aids. • Speak slowly and enunciate clearly. • Determine with the older person the type of aid or media that best facilitates his or her learningauditory, visual, tactile, or some combination of these. • Obtain feedback from participants about pace, speech intelligibility, and value of content(7). Developing the Program The program content was developed to enable participants to choose three over-the-counter medicines from a list of six drugs frequently used by older adults; to list at least three forms in which medicine can be taken; to identify on a medicine label at least three points of information that promote the safe use of drugs; to select four common drug side effects from a list of six; to choose from a list of four choices two medication practices that should be followed; and to identify resources that can help answer questions about medications. We planned the didactic program to last for 35 minutes, to be followed by a period of questions and answers. This length of time was chosen to avoid tiring the participants and to fit in with their weekly routine. The program was advertised by a
142 Geriatric Nursing March/April 198\
flyer printed in large letters and displayed throughout the residence. All visual aids were prepared in large print. Each participant received a large-print pamphlet highlighting the important points of the program. We displayed medicine bottles and pamphlets that we had collected. from local pharmacies, and shared books on OTC drugs. Evaluation The effectiveness of the program was to be evaluated by the amount of group participation, group attentiveness, and the interest generated. A simple six question pre- and posttest was given to determine what the elders learned. Twenty-seven residents attended the program; 21 of them were women. All stayed for the entire hour except one who left, complaining of being cold. Group participation during and after the presentation was high. The audience interjected specific questions and concerns about medicines, and other comments. We observed, however, that some participants could not see to complete the pre- and posttest. Some were confused by the directions, and others said it was not important to them to take the time or trouble to complete the test. At the completion of the presentation, seven participants thought it was redundant to repeat the same test. Others seemed apathetic or wanted to talk about their own experiences. Clearly the audience did not comprehend the purpose of the tests and found them irrelevant, even though the rationale had been care-
fully explained. From the comments and subjective evaluations, it appeared that the program was positively received and stimulated further interest in medicine information. The participants seemed to enjoy the coffee and cookies. The majority lingered to talk, again reiterating that they could hear and understand the speakers. They liked the audiovisual aids. A subjective evaluation was completed by 22 persons. Of these, 19 said they learned something from the program, 13 stated they would like more programs about medicine, 20 said the presentation was clear, and 18 said the handout was useful. Our recommendations, based on conducting this drug program are that participants in such groups should wear their glasses and hearing aids, that the program format take into consideration the various deficits of the aged clients, and that content be discussed in easily understood terminology. In retrospect, we believe our preand posttest should be replaced by hand raising in response to simple questions. We offer the content outlined in the box on page 140 as a tested tool for drug education with older adults living in the community. References I. Brady. E. S. Drugs and the elderly. IN Drugs and the Elderly. ed, by R.
2.
3.
4.
5. 6.
7.
Kayne. Los Angeles. Ethel Percy Andrus Gerontology Center, University of Southern California, 1978, pp. 1-7. Said, F. S .• and Weale, R. A. The variation with age of the spectral transmissivity of the living human crystalline lens. Gerontologia 3:213-231. 1959. Weale, R. A. On the eye. IN Behavior, Aging, and the Nervous System, ed. by A. T. Welford and J.E. Birren. Springfield, III., Charles C Thomas. Publishers, 1965, pp. 307-325. Hilgard, E. R .• and Bower. G. H. Theories of Learning. 4th ed. New York. Appleton-Century-Crofts, 1975. Ibid. Gribbin. K. Cognitive process in aging. IN Nursing and the Aged. ed. by I. M. Burnside. New York. McGraw-Hili Book Co .• 1976. p. 55. Hallburg, J. C. The teaching of aged adults. J.Gerontol.Nurs. 2:18, MayJune, 1976.
140 Geriatric Nursing March/April 1981
nia. The program was first presented to the residents of a retirement home and later repeated several times for groups of about 30 people at nutrition sites and senior centers. The retirement residence had 216 units, each housing one or two persons over the age of 62; the me-
dian age was 75. Sixty-three percent of the residents were women and the majority lived alone. Drug education was presented as part of an established weekly health program in the conference room of the seniors' apartment complex. The clients who attended the weekly health program were alert,
THE PROGRAM I. INTRODUCTION The content is planned to answer five questions: What is a medicine? In what forms are medicines dispensed? Why are m ed ici nes used? What information is needed to take medicines safely? What are the available resources? II. TEXT (30 MINUTES) What is a medicine and in what forms are medicines dispensed? 1) A medicin e is a substance or mix ture of substances. 2) Medicine comes in many forms, the most common are • Li quids (Nyquil, Maalox) • Pills (tetracycline [Achrornycin], Contac, aspirin) • Suppositories (Preparation -H) • Powders (Desenex, baking soda) • Creams (Solarcaine) • Aerosol (Bactine» 3) There are two ca tegories of medicine. Prescription • Obtained o nly by a prescription gi ven by a doctor. • Bought at a drugstore an d filled by a pharmacist (example: digoxin (Lanoxin) . Over-the-counter medicines • No pres c ript io n is needed . • You sele ct it from the shelf . • Y ou buy it at a dru g store, sometimes at a groce ry store (ex am ple : Ma alox) . Why do we take m ed icine ? In order to c ure, tre at, or prevent illness, or simply to fee l bett er. What do you need to kno w ab out takin g medicine s safely?
