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BACKGROUND ` Established on 9th March 2002 ` Ceremonies by; Y.B Dato͛ Dr Hajah Siti Zaharah binti Hj Sulaiman. ` Manager: Datuk Haji Nordin bin Ibrahim ` Workers: 5 people (2 clerks, 1 caretaker, 1 guard, manager) ` Daily elderly care center - Elderly stay at their home - Attendance- Walk in - Operating time- based on suitability of the local environment ` Old folks consist of Malay, Chinese, Indian

BACKGROUND ` ›arget group: a) elderly (56 years old and above) b) able to manage themselves - Old folks are free from any payment - For special case, eg: those with stroke, need to pay RM250 for the extra attention and care services provided. ` Financial source: a) government (RM 30,000 per year) b) NGO

BACKGROUND `

!"#$#%#&' - Hall - Mini gym - Spacious garden - Karaoke set - ›elevision - Surau - Resting room - Reflexology path

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ª"%#(#%#&' -aerobic -gardening -sewing -travelling -invitation from other welfare organizations -visitors

PHARMACEUTICAL CARE ISSUES Centre Caretakers

Medication record

Patient Polypharmacy

Self medication

Financial

Compliance

›ransportation

Inadequate healthrelated knowlegde

pª  ª
ª
 ½ ›here are only 1 caretaker in the centre. ½ ›he caretaker do not have enough health-related knowledge (untrained) ½Difficulty in communicating with old folks who are mostly Chinese. ½Visit from healthcare providers (doctor, dentist, nurse) is only once a month ½No involvement of pharmacists, physiotherapists etc.

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 ½ ›he centre does not keep any records on the diseases and medication taken by the old folks ½ Could cause problems especially during emergency cases as the center do not have any reference on how to handle the situation.

ªªp Money from Jabatan Kebajikan Masyarakat (JKM) per year is not enough to support the center ›he center cannot afford to hire many caretakers


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ª ›he centre does not provide any transportation for the old folks to go to the center Also does not provide transport to the hospital and the old folks have to travel on their own to get their own medication supply

½ p½
 Common diseases of the old folks are: - Hypertension - High cholesterol level - Joint pain - Gastric -Diabetes Patients usually go to the nearby clinic to get their medication ›hey may also go to government hospital for further health evaluation. ›hese patients often seek treatment from a number of physicians without any collaboration. Some patients might take 4 or 5 medicines to treat same disease because they consult a number of physician Serious drug-drug interaction may occur.

½   ½p ›he old folks usually have problems in complying with their drug treatment. Sometimes they forget or fail to take their medication. Some old folks stop taking their medication when they begin to feel better, regardless of the instruction which requires them to finish all the medication. Some old folks who forget to take one or more doses of their medication in a day, may try to make up for their missed dose by taking two or three times the usual dose all at once.

 p p    ›he old folks in the center use their own money to buy medication Some refuse to seek doctors when they have minor ailments because they want to save costs Some old folks might continue to self-medicate themselves, thinking that they just had minor disease without uncovering the serious underlying disease. ›he old folks do not have adequate knowledge about O›C products. Some O›C medication can potentially interact with drug prescribed by doctor( prescription drugs)

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pª  p  ` Some old folks complain they do not understand the doctor͛s instruction when taking the medication from hospital. ` Some are confused about the indication of each medicine because they are taking many medication at the same time ` Some of them also take modern medication with alternative medicines (herbal or traditional product) and O›C drugs without consulting their doctor first ` Serious drug-herb interaction can occur

SUGGESTIONS Medication record

aretaker

›ransportation

Patient knowledge

Balance meal

&)#"!$ *&"+*) ›he centre should keep a medical record of each old folks regarding their current medical conditions easy to know the health status of the old folks and the caretakers can identify which patients need to be given more attention easy to handle should any emergency occurs this serves as a medical review for future diagnosis and treatment process when doctors or pharmacist came to visit.

