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Chapter 6. Medical Care
Chapter Overview
Our bodies change throughout life, and Therefore, recognizing and treating changes that we experience in later years mental health problems can improve can be complex. Mental health problems and physical problems are often related. This chapter provides information and For instance, studies clearly show that practical suggestions to help you use the chronic depression in older adults can health care system so that it provides you increase the risk of having a heart attack, with the care you need for good physical and can also result in greater disability and a higher chance of dying after having a heart attack.
Chapter Contents
A Helpful Mindset for Good Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Making the Most of Doctor Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Before Visiting the Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 While at the Doctor’s Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 New Prescription Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Managing Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Buying Prescription Medicine Online . . . . . . . . . . . . . . . . . . . . . . . . . 54 Types of Psychotropic Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Guidelines for Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Urgent Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Prevention of Disease and Disability . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Medication Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
A Helpful Mindset for Good Care
Following a doctor’s advice about medication and personal care is part of staying healthy. Individuals should also inform their doctor about symptoms and personal habits that are known to affect one’s health. Sometimes physical or chemical changes in the body cause changes that are interpreted as mental health problems. If changes in a person’s thinking, behavior, or ability to remember or understand occurs, it is important to get a physical exam to rule out all possible reasons before assuming that the person has developed dementia or some type of mental illness. Early detection and treatment may help to correct certain problems. It is difficult for some people to ask a doctor questions, and it is difficult for everyone to remember all the questions he or she had planned to ask. It may be helpful to have a caregiver accompany you to medical appointments. That way, the doctor can base his or her assessment on more thorough information. Also, the caregiver can help to gain information from the doctor and provide clarification after the appointment.
Making the Most of Doctor Visits
Here are some issues/questions for individuals and their family members/caregivers to consider before visiting the doctor: „ If something is different, did the change occur after a "The doctor misdiagnosed my father’s condition after a „ Was a thorough physical done to be certain there is no other medical illness that may be causing the change in was in the waiting room, but the person's behavior or thinking? no one interviewed me. I should have gone in with my „ Has the doctor used specific blood tests to check thyroid levels, B12, and other levels? Has a urinalysis complete information." „ Is the person’s nutrition adequate, and eating habits and sleeping habits sufficient? „ Is there any possibility that the person has suffered a trauma to the head due to an „ Is the person taking any medication, prescribed or over the counter, that could have side effects and/or interact with other medication the person might be taking? „ Is the person confused regarding the amount and type of medication they are taking, as „ Is pain medication being used? If so, how much? Are there any side effects? „ Is the person able to afford the medication being prescribed? „ Does the person drink beer, wine, or other types of alcohol, and has their pattern of drinking changed? Could the alcohol have any effect on the medication they are taking? „ Has there been a recent loss such as the death of a loved one, the death of a pet, divorce, loss of a job, financial loss, a move, or the loss of an important relationship (due to moving away or an argument)? If so, these could cause depression or temporary memory problems.
A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers „ Has there been a significant change in health of the support person or another close [Citation: A Mental Health Guide for Older Kansans and Their Families, 2000, page 29] AARP strongly recommends that you be prepared for each visit to your doctor and provides guidelines similar to these noted here. The best way to make the most of your time is to come to your appointment prepared.
Before Visiting the Doctor
What to Do at Home
Write down my questions and observations, and bring a pen and paper to take notes.
Make a list of my symptoms/problems (any changes since last visit to doctor? Change in appetite? Change in sleep? Swelling of feet or ankles?) Bring a list of all of my medications, including vitamins, herbs, over-the-counter medicines, etc. Include dosages and how often I take them, or bring the bottles to the appointment.
Bring a list of all doctors that I see (specialists, eye doctor, chiropractor, etc.) Bring a list of any food or medicine allergies.
How much caffeine do I drink daily (number of cups of coffee, tea, sodas), and how much chocolate do I eat? How many alcoholic drinks, including beer, wine, and cocktails, do I have each week? What size? Does my family have any specific concerns or questions for the doctor? Ask them to write them down, and give this to the doctor during my visit.
