Counseling patients with dementia

1. Counseling patients with dementia Maine Pharmacy Association 16 May 2010 Anne Teichman, Pharm. D. Associate Professor of Pharmacy Practice Husson University

2. Learning objectives • Know the pharmacists legal obligations to an adult patient with dementia • Be able to access the guidelines available to advise the pharmacist counseling patients with dementia • Be able to discuss the blending of legal requirements and best practices to advance medication use for this population

3. Overarching issue • Informed consent • • The nature of the patient’s medical condition and prognosis. • • The nature and purpose of the proposed intervention. • • The risks, benefits, and side-effects of the proposed intervention (and any alternative interventions) or nonintervention.

4. Legal obligations • Most states statutes • Informed consent to medical treatment varies widely • must offer counseling to every adult • Maine State statutes • Informed Consent - Maine Rev. Stats. Ann., Title 24-2905 adopts the “professional community standard.” • Pharmacy statutes – defers to OBRA 1990 guideline • Silver alert [http://bit.ly/ayH9rP]

5. NIH: Ethical Guideline • Individuals should be treated as autonomous agents: “An individual capable of deliberation about personal goals and of acting under the direction of such deliberation.” • Persons with diminished autonomy are entitled to additional protections • Fetus • Child • Dementia?

6. NIH: Ethical Guideline • Because children cannot provide informed consent, children provide assent to participate, to the extent that they are able, and parents/guardians give permission for a child to participate. • Assent varies relative to the age and health condition of the child. • Key concept – can the person understand consequences of the decision?

7. guidelines • Elderly – American Society of Consultant Pharmacists • Mentally retarded - Task Force on Healthcare for Adults with Developmental Disabilities • Children – American Academy of Pediatric Dentistry clinical guideline “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children”

8. Practical Barriers • Patient is not present • How is the offer to counsel extended? • Pharmacist discomfort with uncertainty • Doubt consultation abilities/pharmaceutical knowledge • Cultural embarrassment • “Unfunded mandate” • “Time,” “noise,” “space” • largely not accepted

9. Cases • Practice blending these concepts presented to achieve best health results

10. Thank you. • Please offer constructive comments and ask questions for any part of this topic.