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Pressure Ulcers



Pressure ulcers occur when external tissues are exerted with excess pressure, which is not adequately relieved. The tissues that are exerted with pressure are mostly due to bony prominence. It is a common occurrence that pressure ulcers mostly inflicts the heel and the sacrum. The outcome of the pressure ulcers at the heel has some immense consequences, because it is expensive to treat and it is very painful, and mobility of the victim is severely limited. Older adults have increased chances of being diagnosed with heel pressure ulcers. Others who are likely to suffer from the disease include those who are paralyzed, incontinent, debilitated, and those who are suffering from metastatic cancer. Others include patients who are in the intensive care unit (ICU), those on ventilator, and those with diabetes mellitus. All these have similar level of peripheral vascular compromise, which adversely affect blood circulation, which can contribute to neuropathy and deformities on the foot. This report describes a program for the management of pressure ulcers among the older adults.

Clear Innovation goals and outcomes

            Based on what researchers have found, it is obvious that all the devices are not 100% effective in reducing the tissue interface pressure to the minimum level. The devices normally produce some limited protection on the heel against bony prominences, shear, and friction. This is mostly when the patient is lying on the side. To some degree, the foam boats are effective because the exterior surface aides in reducing friction. If the foam boot is more rigid, there is a high potential of developing pressure areas in the heel plantar surface or the lateral ankles. The booty type devices can reduce internal and external rotation, but have limited potential but can only manage to reduce the rotation only if they are more rigid (Dennis, Bowen & Cho, 2012). The air boot weighs less and does aid in lessening the internal and external rotation, but cannot completely prevent it. Feet sweat in air bags, thus these bags are required to have venting holes to enhance air circulation. Boots have surfaces that make them easier to slip around on the bed surface; however, these allow more positioning checks. Straps ensure the boots stay on, but the straps should not be very tight. Tight straps can cause unnecessary pressure on the dorsum of the feet or the lower leg. Therefore, the boots should be removed at regular intervals, and allow time for the feet to be assessed. Nurses should also check the pressure redistributing device to evaluate whether it is worn correctly (Graff, Bryant &Beinlich, 2000).

Detailed design

Among the treatment procedures being carried out on patients suffering from heel pressure ulcers, or the vulnerable aged adults, repositioning or turning the patient frequently is a recommended procedure aimed at preventing the occurrence of the ailment. Defloor et al. (2005) found that a turning schedule on either viscoelastic foam mattresses or standard mattress proved to be effective after following a preset schedule.

In regards to the heel pressure, it is imperative that this is controlled by use of pressure relief devices. Among the old people who are at risk of heel pressure ulcers, it is important that such individuals use pressure-redistribution device. This device plays a critical role in ensuring that the heel tissue does not breakdown, and remains protected from the adverse effects of the pressure, shear forces and friction (Black, 2004). Patients with boot type devices are mostly those who have been diagnosed with diabetes mellitus, or those with neuropathy; those with limited or poor mobility, and those who are immobile while recovering. There are varieties of boot type devices for all the diverse clients intending to distribute their pressure, and thus play it safe for their heels.

Implementation steps

Most of the medications used for treatment of heel pressure ulcers are similar to the ones used for prevention of the problem. Before the health care providers begin to carry out treatment, it is important for them to perform some risk assessment on the person. Among those who require risk assessments include those with mobility problems or their mobility is impaired, have impaired sensation, are diagnosed with diabetes mellitus, have foot deformities, or their lower extremities have circulation problems. It is unfortunate that most of the assessment scales lack the required parameters required for evaluation of the non-movement in the lower extremity as a result; there could be some instances where one can suffer a leg fracture, but the risk of pressure ulcer when assessed could be lacking. More so, the classification of those at risk is not standardized. Nonetheless, most scholars agree that the older adults who have suffered leg or hip fractures are among those who are at risk. Therefore, appropriate preventive measures should be put in place to guarantee full recovery until they have made full recovery, even if formal risk assessment does not identify the risk (Gilcreast, et al, 2005).

Evaluation process

It is important that full assessment is done on older patients to evaluate their level of risk when they are being admitted to a facility. The patients who are a higher risk should be monitored closely and frequently. It is required that those in the acute care should be assessed every 12 hours in order to evaluate any significant change in their condition.  For those in the long care, they should be assessed every week, but that can be changed depending on the conditions of the patient. Nurses can use the heel pressure ulcer assessment tool to assess the patient risk level. Upon carrying out the assessments, patients whose have damaged skin or reddened skin should be handled with care, and heel protectors should be used to prevent further damage of the heel.

            The focus for the treatment and prevention of the heel pressure ulcers is the connection between the heel vasculature and the external pressure. In order to prevent cases of heel ulcers from arising, comprehensive strategies should be employed, especially among the vulnerable populations. These may include identifying the comorbidities that comprise of skin assessment, the dietary intake, early use of pressure distribution devices, and use of evidence based interventions, among other interventions



Black, J. (2004). Preventing heel pressure ulcers.Nursing, 34, 17.