Take a support person with me who can help ask and answer questions and clarify information as needed.
If I have a special problem.
Write down when the problem began (one week ago, one day ago) and the frequency (once a day, once a week, every hour).
What is the problem (headache, blurred vision, stomach pains, chest pain) and how severe is it? Include other symptoms such as, the headache is accompanied by blurred vision.
If pain is the problem, a description of the pain (throbbing, pulling, sharp, dull, crushing, deep). Give a detailed description, the way you would describe a painting to someone who is blind.
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
When does the problem occur? Do I notice any specific pattern, for example after meals, when I have certain foods, during the night, etc? What was I doing the first time I noticed the problem? Have I ever had a problem/symptom like this before? What was the outcome? Is anything different this time? While at the Doctor’s Office
What to Do Before and During the Visit
Read through your list while waiting for the doctor.
Ask all of the questions you need to. You have a right to question the doctor or medical staff regarding their diagnosis and recommended treatment.
Write down the answers to the questions and anything else relevant to the visit. Be sure to do this while you are still in the office.
What to Ask the Doctor
What is wrong with me? How do you know? What caused the problem? Do I need to have any tests done? What kind of tests? What will the tests reveal? How will they be done? Do I need to prepare for the test? When will I know the results? Will my insurance cover the cost of the tests? Will I need to have the tests done again? If I am given a specific diagnosis.
What are my choices from the current guidelines for treatment? What are the benefits and risks of each treatment? Which treatment is most common for my condition? What would happen if I decline a particular treatment? How do I know if I am improving or getting worse? Should I get a second opinion? Do I need a follow-up visit? A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers Where can I go to get more help and information (web sites, support groups, organizations)? If my doctor prescribes medication.
What does this medicine do? What are the side effects? What should I do if I experience any side effects? Can I take a generic version of this drug? Will this medicine interact with any that I already take? Should I avoid any kind of food or activity while I take this medicine? At the end of your appointment, before leaving the doctor’s office, summarize in your own words what was discussed; that is, “Doctor, let me see if I understand you correctly.” Although you might think your doctor already knows all the medications you are taking, sometimes things are not written in your chart. This happens often when a patient is being seen by more than one doctor, and information about test results or new medications hasn’t gotten from one doctor to the other yet. Make sure that you tell your doctor about your caffeine and alcohol use. Bring any vitamins, nutritional supplements, or herbal medicines you are taking, too. While these usually do not require a prescription, they can still interact with other medicines you are taking. The more information you give your doctor, the better the quality of the information, diagnosis, and treatment you will receive. Think of it as a partnership between you and your doctor: your doctor provides the expertise and medical experience, you provide the information on what is happening to you, the knowledge of your body, and the willingness to be the healthiest you can. [Adapted from: AARP. www.aarp.org/health/stayinghealthy/prevention] New Prescription Medications
Be sure you know the following before you leave the doctor’s office with a new prescription: „ Name of the drug, including generic equivalents.
Repeat this information back to your doctor, nurse, and pharmacist. Also, write down the information, not only so you will remember it, but also in case an error is made in calling in the medication or in filling the medication. Repeat and discuss any side effects with the doctor and/or pharmacist, know whether to take it on a full or empty stomach, with or without water.
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
Know what foods and over-the-counter, herbal supplements, and homeopathic medications to avoid taking with the medication.
Know whether the medication can make you sensitive to the sun.
Managing Prescriptions
Talk to your pharmacist about your medication. This is especially important if you are seeing more than one doctor. USE ONLY ONE PHARMACY. If the cost of medication is an issue, discuss this with your doctor. Perhaps it is possible to obtain a less expensive alternative or samples.
Carry a current list of medications with you at all times in case of an emergency, and bring this list to your medical appointments. Your pharmacy may be able to provide such a list.
Report any medications you are taking to all doctors you see, including over the counter drugs, dietary supplements, and herbal remedies, which have medicinal properties and can interact with other medicines! Here are some questions to ask yourself about your medications: „ Do I find it difficult to take my medications as prescribed; for instance, do I miss doses „ Do I need help remembering to take my medications? „ Have I put off purchasing or taking my prescribed medications because they were too If you answered “yes” to any of these questions, you should consider having a support person help you manage or purchase your medications.
