Immunizations in a Senior Housing Setting

Mr. M is a 71-year-old man who lives in senior housing with his wife. He completed few years of high school and then worked construction. retired at age 65 moved into soon after. independent all activities, walks daily for least 30 minutes, drives, engages socially. has primary care provider, but he not had an appointment many years. feels health good denies any cardiovascular disease, respiratory problems, gastrointestinal urinary issues, musculoskeletal kidney or liver cognitive changes, mood endocrine problems (diabetes thyroid disease). takes no medication. prior cancer screenings (prostate, colon) immunizations, including COVID-19 immunization. smoking alcohol intake been hospitalized. came the interdisciplinary clinic, which includes services nurse practitioner, social worker, nurse, pharmacist, to get blood pressure checked. His philosophy regarding immunizations that if fine, does need tests shots. shares trust vaccines believe they are helpful. During brief examination ambulates without assistive device able up from chair use arms. 140/68, heart rate 72 regular. evidence bilateral lower extremity edema. A full screening was done, recall date accurately respond questions appropriately. The team members concerned M’s decision forego preventive maintenance immunizations. agreed meet (IDT) discuss these concerns. Paige Hector, LMSW Ms. Hector work expert coeditor this column. Before meeting M, I would IDT. segment case scenario focuses on pre-meeting will include actual conversation M. purpose hear members’ concerns what hope accomplish by Supporting IDT helping them clarify their concerns, practice expression nonjudgmental way, prepare empathically listen likely dramatically increase chances all-around goodwill productive collaboration. set goals. Empathizing staff. staff might be exhausted, irritated, even resentful after working living through pandemic. These feelings may surface as attempt educate convince agree immunized, just others’ well-being, too. empathize come reflect matters beneath (e.g., health, impact other people’s wish make jobs easier). Transforming judgments. It some have formed judgments about — doesn’t others because chooses refuse screenings. Holding compromise won’t feel safe himself say what’s true him. disconnect “check out” due feeling afraid, angry, hurt. This could lost opportunity him address team’s Talking transforming help shift “what’s wrong M” important everyone” situation. Understanding agreement. People do agreement empathy one another. I’d want understand reasons behind choices, them. In setting embedded hierarchies expectations, it effort build so people can share truth suffering negative consequences. Being received understanding necessary more willing perspective why important. Releasing attachment outcome. Forgoing outcome relaxed present less create resistance “demand energy.” situation, choose accept control over eventually while fully inviting consider Remaining aware power differences. It’s acknowledge differences strategize how environment built inclusion shared power. affect life nature roles professionals. For example, stimulating sense shame guilt getting immunized label “refusing” going “against medical advice.” There also based identity such race composed white only Black). Discuss dynamics possible safety needs opinions, “no,” stand himself. complete when empathy, they’ve discussed holding, identified differences, strategized support safety, trust, choice being too attached Engaging role-plays put pieces Barbara Resnick, PhD, CRNP Dr. Resnick certified registered geriatrics specialist, colonoscopy prostate priority than focus particularly regard refusal obtain When patients hesitant vaccinated different reasons, personal beliefs, lack accurate information, common myths, experiences, vaccination. first thing explore individual hesitant. practitioner say, “Help me your flu, COVID-19, pneumonia.” Reflect back ensure understands perspective. If misinformation contributing ask receptive sharing handouts materials perceive reliable. Once rationale hesitancy discussed, helpful follow statements “Can you tell heard sure explained hoped?” “Does you?” point, arrangement. continues forgo let know continue him, assure option open return clinic anytime we immunized. Nicole Brandt, PharmD, MBA Brandt professor executive director Lamy Center Drug Therapy Aging University Maryland School Pharmacy. Across settings care, pharmacists front lines like professionals, improving access needed vaccinations well combatting misinformation. All should employ technique known “motivational interviewing,” instrumental enhancing communication patient. Centers Disease Control Prevention (CDC) provides great guidance resources incorporate (https://www.cdc.gov/vaccines/covid-19/hcp/engaging-patients.html). As described CDC, motivational interviews process.1.Embrace attitude approach patient respected comfortable.2.Ask permission vaccines. Asking allows autonomy. CDC recommends says no, provider respect that. However, yes, begin interview.3.Conduct interview. step interviewing scaled question. following example: “‘On scale 1 10, vaccine?’ (1 = never; 10 already vaccinated).” After provide answer, lead own answer. CDC’s 4, “Okay, 4? And number?” something “What move 5 6?” idea here “help become moving toward higher numbers.”4.Respond vaccines, mental health. pharmacist answer accurately, needed, refer another member IDT, provider. Establishing partnership key. Vaccinations, medications, require families where beliefs. That site managers local supports church groups) improve medications. Sonya Ziporkin Gershowitz Chair Gerontology Nursing Baltimore. She Editorial Advisory Board Caring Ages. author, speaker, educator specializing diverse topics team. associate editor Ages.Key Points•Facilitate goals staff, transform (if any), bring awareness strategies choice.•Invite beliefs perspectives understanding.•Approach autonomy, understanding, empathy.•Use techniques M.•Offer educational receptive.•Welcome time services. Key