Defloor, T.,DeBacquer, D., &Grypdonck, M.H. (2005). The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers.International Journal of Nursing Studies, 42, 37-46.

Dennis, M., Bowen, W. T., & Cho, L. (2012). Mechanisms of clinical signs.Chatswood, NSW: Churchill Livingstone/Elsevier.

Gilcreast, D.M.,Warren, J. B., Yoder, L. H., Clark, J. J., Wilson, J. A., & Mays, M. Z.(2005). Research comparing three heel ulcer-prevention devices. Journal of Wound Ostomy Continence,32, 112-120.

Graff, M.K., Bryant, K.,&Beinlich, N. (2000). Preventing heel breakdown.Orthopedic Nurse, 19, 63-69.





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Chronic Obstructive Pulmonary Disease (COPD) in Older Adults

Chronic Obstructive Pulmonary Disease (COPD) is one of the devastating diseases among the elderly people. The disease causes considerable mortality and morbidity among the older adults. Despite the fact that the disease can be prevented, managed, and even to some extend treatable, its occurrence continues to increase due to increase in smoking across the world and exposure to hazardous air conditions. Chronic Obstructive Pulmonary Disease (COPD) is linked with massive health care costs and especially in older adults due to their decreased or weaker immunity. The disease has universal outcomes and linked to some other co-morbid conditions – for instance muscle wasting, osteoporosis, and cardiovascular disease. Other common health complications associated with Chronic Obstructive Pulmonary Disease (COPD) among the older adults include: - anxiety, malnutrition, and depression. These health conditions affect an individual’s quality of life and compliance to therapy. However, it is important to note that malnutrition in older adults diagnosed with Chronic Obstructive Pulmonary Disease (COPD) is an independent mortality forecaster and a sign of poor outcome (O'Neill, 2002).  This paper aims at describing the risk factors, symptoms, diagnosis, management, and treatment of Chronic Obstructive Pulmonary Disease (COPD) among the older adults.  

Risk factors for Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a prevalent disease or condition among the older adults. According to Yoost and Crawford (2014) “age and smoking are the two major risk factors for COPD, which is a group of diseases, including emphysema, chronic bronchitis, and a subset of asthma characterized by chronic airflow obstruction” (p. 279). However, it is important to note that smoking is not the not the only predisposing risk factor for Chronic Obstructive Pulmonary Disease (COPD). Other individuals prone to developing the condition at a later stage in their lives are those with a history of emphysema, chronic bronchitis, obese, asthma, and those with persistent airway obstruction infections. Equally people working in hazardous environments (air polluted with noxious vapors, dusts, and gases) and those living with people who smoke are at a great risk of developing the condition.

Symptoms of Chronic Obstructive Pulmonary Disease (COPD) in older adults

In most cases, signs or symptoms of Chronic Obstructive Pulmonary Disease (COPD) infection show up to people aged 50 years and above. However, people young than 50 years can show signs of this condition. Some of the common symptoms of COPD are: - wheezing, recurrent chest infection and especially during cold weathers, persistent coughing and especially in the morning and increased breathlessness and especially when walking or when exercising. The difficult to breath for those with Chronic Obstructive Pulmonary Disease (COPD) is a result of narrowed and inflamed lung airways. As such, when the air sacs continue to get damaged, breathing out continues to get difficult. This is why it is important for people who experience signs or symptoms of the condition are advised to seek diagnosis and begin appropriate treatment immediately to reduce further lung damages. Other less common signs or symptoms of Chronic Obstructive Pulmonary Disease (COPD) are: - swollen ankles, fatigue, tiredness, and weight loss. It is important to note that Chronic Obstructive Pulmonary Disease (COPD) symptoms or signs are mostly worse during the winter (Lotvall and Busse, 2011).

Diagnosis for Chronic Obstructive Pulmonary Disease (COPD) in Older Adults

Any person aged above 40 years who shows signs of Chronic Obstructive Pulmonary Disease (COPD) should be diagnosed for the condition. Typical symptoms or signs of this condition in older adults as previously outlined in this paper are: - chest tightness, persistent coughing, breathlessness, wheezing, recurrent chest infections, production of sputum and especially during the morning hours, and reduced exercise ability. It is worth to note that other health conditions may depict similar symptoms to those of Chronic Obstructive Pulmonary Disease (COPD). This implies that a medical examination is the only sure approach to diagnose the condition. Chronic Obstructive Pulmonary Disease (COPD) can be diagnosed by practice nurses, a hospital doctors or by GPs. The breathing tests and the test X-ray are used to diagnose the condition (Hanania and Sharafkhaneh, 2011).