Talk with your doctor and have a physical exam before you get any new medicine.
Use only medicine that has been prescribed by your doctor or another trusted professional who is licensed in the U.S. to write prescriptions for medicine.
Ask your doctor if there are any special steps you need to take to fill your prescription.
Buying Prescription Medicine Online
The following advice is offered by the U.S. Food and Drug Administration: The internet has changed the way we live, work, and shop. The growth of the internet has made it possible to compare prices and buy products without ever leaving home. But when it comes to buying medicine online, it is important to be very careful. Some web sites sell medicine that may not be safe to use and could put your health at risk.
„ are not U.S. state-licensed pharmacies or aren’t pharmacies at all.
„ may give a diagnosis that is not correct and sell medicine that is not right for you or A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers „ won’t protect your personal information.
„ are fake, “counterfeit,” or “copycat” medicines.
„ are not FDA-approved (haven’t been checked for safety and effectiveness).
„ are not made using safe standards.
„ are not safe to use with other medicines or products you use.
„ are not labeled, stored, or shipped correctly.
These tips will help protect you if you buy medicines online: „ Know your source to make sure it is safe.
Make sure a web site is a U.S. state-licensed pharmacy. Pharmacies and pharmacists in the United States are licensed by a state's board of pharmacy. Your state board of pharmacy can tell you if a web site is a state-licensed pharmacy and is in good standing. Find a list of state boards of pharmacy on the National Association of Boards of Pharmacy (NABP) web site at www.nabp.info.
The NABP is a professional association of the state boards of pharmacy. It has a program to help you find some of the pharmacies that are licensed to sell medicine online. Internet web sites that display the seal of this program have been checked to make sure they meet state and federal rules. For more on this program and a list of pharmacies that display the Verified Internet Pharmacy Practice Sites ™ Seal (VIPPS Seal), go to www.vipps.info.
„ Look for web sites with practices that protect you. A safe web site should.
Š be licensed by the state board of pharmacy where the web site is operating.
Š provide a licensed pharmacist to answer your questions.
Š require a prescription from your doctor or other health care professional who is licensed in the U.S. to write prescriptions for medicine.
Š provide a way for you to talk to a person if you have problems.
„ Be sure your privacy is protected.
Look for privacy and security policies that are easy to find and easy to understand.
„ Don’t give any personal information (such as social security number, credit card number, or medical or health history) unless you are sure the web site will keep your information safe and private.
Make sure that the site will not sell your information, unless you agree.
Report web sites you are suspicious of or that you have complaints about. Go to
www.fda.gov/buyonline and click Notify FDA about problem web sites.
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
Buying your medicine online can be easy. Just make sure you do it safely. For more
information on buying medicines and medical products over the internet, go to
www.fda.gov, and click Buying Medicines Online.
For related information, go to one of the following: „ Imported medicine, www.fda.gov/importeddrugs. „ Counterfeit medicine, www.fda.gov/counterfeit.
„ Generic drugs, www.fda.gov/cder/ogd.
„ U.S. Department of Health and Human Services/Food and Drug Administration, www.fda.gov, 888-INFO-FDA (888-463-6332).
„ National Council on Patient Information and Education, www.talkaboutrx.org.
Types of Psychotropic Medications
The following is a sample list of medications that might be prescribed for mental health symptoms. New medications are always being added, so this list may not be current.
Generic Name
Brand Name
Mood Stabilizer
Antidepressant
A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers Generic Name
Brand Name
Anti-psychotic
Cholinesterase
Enhancing Agent
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
Guidelines for Medical Care
Urgent Medical Care
An urgent medical evaluation/examination is recommended if you have any of the following symptoms.
„ Recurrent, persistent chest pain, and new onset of chest pain.
„ Acute shortness of breath, persistent coughing, or choking.
„ Recent trouble with acute right or left-side weakness, slurred speech, or numbness.