1) Medicines are potentially hazardous if not taken properly. 2) If you are taking more than three or four medicines in one day, you are increasing your chances of experiencing side effects . 3) If you are only taking medicines prescribed by one doctor, he has taken into consideration the potential side ef fects wh ich may be hazardous to y o u. 4) If you are taking prescribed medicine with OTC medicine or if you are taking me dicine prescribed by more than one doctor without t he doctor knowing what other medicines you are taking, yo u are inc rea si ng your chances for experiencing side effects. 5) When you are taking medicines to gether yo u may: • Make them work too well. • Make them work less well than they are sup po sed to . • Ma k e th em stop working altogether (examp le: tetracycline and iron). 6) Th e most common side effects you may experience are nausea, vom it ing, diar rhea or cons t ipation , rashes, and weakness . You may also experience nightmares, fe e lings of co nfusion or depr ession. You should know the fo llowing: • Th e name of the me dicine you are t aking. • Th e reason you are taking it. • How to take the medicine. • The side effect s of the medic ine. • The expiration date of the pre scription. • The precautions for taking the me dicine. • W here you should keep the drug.
for the Well Elderly guide in establishing your own workshop. mot ivated, and sufficiently mobile to com e to a group meet ing . Using a fam iliar room , time, and agency lent credence and authenticity, and encouraged acc ept ance by th e. elderly residents. . The changes th at many older adults experience calI for specific criteria in choosing a physical set-
ting for teaching. The elderly ha ve visua l difficulty discr iminating among blue, blue green, and violet ; smaII det ails are also a problem (2-3) . Aged clien ts also have lengthened reaction times and varying deg rees of memory fu nction(4). Motor loss due to pathological changes may prolong their per-
UTLINE • How many day 's supply you have on hand . You need to do the following: • Keep a list of the prescription and TC medicines you take. • Keep the list in a handy and visible place, like the medicine chest or refrigrator doo r. • Carry a wallet size card tha t lists your health problem(s) and the medicines you are taking . • Wear a Medic-Alert bracelet or necklace . • Always take the medicine at the prescribed times. You should never do the following: • Take an OTC medicine without first checking with your doctor or pharacist. • Take a medicine at othe r times than prescribed or suggested by the lael. • Take more or less of the medicine ithout first checking with your doctor (i f one pill is good, two are not necesarily better). 'hat resourc es are available? Only you can take responsibility for taking your medicines safely, but the following resources are available. he label If the label does not have the necesary information, ask your pharmacist for clarification . our doc tor 1) Take a list to your doctor of OTC nd prescription medicines you are currently taking (particularly when you ave more than one doctor). 2) Write down the health concerns you wa nt to discuss with your doctor so
you do not forget. 3) Whenever the doctor prescribes a new medicine for you, ask the following: • Name of the medicine • Reason for taking the medicine • How much, how often, and how long to take the medicine • Specific directions abo ut taking it or not taking it with meals, milk products, or fruit juices • Side effects you might have from taking the medicine and which side ef fects you should report immediately • Is the prescription safe to take with the common OTC medicines The pharmacist 1) He can tell you the difference be tween generic and brand names. 2) He can provide you with price lists or let you know if discounts are availabl e to seni ors . 3) He can keep a record of all your medicines and any drug allergies that you may have. 4) He can tell you about books avail able on medicines. Th e nurse 1) Explains how the medicines work and what possible side effects might be experienced. She clarifies the physician's directions. 2) Instructs in the proper storage of medicines. 3) Assists in keeping medicine rec ords. III. Program evaluation (5 minutes). IV. Question and answer period (20 minutes).