The breathing tests also referred to as the spirometry are done to a patient in order to determine the presence of COPD or exclude its presence. The machine used to perform the breathing tests is known as spirometer. The breathing tests can “… be performed in many GP surgeries, specialized lung laboratories, hospital wards, or out-patient clinics” (Currie, 2009 p. 16). During the test, the medic professional requests the “… to take a full breath inwards, and then blow out as hard and as fast as possible, for as long as possible, into a plastic tube attached to a  recording device” (Currie, 2009 p.16). This practice or procedure for that case is repeated a number of times until a number of recordings with similar result or values are obtained. Through evaluating the results obtained from these tests and making a comparison with known findings of healthy persons, it is possible to determine whether the person being tested has Chronic Obstructive Pulmonary Disease (COPD) or not. The breathing tests can also be used to determine the level of lung damage caused by the condition. The lung damage caused is classified as severe, moderate, or mild. This is important in order to device the most appropriate treatment approach.

Management and treatment of Chronic Obstructive Pulmonary Disease (COPD) in older adults

Although Chronic Obstructive Pulmonary Disease (COPD) is not curable, it can be managed and especially when diagnosed early. Ceasing smoking is one of the behavioral changes an older adult who smoke can adapt to manage the condition. Continuing smoking after being diagnosed with this condition serves to increase further lung damage up to a level that the condition cannot be managed. As such, early diagnosis is important in order to prevent further lung damage. The condition can also be treated and managed through pneumococcal and influenza vaccination, by using short and long acting bronchodilators, and use of corticosteroid inhalers. In most cases, a combination of therapies is required to treat and manage the condition in older people. It is important to note older adults, and most likely those in severe conditions have insufficient aspiratory force and hence some inhalers cannot work for them (Bourbeau, Nault and Borycki, 2002).  Other available treatment and management option for the condition include oxygen therapy, osteopenia and depression screening, and pulmonary rehabilitation. Care takers looking after older adults with severe COPD exacerbation ought to safeguard them against prognostic negativity (Nici and ZuWallack, 2012).  

Although Chronic Obstructive Pulmonary Disease (COPD) is linked with disability in older adults, there are a range of treatment interventions available to assist the patient. This is especially when the condition is detected early. As such, it is advisable to seek doctor’s advice or diagnosis for that case in case of any sign or symptom.









Bourbeau, J., Nault, D., & Borycki, E. (2002). Comprehensive management of chronic      obstructive pulmonary disease. Hamilton, Ont: BC Decker.

Currie, G. P. (2009). Chronic obstructive pulmonary disease. Oxford: Oxford University Press.

Top of Form

Hanania, N. A., & Sharafkhaneh, A. (2011). COPD: A guide to diagnosis and clinical       management. New York: Humana Press.

Bottom of Form

Lotvall, J., & Busse, W. W. (2011). Advances in combination therapy for asthma and COPD.       Chichester, West Sussex: John Wiley & Sons.

Nici, L., & ZuWallack, R. L. (2012). Chronic obstructive pulmonary disease: Co-morbidities         and systemic consequences. New York: Humana Press.

O'Neill, P. A. (2002). Caring for the older adult: A health promotion perspective. Philadelphia:      W.B. Saunders.

Yoost, B. L., & Crawford, L. R. (2014). Fundamentals of Nursing: Active Learning for     Collaborative Practice. New York, NY: Elsevier Health Science.



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Interventions to reverse risks associated with cardiovascular disease

A treadmill test assists to reveal signs and symptoms of heart disease through exposure of the heart to exercise and stress. When one is involved in an exercise, the narrowed arteries undergo starvation and symptoms such as chest discomfort, shortness of breath are revealed through the treadmill test (, 2013). The 54-year-old who underwent an abnormal treadmill test was said to have risk factors like high fat diet and cigarette smoking, the following are the interventions that would help in reversing the risk factors.

The risk factors can be reduced through modification of life style because the risk factors are associated with lifestyle.

Rehabilitation can be introduced where the patient undergoes through a rehabilitation process to help reduce the cigarette smoking which is a risk factor (Buttar, Li, & Ravi, 2005).

Dietary intervention where   the patient is linked to a nutritionist to enable him have a healthy and balanced diet to reduce high intake of fat diet which is also a risk factor (Buttar, Li, & Ravi, 2005).

The above two interventions can be combined with medical treatments such as the cardiac bypass surgery depending on the type of cardiovascular disease to reverse the situation of the patient (Buttar, Li, & Ravi, 2005).

Physical exercise is important in reversing the risk factors; however, advice from a medical officer is important to determine the kind of exercise that the patient can engage in. The reason is that some patients suffering from heart conditions may not be able to engage in strenuous physical exercises. Exercise help to break down clots within the blood vessels (Buttar, Li, & Ravi, 2005).

Counseling sessions can be done to the patients before and after test to advise them on the measures and control of the disease. When patients get information regarding the disease, they take the right measures and control (Labarthe, 2011).


Buttar, H. S., Li, T., & Ravi, N. (2005). Prevention of cardiovascular diseases: Role of exercise, dietary interventions, obesity and smoking cessation. Experimental and linical Cardiology, 229-249. (2013, December 18). Treadmill Stress Test. Retrieved from

Labarthe, D. (2011). Epidemiology and prevention of cardiovascular diseases: A global challenge. Sudbury, Mass: Jones and Bartlett Publishers.