„ Sudden changes in vision, hearing, or comprehension.
„ Acute onset of confusion or disorientation (assess with MMSE).
„ New onset of urinary incontinence.
„ Persistent nausea, vomiting, or diarrhea.
„ Dizziness or difficulty with balance.
„ Areas of redness, swelling, or unhealing sores.
„ Severe chills, sweating, or fever.
„ Unexplained and persistent bruising.
Prevention of Disease and Disability
The following are guidelines for preventive medical care based on U.S. Preventative Task Force and other national guidelines. This is a sample of the kinds of guidelines used for medical screening of older adults. Your physician may have similar guidelines that she or he uses. Guidelines do change periodically, so you should consult with your physician about any medical tests and examinations.
A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers Screening Recommendations
Disease to Be
Detected
Frequency
Commenta b
USPSTF for men who have ever smoked; recommendation C for men who have never smoked; recommendation D for women An initial visit, and Recommendation B by older; USPSTF recommends counseling to reduce to one or fewer drinks/day for people 65 or over who consume more than 1 drink/day; abstinence is recommended for those who meet the criteria for alcoholism USPSTF for general population 65 or older, but recommendation B for everyone with hypertension or dislipidemia; Medicare covers screening every 6 months for people with hypertension, diabetes, dislipidemia, or a history of high plasma glucose levels National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
Disease to Be
Detected
Frequency
Commenta b
disease, diabetes, peripheral arterial disease, or who have had a stroke USPSTF; Medicare covers test yearly for high-risk patients (those with diabetes, a family history of glaucoma, and Blacks 50 or older) Recommended by USPSTF and CTFPHE everyone 65 or older, but neither recommends a strategy Blood pressure (BP) At least every two Recommendation A by test less than 130 mm Hg and diastolic BP less than 85; more frequently for people with higher BP over 25 indicates overweight; body mass index over 30 indicates obese A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers Disease to Be
Detected
Frequency
Commenta b
USPSTF; cessation counseling and appropriate drug therapy for all who report tobacco use aUSPSTF recommendations based on strength of evidence and net benefit, that is, benefit minus harm: A=strong evidence in support B=good evidence in support C=balance of benefit and harm too close to justify recommendation D=evidence against I=evidence is insufficient to recommend for or against bUSPSTF (U.S. Preventive Services Task Force) AGS (American Geriatrics Society) BGS (British Geriatrics Society) AAOS (American Academy of Orthopoedic Surgeons) CTFPHE (Canadian Task Force on the Periodic Health Examination) [Source: Merck Geriatric Manual, available on their web site at www.merck.com/map] National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Chapter 6. Medical Care
Record information here that you may use regularly or need quickly. This is a partial list of topics – add your own.
A New Hampshire Guide to Mental Health and Healthy Aging for Older Adults and Caregivers Medication Log
Type of Medication
Dosage, Frequency
National Alliance on Mental Illness New Hampshire NAMI NH www.naminh.org Cover artwork: Sailing through Life, September, 2001, by Al Goodridge at age 64. Al and his wife, Patsy, have been active in mental health and aging advocacy efforts in New Hampshire.
Copyright April 2006
Copyright 2006, NAMI NH. Do not use the printed or web version of this document
for other than personal use without permission from NAMI NH.
The information in this Guidebook is presented as a supplement to, and NOT a substitute for, the knowledge, skill, and judgment of qualified psychiatrists, psychologists, physicians, and other health care professionals. The information has been obtained from sources believed to be accurate and reliable and is as current as possible, but as our knowledge and understanding about aging and mental illness grows and as organizations and services evolve to meet the changing information, some information in this Guidebook may change and become outdated. It is also noted that the resources identified within are not inclusive, and no omissions are intentional. Should you have any health, medical, or disability questions or concerns, please consult a physician or other health care professional. The reader may go to the NAMI NH website, www.naminh.org, where information is updated more regularly and where links to other relevant sites are provided.
For additional copies, questions, or comments, please contact: NAMI New Hampshire
(National Alliance on Mental Illness, New Hampshire Chapter)

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