Counseling patients with dementia Maine Pharmacy Association 16 May 2010 Anne Teichman, Pharm. D. Associate Professor of Pharmacy Practice Husson University

Learning objectives Know the pharmacists legal obligations to an adult patient with dementia Be able to access the guidelines available to advise the pharmacist counseling patients with dementia Be able to discuss the blending of legal requirements and best practices to advance medication use for this population

Overarching issue  Informed consent  The nature of the patient’s medical condition and prognosis.  The nature and purpose of the proposed intervention.  The risks, benefits, and side-effects of the proposed intervention (and any alternative interventions) or nonintervention.

Legal obligations Most states statutes – Informed consent to medical treatment varies widely – must offer counseling to every adult Maine State statutes – Informed Consent - Maine Rev. Stats. Ann., Title adopts the “professional community standard.” – Pharmacy statutes – defers to OBRA 1990 guideline – Silver alert [

NIH: Ethical Guideline Individuals should be treated as autonomous agents: “An individual capable of deliberation about personal goals and of acting under the direction of such deliberation.” Persons with diminished autonomy are entitled to additional protections – Fetus – Child – Dementia?

NIH: Ethical Guideline Because children cannot provide informed consent, children provide assent to participate, to the extent that they are able, and parents/guardians give permission for a child to participate. Assent varies relative to the age and health condition of the child. Key concept – can the person understand consequences of the decision?

guidelines Elderly – American Society of Consultant Pharmacists Mentally retarded - Task Force on Healthcare for Adults with Developmental Disabilities Children – American Academy of Pediatric Dentistry clinical guideline “Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children”

Practical Barriers Patient is not present – How is the offer to counsel extended? Pharmacist discomfort with uncertainty – Doubt consultation abilities/pharmaceutical knowledge – Cultural embarrassment “Unfunded mandate” “Time,” “noise,” “space” – largely not accepted

Cases Practice blending these concepts presented to achieve best health results

Thank you. Please offer constructive comments and ask questions for any part of this topic.