Table 1.

Principles of care for older adults

Barrier	Identification	Strategies
Sensory deficits	Screening for visual acuity and hearing loss formally, informally	-Referral for aids (glasses, hearing aids)
		-Optimize the learning environment (adequate lighting, minimize glare, limit background noise)
		-Written instructions with large font sizing and multimodal information (visual and verbal through writing, pictogram, hands-on experience, videos, web-links, online)
		-Appropriate voice intensity, pitch, pacing, eye level, direct visualization to allow for lip reading
Cognitive impairment	Screening with MMSE, MoCA, clock drawing, cognitive battery testing	-Breakdown information into small units (focus on only 3–5 issues or ess per session, <15 minutes per session)
		-Explain each element separately
		-Direct, actional, concrete language (“take one tablet in the morning and one at night” not “take twice a day”)
		-Individualized, tailored educational sessions
		-“Right branching” (“take a seat and you won’t miss the session” not “if you don’t want to miss the session, take a seat”)
		-Teach-back technique
		-Involvement of caregiver
		-Refer for treatment as indicated
Mood disorders	Screening formally, informally	-Reassurance
		-Simplify
		-Pacing
		-Refer for treatment as indicated (medications, CBT)
Health literacy	Assuming baseline limited health literacy vs. screening	-Limiting language complexity
		-The use of appropriate terminology in all forms and venues of communications (“high blood pressure” not “hypertension”)
Adherence	“How many times have you missed (behavior) in the last week?”	-Simplify
		-Explain (indications, consequences, prioritization)
		-Reinforce
		-Checking/rechecking understanding
		-Address feasibility, acceptability
		-Involvement of caregiver

MMSE Mini Mental Status Examination, MoCA Montreal cognitive assessment, CBT cognitive behavioral therapy