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Factors That Influence Medication Adherence in Non-English Speaking Patients



            This paper provides an overview and analysis of the factors that influence medication adherence in non-English speaking patients. It highlights the barriers to medication adherence and focuses on the barriers to medication adherence in non-English speaking patients. It examines a range of solutions that will help overcome the existing barriers to medication adherence among this group of patients. Analysis of the recent scholarly sources clarifies that the principal barriers to medication adherence in these patients are linguistic and cultural barriers.

            Patients with relatively low level of English proficiency, (e.g. immigrants from non-English speaking countries) have been found to be less adherent to scheduled ingestion of prescribed medication; whereas non-immigrants patients adhered better. The social factor has been found to act as a restrictive force to adherence. Cultural barriers also play a vital role in the non-compliant demographic, along with psychosocial factors such as fears, distrust, prejudice towards the Western medicine, and lack of provider’s interest into the perception and approach of the patients are all the more paramount to the fundamental aversion to medication adherence. Bridge building apparatus, such as interpreting services in hospitals, educational workshops and other measures would help remove the barriers. It has been also found that both parties of the process (the provider and the patient) need to improve their perception of personal accountability for adherence to medication.

Keywords: medication adherence, linguistic, cultural, perception




Factors That Influence Medication Adherence in Non-English Speaking Patients        Introduction

Patients with limited proficiency in English are more likely to face language barriers and miscommunication from their providers with a negligible ratio of shorter and less frequent patient-centered office visits than their English speaking counterparts. Patients’ race and ethnicity have been associated with physicians’ assessment of patient intelligence, feelings of affiliation toward the patient, and beliefs about the patients’ likelihood of risk behavior and adherence to medical advice. Language barriers may also exacerbate that misunderstanding and be used by the practitioners as an explanation to comprehend the misuse of prescribed drugs. The mutual response to race and ethnic relations may either aid or incapacitate the relationship between the health practitioners and the non-English speaking patients. Some may argue that non-English speaking patients who suffer from a mild to severe mental illness, such as depression may in part contribute to poor medication adherence (Klinge, 2001).

Prescriptions given by doctors and nurses are for the benefit of patients and usually given in relation to diagnosed illnesses. A drug becomes effective when used in strict compliance to the unadulterated doctor’s recommendations to maximize its efficacy in the healing process. Such realization in this forum becomes the focal driver to effective adherence to medication. It is undeniably indispensable for all patients to respect the instructions formulated by their physicians on the scheduled ingestion of prescribed medications. The main aim for all stakeholders is for a patient to recover from an existing condition. Generally, patients are advised to only obtain medications from an accredited medical institution and/or licensed medical doctor in order to avoid misdiagnosis, inadequate medications and abuse of drugs (Marsha et al, 2012). The purpose for this forum is to determine the factors that affect non-English speaking patients’ adherence to a medication regimen. Medication adherence is central to good patient outcomes. 

Definition of Concepts and Terms

The current relevant literature was searched by using the electronic databases CINAHL, Pubmed.  Key words and combinations searches included medicationadherence, linguistic barriers, cultural barriers, perception. Abstracts and journals were reviewed for relevance; reference lists from the obtained articles were also reviewed for any additional pertinent articles. Editorials, review articles, and abstracts were excluded.  This yielded 10 articles that were used for this review.

Medication Adherence and Non-Adherence

The intention of the use of the medications is to treat and cure diseases. However, in some instances, these medications may have adverse effect on patients if used improperly. According to Rocha (2012), the Federal Food, Drug and Cosmetic Act (FDA) provides the Joint Commission with lists of medications that health care providers can safely use to treat their patients. Researchers carry out many rigorous clinical trials to provide these safe and effective drugs. Drousel-Wood et al. (2010) suggested that throughout the clinical trial process, researchers need to keep in mind how difficult it may be for patients to take certain medications and to make every attempt to make them accessible and easy to use.

            Medications are more effective when taken as directed. Patients may fail to follow directions and be noncompliant for different reasons. Although patients may be educated on the importance of adhering to the medication regimen, they may still default. The term medication adherence has been commonly used since the 1970s by researchers and clinicians who need to describe the degree to which the behavior of the patients’ matches certain agreed medication recommendations or clinician’s instructions (Rocha, 2012).

As a case study, medication adherence has been the focus of research due to alarmingly low rates of adherence to prescribed therapies, especially among certain groups of patients. As a result, patients may not achieve anticipated medical progress. According to Dr. Yach, WHO’s Executive Director for Non communicable Diseases and Mental Health, lack of adherence to medication regimen prevents the full health benefits from being achieved (WHO 2012, p. 13). However if patients take the medications as prescribed, they would attain the goals set for improvement of population health.

Adherence problems arise in all situations when patients are required to self-administer the treatments, in particular with such diseases as asthma, diabetes, depression, HIV/AIDS, hypertension, tuberculosis, dependence on narcotic substances and tobacco. In the industrialized countries, on average, the rate of adherence to the prescribed medication therapy is fifty percent (50%), whereas in less developed countries the figures are much lower (Rocha, 2012).

