Patients with Disabilities

1. Patients with Disabilities Essentials of Cultural Competence in Pharmacy Practice: Chapter 13 Notes Chapter Author: Dr. Jeanne Frenzel

2. Learning Objectives • Identify the major disabilities affecting the U.S. patient population. • Articulate strategies for treating patients with a variety of disabilities. • Understand the risk factors and health disparities that may exist for people with disabilities. • Understand deafness as a cultural model. • Articulate barriers to health care that are relevant for people with disabilities. • Identify common disabilities that will present in pharmacy practice.

3. Overview • 1 in 5 people living in the U.S. has a disability • 1 in 7 has an activity limitation (37.7 million). Of these 11.5 million cannot attend school or work or care for themselves. • In people older than 15, 34.2 million people have a functional limitation and often multiple limitations (e.g., unable to walk short distances, hear a normal conversation, read newsprint, or make themselves understood). • 1 in 25 people rely on personal assistance with activities of daily living (ADL) such as bathing, dressing, eating, and walking. • An estimated 2.5 million people have developmental disabilities, resulting in activity limitation. • Groups of people with disabilities often build a common identity, a culture of disability, that is based on similar experiences, values, and beliefs.

4. Deaf Culture • About 10% of the U.S. population report hearing loss, a subset of which are deaf. • About 2 million people are deaf in the U.S. • Primary communication is ASL (American sign language) • Socioeconomic, education, and literacy levels are lower among deaf individuals. • Deaf high school graduates have a literacy level of 4th-5th grade, due to English being their second language. • Deafness is measured on a spectrum and described by three models: medical, cultural and social.

5. Blindness • The condition of lacking visual perception, with varying degrees of severity. • Total blindness: complete lack of form and light perception. • Legally blind: a person whose vision measures 20/200 with correction. A person who has 20/200 vision is able to see an object 20 feet away, whereas a person with normal sight (20/20) can see that same object from 200 feet away. • Low vision: People who do not meet the standard of legally blind, but still have significant visual impairment.

6. Blindness (continued) • Approximately 10 million people in the U.S. are blind. More than 50% of those are over 65. About 1.3 million people are legally blind. • Age related macular degeneration is the #1 cause of blindness in the U.S., followed by glaucoma (#2), and Retinal damage due to diabetes (#3).

7. Verbal Communication Impairments • Patients may be nonverbal or have verbal communication impairments. • To address these patients, pharmacists must seek alternative methods of communication: • Assistive devices • Electronic communication devices • Continue to partner with the patient in healthcare decisions

8. Impact of Disabilities • Families and caregivers largely impact the care of a person with disabilities. • Pharmacists should be aware of the beliefs of the patient and the family. • Disability typically results in the loss of income. Approximately 6.5 million people who belong to low-income families have activity limitations. • 1 in 5 people older than 15 with a functional limitation has income below poverty level.

9. Risk Factors and Nutrition • People with mental illness • Comorbid health issues (cardiovascular and respiratory diseases, diabetes, and obesity) • Medication use, unemployment and poverty may contribute to weight gain • Poor nutritional status • Falling prey to people promoting curative products

10. Pregnancy and Sexuality • People with developmental disabilities have poor knowledge of pregnancy, childbirth, contraception, and STDs • Individuals with moderate developmental disabilities are less sexually active than the general population but are more likely to be targets of sexual abuse.

11. Spirituality • Studies have shown that spirituality is common among those dealing with chronic disability and chronic illnesses such as hypertension, diabetes, and chronic renal failure. • Spirituality, when used as a source of strength, has positively impacted recovery from illness and coping skills for those with disabilities. • Reductions in stress and symptom severity, as well as decreases in hospitalization, have been linked to activities such as prayer, worship, and meditation.

12. Health Care Barriers • People with disabilities have many barriers to adequate health care services. Four issues responsible for these barriers are: • Attitude • Program • Physical limitations • Communication

13. Reflection Questions • How will you assist patients with disabilities in obtaining and understanding their medications? • As a pharmacist, what types of disabilities do you feel you should be most prepared to handle? • How would you need to change your pharmacy if another pharmacist working with you had a disability? What types of disabilities would you be the most and least prepared to manage?