Welcome to question of the day #365

Eyetool question of the day #365

I work in community practice and see a lot of older people who have lots of health problems. I want to make sure I am doing the best I can for these vulnerable patients do you have any tips?

I too see a lot of older people in my clinical practice. Most of the patients are examine fall in the 75 to 100 age group. Many have several chronic health conditions and some have chronic eye conditions.

I have noticed that even a small amount of positive news can have a marked effect on the patient. For example something like ‘your cataracts haven’t got any worse’ can be very comforting to patients.

I have been thinking about this reaction to small amounts of positive news. Older patients may be going through difficult times or may be dealing with chronic illness or pain. Many of them may see many doctors for health problems and often receive bad news. Patients having an eye examination may expect more bad news and this might make them worried about the examination. Their reaction to a small amount of positive news could provide relief that they don’t have another health problem to deal. I have learnt that many patients benefit from being given or good news about what is healthy in their eyes and it can really make their day and provide relief.

I often make comments like:

‘Most people in your age group need operations for cataract but your eyes have very little (or no) cataract.’

‘Your cataracts haven’t got any worse.’

‘The pressure in your eyes is in the normal range.’

‘You have a little bit of macular degeneration but most people in your age group have much more.’

‘Your eyes are very healthy for the age group that you are in.’

‘Things are looking stable which is good.’

Also, many older people live alone and may have lost the social connection they had from work, family, and friends. I try to engage them in something they like to talk about, whether it be their former work, family, hobbies, or something that excites them and is positive that they enjoy talking about. This will also help you understand how they use their eyes and what their visual needs truly are.

I like to watch old films and had a wonderful conversation with an older patient who also liked to watch old films. I learned about a film with my some of my favourite actors that I’d never heard of before. I’m looking forward to watching it.

I know that sometimes we have to deliver bad news, but it’s good that where we can to help our people feel positive after they have had their eyes examined and particularly our older patients.