            The manifestations of non-adherence to medication include: patient’s discontinuation of medication use, modification of restrictions and specific instructions, changing dosage amounts,  compromised regularity and/or time interval between dosage perturbing the rhythm and efficacy of the way the prescribed medicine should be taken; inclination to take someone else’s drug for an apparently common symptom, and contraindication of improvised compound of drugs for seemingly identical symptoms (e.g. use of old prescriptions, herbal medicines, drugs prescribed by different healthcare providers, etc…) (Jonathan, 2012).


Issues Contributing to Non-Adherence

Multiple factors may affect adherence to prescribed medications and treatment plans. Gilmer et al. (2009) cited the classification of factors of medication adherence suggested by Osterberg and Blaschke. It includes factors that impact both patients and providers. The patient level factors encompass such things as forgetfulness, intentional omission of prescribed doses, other priorities of patients, and emotional factors. As for the provider-level factors, these encompass such things as prescription of the complex regimen of medications, disregard for the lifestyle or economic resources of the patient, failure of the medical staff to explain side effects as well as benefits associated with the prescribed medication, and poor relationships between patients and providers (Gilmer et al., 2009).

            Non-adherence takes place intentionally or unintentionally. Reasons that are classified as intentional relate to personal attitudes, lifestyle choices, perceptions, while the demographic and economic status of people are classified as non-intentional reasons. Sorkin et al. (2008) found that medication non-adherence correlates to a set of factors including, sex, age, health status, as well as annual income. One common factor is chronic diseases. According to the data by WHO (2011), fifty percent of the population who have at least one chronic disease do not take their medications. How did they discover that? This would be a good place to stratify the study in order to collect data pertinent to the number of patients who were involved, their purpose for looking for medical assistance, demographic and socio-economic correlations from either a survey or an interview? Was its statistical significance scientifically compliant?

Across all groups of patients who do not adhere to scheduled ingestion of prescribed medications, age is a significant barrier. With the elderly, the declines in everyday functional capability make it hard for the older people to differentiate between tablet colors, remove child proof lids on medicines, read directions, and swallow the medication (Doggrell, 2010).

Financial problems is a common concern that non-English speaking migrants may face along with the U.S. citizens. Doggrell (2010) found that medicine’s high cost is a key factor why patients cannot procure and adhere to scheduled ingestion of prescribed medications. People who can pay out-of-pocket co-pays tend to be more adhering to medication than those with lower income. Little money prevents people from purchasing adequate medical insurances and use prescribed medicines.

Additionally, medication non-adherence has been found to be impacted by the use of multiple medication prescription. In the study carried out by Beusterien et al. (2008), it was reported that taking multiple medicines to treat every co-occurring medical illness increases the risk of non-adherence to prescribed medication. Pertinent material facts seem to have been omitted, (e.g. how many patients, how was it done, how many did not comply, etc…).Henriques, Costa, &Cabrita (2012) suggested that the elderly populations are not loyally taking their medications due to medical conditions. In cases where the elderly live at home alone, sometimes cause them to not remember if they have taken their medication earlier, later, a contraindicated extra dose, or not taken it at all. The elderly population sometimes have too many medications to take at one time and that could cause them to be involuntarily non-compliant. Quine et al. (2012) put forward that lack of adherence especially in anti-hypertensive medication cause more injuries to the patients and the health care system.

            Furthermore, depressive symptoms have been found as a significant barrier that prevented patients with hypertension from medication adherence (Krousel-Wood &Frohlich, 2009). The depression in these patients is thought to stem from adverse health outcomes, excessive use of healthcare resources, and poor life quality.

Cultural and linguistic barriers have been found to prevent certain minority groups from adequate medication adherence. Minority groups with limited English comprehension and low educational attainment are likely to experience the adverse effects of medication non-adherence most of all. Across all age groups, including the oldest, immigrants without knowledge of English and those for whom English is the second language have very low health literacy and are prevented from adequate medication adherence. For instance, language problems, as well as issues with health insurance coverage are typical barriers for Latino populations. This was confirmed in a study by Tripp-Reimer et al. (2001) in which it was found out that 34% of Latinos lack health insurance coverage and thus have to depend on out-of pocket payments for medications from their unreliable low incomes. They also reported that Latinos among other non-English speakers could not communicate effectively in English and this prevented access to health care.

Literature Review

Taylor et al. (2010) reported that patients of color are likely to suffer from language barriers as well as miscommunication with their healthcare providers, which prevents them from adequate adherence to medication. This is particularly true about Spanish-speaking patients: (51% versus 45%, p<0.05). This was reported on the 2166 Spanish speaking patients out of the 131, 277 patients from the Kaiser Permanente Northern California patients who were studied. The data was collected using probit models to study the effect of patient and physician ethnicity/ race and language adherence to cardiovascular disease medications after the patients’ as well as the physicians’ characteristics were controlled.

