1. Essentials of Cultural Competence in Pharmacy Practice: Chapter 13 Notes Chapter Author: Dr. Jeanne Frenzel Patients with Disabilities

2. Learning Objectives 1. Identify the major disabilities affecting the U.S. patient population. 2. Articulate strategies for treating patients with a variety of disabilities. 3. Understand the risk factors and health disparities that may exist for people with disabilities. 4. Understand deafness as a cultural model. 5. Articulate barriers to health care that are relevant for people with disabilities. 6. Identify common disabilities that will present in pharmacy practice.

3. Overview 1 in 5 people living in the U.S. has a disability 1 in 7 has an activity limitation (37.7 million). Of these 11.5 million cannot attend school or work or care for themselves. In people older than 15, 34.2 million people have a functional limitation and often multiple limitations (e.g., unable to walk short distances, hear a normal conversation, read newsprint, or make themselves understood). 1 in 25 people rely on personal assistance with activities of daily living (ADL) such as bathing, dressing, eating, and walking. An estimated 2.5 million people have developmental disabilities, resulting in activity limitation. Groups of people with disabilities often build a common identity, a culture of disability, that is based on similar experiences, values, and beliefs.

4. Deaf Culture About 10% of the U.S. population report hearing loss, a subset of which are deaf. About 2 million people are deaf in the U.S. Primary communication is ASL (American sign language) Socioeconomic, education, and literacy levels are lower among deaf individuals. Deaf high school graduates have a literacy level of 4 th -5 th grade, due to English being their second language. Deafness is measured on a spectrum and described by three models: medical, cultural and social.

5. Blindness The condition of lacking visual perception, with varying degrees of severity. Total blindness: complete lack of form and light perception. Legally blind: a person whose vision measures 20/200 with correction. A person who has 20/200 vision is able to see an object 20 feet away, whereas a person with normal sight (20/20) can see that same object from 200 feet away. Low vision: People who do not meet the standard of legally blind, but still have significant visual impairment.

6. Blindness (continued) Approximately 10 million people in the U.S. are blind. More than 50% of those are over 65. About 1.3 million people are legally blind. Age related macular degeneration is the #1 cause of blindness in the U.S., followed by glaucoma (#2), and Retinal damage due to diabetes (#3).

7. Verbal Communication Impairments Patients may be nonverbal or have verbal communication impairments. To address these patients, pharmacists must seek alternative methods of communication: Assistive devices Electronic communication devices Continue to partner with the patient in healthcare decisions

8. Impact of Disabilities Families and caregivers largely impact the care of a person with disabilities. Pharmacists should be aware of the beliefs of the patient and the family. Disability typically results in the loss of income. Approximately 6.5 million people who belong to low- income families have activity limitations. 1 in 5 people older than 15 with a functional limitation has income below poverty level.

9. Risk Factors and Nutrition People with mental illness Comorbid health issues (cardiovascular and respiratory diseases, diabetes, and obesity) Medication use, unemployment and poverty may contribute to weight gain Poor nutritional status Falling prey to people promoting curative products

10. Pregnancy and Sexuality People with developmental disabilities have poor knowledge of pregnancy, childbirth, contraception, and STDs Individuals with moderate developmental disabilities are less sexually active than the general population but are more likely to be targets of sexual abuse.

11. Spirituality Studies have shown that spirituality is common among those dealing with chronic disability and chronic illnesses such as hypertension, diabetes, and chronic renal failure. Spirituality, when used as a source of strength, has positively impacted recovery from illness and coping skills for those with disabilities. Reductions in stress and symptom severity, as well as decreases in hospitalization, have been linked to activities such as prayer, worship, and meditation.

12. Health Care Barriers People with disabilities have many barriers to adequate health care services. Four issues responsible for these barriers are: Attitude Program Physical limitations Communication

13. Reflection Questions 1. How will you assist patients with disabilities in obtaining and understanding their medications? 2. As a pharmacist, what types of disabilities do you feel you should be most prepared to handle? 3. How would you need to change your pharmacy if another pharmacist working with you had a disability? What types of disabilities would you be the most and least prepared to manage?