✔ Introduce sensitive topics with the “common concern” approach:
“As we age, many of us have more trouble with . . .” or “Some people taking this medication have trouble with . . .”
✔ Keep educational materials available and visible to encourage discussion.
✔ Raise topics such as safe driving, long-term care, advance care directives, and end-of-life care early, before they become urgent matters.
talking about sensitive subjects 35
Supporting Patients With
Chronic Conditions
Case managers can play an important role in educating patients and families and can connect them with appropriate community resources and services.
“Let’s discuss living with . . .”
Four years ago, Mrs. Smoley suffered a stroke. Although she takes her pills just like the doctor ordered, she has not been able to quit smoking. Now she has emphysema and may soon need oxygen.
Dr. Nguyen thinks she should participate in a disease management program at a local hospital that will give her the information she needs to manage on her own. “It could help you prevent the problems you’ve had with shortness of breath,” the doctor explains. “And you might learn some tips about how to manage your day so that you have some more energy.” She offers to help Mrs. Smoley schedule her fi rst appointment.
Approximately 80 percent of older adults have at least one chronic health condition, and 50 percent have at least two chronic conditions. For many older people, coping with multiple chronic conditions is a real challenge.
Learning to manage a variety of treatments while maintaining quality of life can be problematic. People with chronic conditions may have different 36
supporting patients with chronic conditions
c h a p t e r 6
needs, but they also share common challenges with other older adults, such as paying for care or navigating the complexities of the health care system.
Try to start by appreciating that people living with chronic disease are often living with loss—the loss of physical function, independence, or general well-being. Empathize with patients who feel angry, sad, lost, or bewildered.
Ask, “Is it hard for you to live with these problems?” From there you can refer patients to community resources that may meet their needs or, when available, recommend a disease management program or case managers in the community.