            Another factor is the subjects’ experience of having shorter and less primary symptom-centered visits to the physician and potential risk of being negatively perceived by their doctor (Traylor et al., 2010). Thus, negative physician perceptions are an additional factor, which influences how well the physician will assess the intelligence of a patient, will form affiliation towards the patient and shape certain beliefs about the likelihood of risky conduct, and will adhere to medication.

            Gilmer et al. (2009) compared the groups of Latino and Asian immigrants on the basis of their levels of English proficiency and rates of medication adherence.They found that Latino patients who had a higher level of English proficiency were less likely to adhere to schizophrenia medication treatments than those Latino patients with low levels of English proficiency were. On the contrary, among the Chinese patients who were prescribed antipsychotic drugs, those with higher level of English proficiency adhered better those with the lower of the English language knowledge. Besides, Latino and Asian patients with limited English proficiency were likely to be excess fillers. Caucasian patients were the most likely to act as excess fillers (20% vs. 15% for Latinos and 13% for Asians). Further, for both large groups of respondents with different levels of English, the probability of non-adherence increased with age, regardless of language proficiency.                          

Gilmer et al. (2009) found that Latinos with lower English proficiency, who better adhered to prescribed treatments, were less likely to get hospitalized and had better outcomes for their psychotic disorders compared to Latinos with the higher level of English proficiency. However, the researchers do not attribute this outcome solely to the language factors. Instead, they assume that these Latinos have better outcomes because of higher levels of social and familial support. “Family social support may serve as a cultural buffer, and family involvement in the client’s life and treatment plan may improve medication adherence and independently affect service utilization” (Gilmer et al., 2009). The language factor may not be the sole defining factor of medication adherence, but it goes along with familial and social support.

            Renfew et al. (2013) studied which factors acted as barriers to care for the patients of Cambodia origin who had diabetes. In a qualitative study, five focus groups were conducted with three study groups: frontline bilingual Khmer staff, Cambodian immigrants with diabetes, and health care providers. It was found that the quality of care for Cambodians was negatively affected by differences in cultural beliefs as well as barriers to language and health literacy. Psychosocial factors and patients’ fears impacted the quality of healthcare and is a challenge when interacting with the American healthcare system.

            Out of those, language barriers along with low levels of general and healthcare literacy were the key barriers to adherence. Clinicians reported inconveniences of interaction with the help of an interpreter. One cultural barrier that was reportedly important was deference to physicians and the Cambodians’ desire to please them. It was found that adherence to treatment plans was hampered by the psychosocial factors of fear of starvation (which has its roots in mass starvations under Khmer Rouge and prevents the patients from limiting themselves in eating) and close family interaction, where a few generations live in one household. It is hard for grandparents to get out to the healthcare center for a consultation, since they are caregivers to their grandchildren (Renfew et al., 2013).

Additional language barrier factors are the fears and challenges non-English speaking patients face while interacting with the American healthcare system. The Cambodian patients face difficulties when requesting for pharmacy related services especially during medication pickups and refills, which can be attributed to literacy and language barriers. Non-adherence to prescribed medication by non-English speaking patients may happen involuntarily, as a result of mistakes. Other fears include fear of medical procedures and distrust in relations to the clinicians and to the system of healthcare in general (Renfew et al., 2013).

            A special group of studies into the factors impacting adherence levels in patients with low levels of English proficiency targeted the elderly immigrant population of the Vietnamese and Chinese. In particular in the study by Johnson (2012), it was established that the Vietnamese American at the age of 65+ were likely to have poor medication adherence levels because of language barriers, lack of initiative between patients and prescribers to work out an agreement and high level of understanding of prescribed medications, poor health, and low income levels, as well as lack of counseling on the part of healthcare providers, education levels, and reliance on alternative medicine. Eighty-eight percent of the Vietnamese Americans aged over 65 years have little to no English fluency.  Similarly to the results of the previously discussed study into the factors affecting the Cambodian patients, the Vietnamese elderly patients turned out to have poor adherence levels due to their general mistrust in relations to the U.S. doctors and our healthcare as representatives of the Western medicine. Finally, lack of informative health services is a factor that affects the elderly Vietnamese patients’ adherence.

            In the study by Salt & Frazier (2011), the medication adherence barriers were researched with references to patients with rheumatoid arthritis. With this category of patients, medication adherence remains a considerable problem. In a cross-sectional descriptive study, based on self-reported data of 108 research participants, it was found that ethnicity was a crucial determinant of medication adherence: non-Caucasian (Hispanic and African-American) patients were 3-10 times less likely to be adherent to the medication that was prescribed. In addition, to ethnicity, living in remote rural areas was said to be a predictive factor of decrease adherence, along with the need to take multiple medications by prescription.

            Finally, being of Latino origin, with a low level of English proficiency, was found to be a factor of non-adherence among the subjects in the studies of Banta et al. (2009) and Compton, Haack, and Phillips (2010). In the study of Banta et al. (2009), Latino respondents were found to be less likely to adhere to prescribed medications in comparison with other ethnicities. Besides, the factors that affected the level of adherence were non-U.S. citizenship, low level of education, lack of insurance, lack of regular medical care, and younger age. Interestingly, binge drinking was not found to be a barrier to medication adherence.