formance time(5). Thirty-three percent of our program participants had some degree of visual impairment and many had hearing deficits. The conference room and the 2 to 3 P.M. class hour met our criteria for the drug prog ram setting: convenient time of day for participants, adequate ventilation' and warmth, nonglare lighting, good acoustics, enough space for clie nt comfort but not too much distance between teachers and participants, familiar surroundings, privacy, room for canes, wheelchairs, and walkers, comfortable chairs, easy access by elevator or ramp, and tables for large displays . Th e drug prog ram was presented by two of us (K.G., B.M.) who are public health nurses with experience in education and group work with the elderly. We knew the district public health nurse who regularly conducted health education programs at the residence. We used an eclectic approach in teaching, combining elements of behaviorism, humanism, and cogn itivism. Behavioristic repetition and reinforcement are effective with the aged. Principles of cognitivism, such as perception, problem solving , information processing, and und erstanding, guided our choice of visual aids , ad vance organizers (handouts, comparisons, and flip charts), and the didactic teaching. A cognitive approach permits students to question specific areas of concern; humanism emphasizes self-paced instruction and a nonthreatening student-teacher relationship. Gribbin states, " Allowing people to proceed a t the ir own pac e, making task s meaningful, avo iding irrelevant information, keeping tasks as simple as possible, providing cues, etc., are very important factors to consider if one wishes to im-
Geriatric Nursing M archi April 1981 141
Our use of large, easily read visual aids encouraged participation and stimulated interaction.
prove the learning and memory performance of the elderly."(6) Hallburg listed numerous recommendations for teaching older adults. We adhered to the following Hallburg guidelines: • Select large easily seen visual aids. • Speak slowly and enunciate clearly. • Determine with the older person the type of aid or media that best facilitates his or her learningauditory, visual, tactile, or some combination of these. • Obtain feedback from participants about pace, speech intelligibility, and value of content(7). Developing the Program The program content was developed to enable participants to choose three over-the-counter medicines from a list of six drugs frequently used by older adults; to list at least three forms in which medicine can be taken; to identify on a medicine label at least three points of information that promote the safe use of drugs; to select four common drug side effects from a list of six; to choose from a list of four choices two medication practices that should be followed; and to identify resources that can help answer questions about medications. We planned the didactic program to last for 35 minutes, to be followed by a period of questions and answers. This length of time was chosen to avoid tiring the participants and to fit in with their weekly routine. The program was advertised by a
142 Geriatric Nursing March/April 198\
flyer printed in large letters and displayed throughout the residence. All visual aids were prepared in large print. Each participant received a large-print pamphlet highlighting the important points of the program. We displayed medicine bottles and pamphlets that we had collected. from local pharmacies, and shared books on OTC drugs. Evaluation The effectiveness of the program was to be evaluated by the amount of group participation, group attentiveness, and the interest generated. A simple six question pre- and posttest was given to determine what the elders learned. Twenty-seven residents attended the program; 21 of them were women. All stayed for the entire hour except one who left, complaining of being cold. Group participation during and after the presentation was high. The audience interjected specific questions and concerns about medicines, and other comments. We observed, however, that some participants could not see to complete the pre- and posttest. Some were confused by the directions, and others said it was not important to them to take the time or trouble to complete the test. At the completion of the presentation, seven participants thought it was redundant to repeat the same test. Others seemed apathetic or wanted to talk about their own experiences. Clearly the audience did not comprehend the purpose of the tests and found them irrelevant, even though the rationale had been care-
fully explained. From the comments and subjective evaluations, it appeared that the program was positively received and stimulated further interest in medicine information. The participants seemed to enjoy the coffee and cookies. The majority lingered to talk, again reiterating that they could hear and understand the speakers. They liked the audiovisual aids. A subjective evaluation was completed by 22 persons. Of these, 19 said they learned something from the program, 13 stated they would like more programs about medicine, 20 said the presentation was clear, and 18 said the handout was useful. Our recommendations, based on conducting this drug program are that participants in such groups should wear their glasses and hearing aids, that the program format take into consideration the various deficits of the aged clients, and that content be discussed in easily understood terminology. In retrospect, we believe our preand posttest should be replaced by hand raising in response to simple questions. We offer the content outlined in the box on page 140 as a tested tool for drug education with older adults living in the community. References I. Brady. E. S. Drugs and the elderly. IN Drugs and the Elderly. ed, by R.
2.
3.
4.
5. 6.
7.
Kayne. Los Angeles. Ethel Percy Andrus Gerontology Center, University of Southern California, 1978, pp. 1-7. Said, F. S .• and Weale, R. A. The variation with age of the spectral transmissivity of the living human crystalline lens. Gerontologia 3:213-231. 1959. Weale, R. A. On the eye. IN Behavior, Aging, and the Nervous System, ed. by A. T. Welford and J.E. Birren. Springfield, III., Charles C Thomas. Publishers, 1965, pp. 307-325. Hilgard, E. R .• and Bower. G. H. Theories of Learning. 4th ed. New York. Appleton-Century-Crofts, 1975. Ibid. Gribbin. K. Cognitive process in aging. IN Nursing and the Aged. ed. by I. M. Burnside. New York. McGraw-Hili Book Co .• 1976. p. 55. Hallburg, J. C. The teaching of aged adults. J.Gerontol.Nurs. 2:18, MayJune, 1976.