Question: JC is an at-risk 86-year-old Asian male with numerous factors that impact his ability to seek adequate care. One major source of concern is his physical and financial dependence on his daughter that is unable to devote ample time and money to him. JC has numerous comorbidities that require consistent medication therapy. JC suffers from hypertension and takes lisinopril daily for management. Failure to treat the hypertension would result in him being at greater risk of suffering from a myocardial infarction or ischemic cerebrovascular accident related to atherosclerosis of various arteries due to continued hypertension. JC also appears to be at risk for developing depression. His feelings of being a burden to his daughter signal that he may already be suffering from the effects of depression related to his overall condition. It is imperative that the clinician further assesses his feelings and his fears to determine his emotional state. Demirtürk and Hacihasanoglu Asilar (2018) stated that patients suffering from depression are at much greater risk for non-adherence to antihypertensive medication therapy, placing them at risk for the complications listed above.

JC also suffers from gastroesophageal reflux disease and takes prilosec daily for management. Failure to treat this condition could cause gastrointestinal ulcers and severe gastrointestinal pain. JC also suffers from vitamin B12 deficiency and gets vitamin B12 injections monthly to correct his deficiency. Failure to seek treatment monthly would result in increased fatigue and place JC at risk for muscle atrophy and activity intolerance related to a sedentary lifestyle. Finally, JC suffers from chronic prostatitis and takes cipro daily. Failure to take the prescribed medication therapy could result in prolonged suffering from the side effects of the disease, including frequency, urgency, and difficulty initiating urination. Each of these side effects places JC at greater risk for falls, as he would likely have to attempt to make it to the restroom frequently if he is able to do so. A lack of physical ability places JC at risk for not being able to routinely get his prescriptions filled, which places him at risk for the adverse complications of non-adherence to medication therapy listed above for each comorbidity. A lack of funding places JC at risk for not being able to pay for his prescriptions that yields the same risks.

JC's statement concerning not wanting to be a burden to his daughter serves as proof that the clinician needs to further explore that situation and determine if his daughter is able to be of assistance with JC's care. If JC is unable to provide self-care and lacks resources that allow him to seek care outside of his daughter that is unable to assist, then the clinician needs to seek resources for JC so that he does not avoid healthcare out of ignorance or embarrassment. Lee, Rhee, Kim, and Ahluwalia (2015) conducted a study of Asian American immigrants to determine their health literacy compared to participants of other descents, and determined that the Asian American participants had significantly lower health literacies than the other ethnicities in the study. The study concluded that for this reason, Asian American patients are much less likely to seek indicated healthcare for necessary reasons.

When interacting with JC, it would be important to be sensitive regarding the self-care activities that he is unable to do for himself. It is apparent the JC is embarrassed concerning his inability to care for himself, as he is stating concern about being a burden to his daughter. For this reason, it is extremely important that the clinician be sensitive regarding his inability to provide self-care so that JC does not shut down emotionally. Also, the clinician would need to be very careful not to break JC's spirit by focusing on the unfavorable circumstances regarding his inability to provide self-care and the lack of support resources that JC possesses. JC is making an active effort to seek healthcare despite his shortcomings. It is important that the clinician avoid overwhelming JC with the facts of the situation to avoid breaking JC's spirit and causing him to lose the aspiration to seek necessary medical care. Applauding JC's effort and perseverance throughout the circumstances could be effective in inspiring JC to continue putting forth his best effort.

To further assess the patient's health history, I would ask the following questions:

Is there anyone else besides your daughter that can assist you with your healthcare needs?

Can you further explain the aspects of your care that you need assistance with so that I can be in a better position to get you the care that you need?

Do you consistently take your prescribed medications? If not, what keeps you from consistently taking them?

What are your feelings regarding assisted living?

Would you be interested in speaking with a social worker to further explore your specific situation so that we can provide you with the assistance that you need?

The above listed questions would aid the clinician in establishing a rapport with JC while also providing needed information concerning JC's needs. Ball, Dains, Flynn, Solomon, and Stewart (2015) stated that it is important to build rapport prior to progressing the patient's health history for better comfort and results. The questions above introduce the idea of additional support resources without coming across as aggressive or forceful. In JC's case, it is important that the clinician present these things in a helpful manner to ensure that JC doesn't begin to feel as if he is a burden to the clinician or any of the support resources.