            The qualitative study by Compton, Haack, and Phillips (2010), focused solely on Latino respondents and was based on the pharmacy in Des Moines, Iowa. It found that cultural influences and the language issue were not significant in preventing the Spanish-speaking respondents from medication adherence. This was explained by the fact that the pharmacy and medical staff who prescribed the medication were bilingual. So the respondents did not face difficulties in dealing with the prescribed medications and talking with the staff. Instead, chronic illnesses were found to be the factor that affected the adherence. Other factors named by the study subjects were “communication issues (i.e., content matter, such as when the prescription was ready), logistics, and limited hours of pharmacy operation as the primary barriers in picking up their medications” (Compton et al., 2010).


Just as one of the factors to medication adherence is the language barrier, patients who do not speak English or with limited English proficiency will benefit from translations of medication instructions and detailed explanations of how to use them. Following the experience of the European countries, the United States is recommended to make available the medication information on multiple languages. This can increase medication adherence and will help prevent medical errors (Regenstein et al., 2013).

            Further, based on the study implications from Glenn et al. (2008), the services of interpreters should be made readily available in hospital, given the large percentage of families in the United States with limited English proficiency. Interpreters should be hired as regular, full-time staff or may be reimbursed by the third-party affiliates. Additionally, volunteer help is welcomed. This will make the basis for prevention of medication non-adherence through removal of cultural, communication barriers, barriers to empathic understanding on the part of clinicians and to distrust on the part of the non-English speaking patients. This will help provide the patients with detailed and comprehensible explanations for how to adhere to medication.

            Patients who live in rural and remote areas should be provided with the opportunity to get in touch with the medical professionals. Also, they should be educated by nurses and physicians as to how to take the prescribed drug and how to avoid non-adherence (Salt & Frazier, 2011).

            Involvement of non-English speaking patients in decision-making process as to the prescription of the medication and its application is a predictor of successful adherence. Physicians should be educated as to boost their cultural competence along with increasing health literacy for the patients. Bridging the gap in communication is possible through increasing providers’ cultural awareness of the non-English speaking patients they work with (Renfew et al., 2013).



This paper has provided an overview of multiple barriers to medication adherence faced by non-English speaking patients in the United States. Having carefully analyzed the up-to-date scholarly sources on the issue, key barriers to medication adherence include linguistic and cultural barriers. People with low level of English proficiency (immigrants) have been found less adherent to the prescribed medication, whereas Caucasian patients adhered the best. However, it is important to differentiate between different groups’ of immigrants and the impact of the language factor: Latino patients who are illiterate are more likely to adhere due to the powerful impact of other cultural factors (family and social support). With Asians, everything is different; their non-adherence is proportionate to their level of the English language knowledge.  Moreover, the social factor (family binds) acts as a restrictive force to adherence.

             Cultural barriers have been found to be very important, along with psychosocial factors, fears, distrust, prejudice towards the Western medicine, and of providers’ interest into the perception and approach of the person who is to be prescribed a medication. It has been found that interpreting services in hospitals would help remove the barriers. It has also been found that clusters of factors should be considered when looking into what impacts the adherence. These may include depression, poor health status, need to take numerous drugs, and low income. They are typical for all patients and can often be found in non-English speaking patients. Finally, it depends upon the nature of the illnesses and on the providers’ knowledge of their non-English patients to determine which factors are more impactful. Overall, both parts of the process need to improve their perception of personal accountability for both prescription of and adherence to medication. This should be followed by the practical measures described above.



Banta, J. E., Haskard, K. B., Haviland, M. G., Williams, S. L., Werner, L. S., Anderson, D. L., &DiMatteo, M. R. (2009). Mental health, binge drinking, and antihypertension medication adherence.American Journal of Health Behavior, 33(2), 158-171.

Beusterien, K. M., Davis, E. A., Flood, R., Howard, K., & Jordan, J. (2008).HIV patient insight conditions.Drugs & Aging, 27(3), 239-254.DC: U.S. Government Printing Office.

Doggrell, S. A. (2010). Adherence to medicines in the older-aged with chronic conditions.Drugs & Aging, 27(3), 239-254.

Drousel-Wood, M., Muntner, P., Islam, T., Morisky, D., & Webber, L. (2009). Barriers to and determinants of medication adherence in hypertension management: Perspective of the cohort study of medication adherence among older adults (CoSMO). Medical Clinics of North America, 95(3), 753-769.

Flores, G., Torres, S., Holmes, L. J., Salas-Lopez, D., Youdelman, M. K., &Tomany-Korman, S. C. (2008). Access to hospital interpreter services for limited English proficient patients in New Jersey: A statewide evaluation. Journal of Health Care for the Poor and Underserved, 19(2), 391-415.