!*&%!,&* ›he management should hire more caretakers to take care of all the needs of the old folks and to help them manage their daily life ›he caretaker hired should be well-trained ›hey also have to monitor the diet of the old folks as some of them may have diet restriction due to their disease ›hey can also help to improve the drug compliance of the old folks by reminding them to take their medication so that missed dose does not occur

&!$%- ,.+/$&)0& Regular visit of health care professional to the old folk home is important to educate and improve knowledge of elderly about the importance of a healthy life

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Role of pharmacists: provide counseling regarding medication related problems such as medication use, storage, compliance and side effects review patients medication history Review old folks dietary habit Monitor the effectiveness of the drugs Monitor outcome of the treatment Identify if there are any possible drug-herbs interactions, drug-food interactions or drug-drug interactions ›his will help to reduce the medication errors and non compliance

!$!."&) 1&!$' ›he center must provide a balanced meal for the old folks must take into consideration about the health status of the elderly such as what kind of food they need to increase in their diet and which food they have to avoid in their diet the caretaker who prepares the meal must have basic knowledge about the nutrition and the health status of the old folks

*!.'2+*%!%#+. ›he centre needs to provide transports in case any emergencies occur necessary to bring the elderly to the nearest ͚klinik kesihatan͛ if the healthcare professional cannot make a visit it will be easier for the elderly who need to take their medication regularly from a hospital ›he centre can provide transport such as bus or van so that the old folks can go to any places or activities organized by the center. ›his can improve the quality of life of old folks and they will not feel bored by just staying at the center.

%-&*' 300&'%#+.4 ` Organize more activities for the old folks such as aerobic exercise, ͞›ai Chi͟ to promote healthy lifestyle and to improve quality of life among the old folks. ` Find more sponsors whether from NGO or non-NGO to improve the financial status of the centre so that better facilities or accomodations can be provided and more activities can be planned for them in order to improve their quality of life.

IN›ERVIEW͙͙

CASE STUDY Name: Yong Soo Shin Gender: Female Age: 68 years old Hometown: Cheras, KL Race: Chinese Years joining: 2 years

Disease

: Hypertension, Gout, Gastric, Hyperlipidemia, Flu

Medicines

: Atenolol, Allopurinol, Cimetidine, Pravastatin, ›ripolidine HCl and Pseudoephedrine (Actifed), Ascorbic acid

Hospital visited: Hospital Ampang , nearer clinic Missed dose: Yes. Sometimes she forgets to take her medicines. Action: Just continue taking the medication on the next day Storage of medication: Medication box

-!*1!"&3%#"!$ !*& ''3&'

300&'%&) -!*1!"&3%#"!$ "!*& 2$!.

1. Polypharmacy. ›ake more than 5 drugs a day. Chances to get drug-drug interaction.

Ask patient to bring all medication to hospital and consult the pharmacist.

2. She sometimes complains of not being able to understand what the pharmacist tells her when taking the medication from hospital.

Spend more time with the pharmacist on counseling

3. She forgets to take her medication on a regular basis due to poor memory.

›he caretaker needs to remind her to take her medication and pharmacists need to counsel patient what to do if missed dose.

4. She complains about the side effects of drowsiness when taking her flu medication.

Pharmacist should advise her to avoid driving and operate dangerous machine while taking that flu medication. She should just get some rest and drink plenty of water

CASE STUDY ½ Name: Lim Ah Poh ½ Age: 68 ½ Condition: Hypertension (10 years), hyperlipidemia ½ Medications: -›. Captopril -›. Aspirin -›. Adalet - ›. Pravastatin ½ Hospital visited: private clinic near home, once in 4 months ½ Missed dose: sometimes, just continue with the next dose and forget the missed dose

-!*1!"&3%#"!$ !*& ''3&'

300&'%&) -!*1!"&3%#"!$ "!*& 2$!.

1. Lack of knowledge on the purpose/indication of each medication

Consult a pharmacist for more information on medication

2. He forgets to take medicine on a regular basis

Caretaker should remind him to take his medications while at the centre

3. Not willing to talk to doctors/pharmacists/caretaker when feels uncomfortable after taking medications

Pharmacists should always maintain a caring attitude and try to explain by using simple terms and layman language so that patients can easily understand and feel comfortable to share their drug-related problems.

THANK YOU