Gilmer, T. P., Ojeda, V. D., Barrio, C., Fuentes, D., Garcia, P., Lanoutte, N. M., & Lee, K. C. (2009).Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency.Psychiatric Services, 60(2), 175-182.

Henriques, M., Costa, M., &Cabrita, J. (2012).Adherence and medication management by the elderly.Journal of Clinical Nursing, 21(21/22), 3096-3105.

Jonathan, N. (2012). Adherence to medications among Vietnamese Americans 65 years of age and older.California State University Master’s Thesis.Retrieved from ProQuest database.

Krousel-Wood, M.,&Frohlich, E. (2010). Hypertension and depression: Co-existing barriers to medication adherence. Journal of Clinical Hypertension, 1(7), 481-486.

Regenstein, M., Andres, E., Nelson, D., David, S., Lopert, R., & Katz, R. (2012).Medication information for patients with limited English proficiency: Lessons from the European Union. The Journal of Law, Medicine, and Ethics, 40(4), 1025-1033.

Renfrew, M. R., Taing, E., Cohen, M. J., Betancourt, J. R., Pasinski, R., & Green, A. R. (2013).Barriers to care for Cambodian patients with diabetes: results from a qualitative study. Journal of Health Care for the Poor and Underserved, 24(2), 633-655.

Steadman, L., Thompson, S., &Rutter, D. R. (2012). Adherence to anti-hypertensive medication: Proposing and testing a conceptual model. British Journal of Health Psychology, 17(1), 202-219.

Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010). Adherence to cardiovascular disease medications: Does patient-provider race/ethnicity and language concordance matter? Journal of General Internal Medicine, 25(11), 1172-1177.

Tripp-Reimer, T., Choi, E., Kelley, L. S., &Enslein, J. C. (2001). Cultural barriers to care: Inverting the problem. Diabetes Spectrum, 14(1), 13-22.


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Right-Sided Congestive Heart Failure

Right-Sided Congestive Heart Failure is a condition that occurs when the right side of the heart fails to pump blood to the lungs in an ordinary way. This situation arises when the right vertical develops problems resulting to heart failure. Heart failure is common in people whose left ventricle develops problems. When blood piles in the left ventricle that has problems, the right ventricle may not effectively pump blood to the lungs, thus, it weakens and result to heart failure. Thus, the most common cause of the Right-Sided Congestive Heart Failure is failure of the left side ventricle (Robinson & Sprayberry, 2009). Failure of the right ventricle may either by diastolic or systolic heart failure. Although failure by the left ventricle is the major cause of the Right-Sided Congestive Heart Failure is the problem linked to right side of heart, other conditions may result to condition.

            Other factors that cause the Right-Sided Congestive Heart Failure include high blood pressure, coronary artery disease, and valve conditions. High blood pressure arises in a situation whereby cholesterol or fat becomes deposited on the blood vessels, and the vessels become small hence making it hard for blood to pass through it. The damage on the coronary arteries of the heart may result to Right-Sided Congestive Heart Failure because of restriction of the flow of blood. The coronary arteries may be blocked by the fatty layers or cholesterol and they become narrow. As the heart valves control the flow of blood in and out of the heart by opening and closing, these valves may malfunction hence forcing the heart to pump the blood hard. Pumping the heart hard may result to Right-Sided Congestive Heart Failure (Uzelac, Moon & Badillo, 2005).  

For individual suffering from Right-Sided Congestive Heart Failure, the initial signs may include:

  • Fatigue,
  • The legs, feet, and ankles may swell,
  • One gains weight,
  • There are is an increased rate of urinating

Upon the condition of the Right-Sided Congestive Heart Failure worsening, one may experience:

  • Heart beat which is not regular,
  • Wheezing,
  • One may cough when the lungs gets congested,

Other symptoms indicate that the condition of the Right-Sided Congestive Heart Failure is severe. These conditions include:

  • Chest pains that cause the upper part of the body to ache,
  • Breathing rapidly,
  • In some instances, the skin may appear bluish,
  • One may suffer heart attacks
  • One may also faint in some cases.

When an individual suffers these conditions, the person should be referred to a cardiologist. The cardiologist does some physical examination of the patient that may entail listening to the heartbeats through the stethoscope. The stethoscope is used to evaluate whether the hearts beats are normal or irregular. This monitoring is very critical because the cardiologist may be required to carry out further tests after evaluating the results of the initial tests. The other tests that the cardiologist can carry out include magnetic resonance imaging, stress tests, and the blood tests. The magnetic resonance imaging takes the photograph of the heart in efforts to evaluate any abnormalities. Stress tests are done to evaluate whether the patient is suffering from any level of stress, while the blood tests evaluate whether there blood is infected or whether there exists any abnormal cells in the blood.




Robinson, N. E., & Sprayberry, K. A. (2009). Current therapy in equine medicine. St. Louis, Mo: Saunders Elsevier.

Uzelac, P. S., Moon, R. W., & Badillo, A. G. (2005). SOAP for internal medicine. Oxford: Blackwell.