Drug-related problems in the elderly


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Also, prescribing for elderly patients presents unique- challenges. Many medications need to be used with special caution because of age-related changes in pharmacokinetics ie, absorption, distribution, metabolism, and excretion and pharmacodynamics the physiologic effects of the drug.

Background

Optimizing drug therapy is an essential part of caring for the elderly. The process of prescribing a medication is complex, and includes:.

Dr John Budd - Working with older people with drug-related problems

Boyd, CM, et al. Primary drug reactions 1 drug with 1Side-Effect. Erythromycin and Theophylline or Indometacin and Propanaolol. Inadequate assessment and incorrect diagnosis from the start as elderly people have atypical and altered presentation. Excessive prescribing with multiple- complex drug regimens because of the multiple co-morbidities.

Inadequate supervision of long- term medication and lack of compliance from the complicated regime. Almost all elderly tend to take non prescribed medication, alternative complimentary medications and supplementation.

Adverse reactions to drugs

In Malaysia, elderly patient tend to go doctor- hopping and that they will visit 1 doctor after another doctor until they meet the one that satisfied them most. The multiple physicians they visited may prescribe drugs of similar indication but of different brand names. Appropriate drug use in elderly will increase quality of life and reduces disabilities from illnesses. However the treatment of illness in elderly is very challenging as it involved the patient, the prescriber and the drugs.


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As mentioned prescribing in elderly is very complex and intrigued and it is not easy for doctors to stay up to date with all the new medications and let alone memorize all the new medications. The aim of prescribing in elderly is to minimized mistakes. It also identifies strategies to minimize these risks. Older persons react differently to medications than younger persons. These changes can alter therapeutic drug levels, causing greater concentrations of water-soluble drugs and longer half-lives of fat-soluble drugs.

Also, because the liver metabolizes many drugs, such age-related changes as reduced hepatic blood flow and liver size alter drug clearance. Drug elimination also may be affected by age-related decreases in renal blood flow, kidney size, and glomerular filtration rates, as well as changes stemming from chronic diseases. Additionally, digoxin and certain other drugs are bound to plasma proteins so that only the unbound or free portion of the drug is biologically active.

Therefore, decreases in serum albumin levels—common in older adults with chronic illnesses, malnutrition, or severe debilitation—can lead to higher drug blood levels. Subsequently, older patients may be more sensitive to some drugs and less sensitive to others. Adverse reactions are common in older adults and often manifest differently than in younger patients.

For instance, falls, dementia, and urinary incontinence are common in the elderly and can result from a health problem or a medication. In a prescribing cascade , an adverse reaction to one drug goes unrecognized or misinterpreted, causing the healthcare provider to inappropriately subscribe a second drug to treat signs and symptoms. This can lead to potentially dangerous situations and overprescribing.

Dietary supplements such as vitamin and mineral supplements and herbal preparations have become popular. For instance, ginkgo biloba, St. A person may start taking these preparations after hearing about them from friends, family, or the media. Yet these preparations can interact with prescribed medications and lead to serious adverse effects. So be sure to ask the patient about all preparations—not just prescription drugs—he or she is taking.

Drug-related problems in the elderly

Poor adherence to the medication regimen is an ongoing problem among older adults. Although most patients are motivated to take their medications as prescribed, some may fail to comply due to lack of understanding, confusion, or simple forgetfulness. In other cases, prescribers may advise a patient to cut tablets in half to lower the dosage—but this task may be difficult or impossible for elderly patients with decreased vision or poor manual dexterity. Also, some patients may attribute unpleasant symptoms to a medication and, without consulting the prescriber, decrease the dosage or even stop taking the drug.

Those with visual deficits may have difficulty reading the prescription label. Patients with financial problems or who live on fixed incomes may decide to take lower-than-prescribed dosages to extend their supply—or they may not fill a prescription at all. As a nurse, you can be pivotal in helping older patients manage their medications and prevent polypharmacy.

The keys to reducing polypharmacy risks are information, instruction, and organization summarized in the table below. Also, if appropriate, help patients establish memory aids. For instance, advise patients to link drug administration to their daily routine or to use color-coded charts, automatic dispensers with bells, or voice-activated message services to remember to take their doses. Advise them to record the medication names generic and brand , prescribed dosage and dosing frequency, and the reason it was prescribed. The sample template below can be useful for older patients.

Inform patients of any dietary restrictions necessitated by a specific medication. During healthcare appointments, teach the patient about potential side effects, including when to call the clinic or go to the emergency room. This also gives you an opportunity to clear up any confusion caused by look-alike or sound-alike drug names or drugs with similar appearances. These face-to-face meetings are invaluable; as you establish a strong relationship with the patient, you can find out how the patient is actually taking the medications.

Instruction must be combined with good communication. Optimally, patient care should be directed by a limited number of healthcare providers. The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems. Advise patients to use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.

Instruct patients to take medications as instructed and to inform their providers if health changes occur, especially after starting a new medication.

Caution them not to stop taking a drug without consulting their healthcare provider. At each visit, ask patients about their adherence to the medication regimen and their use of OTC preparations. Organization can improve adherence. Complex medication regimens are challenging even for the most diligent patients. Caution patients to take only those drugs prescribed for them and not to share medications with others or save them for future use. Teach them to store medications in a secure, dry location away from direct sunlight or to refrigerate them if needed.

Drug-Related Problems in the Elderly - PORTAL MyHEALTH

As appropriate, recommend use of 7-day pill boxes, daily pill boxes, or blister packs to help patients adhere to their regimen. Color-coded charts can help elderly patients set up pill boxes. For patients with cognitive deficits, recommend the use of drug dispensers with bells, automatic dispensers with voice-activated messages, and regular or video-telephone call reminders, as appropriate. Another basic technique to improve adherence is to link dosing schedules to routine activities of daily living, such as brushing the teeth, eating breakfast, or other activities that can serve as memory triggers.

Where appropriate, healthcare providers should explore nonpharmacologic alternatives to drugs, such as dietary changes. However, know that underprescribing of effective therapies in older patients also is a concern. Advances in information technology, such as electronic prescribing, electronic medical records, and electronic laboratory records, are innovative ways to decrease the risk of adverse drug reactions and interactions. Technology-driven integrated prescribing systems and administration-alerting systems are being explored to address these problems.

Also, the relatively new field of human-factors engineering focuses on the design of human-machine interfaces and is directly applicable to helping older adults stay independent and improve their medication management. As a general rule, healthcare providers should minimize the number of medications prescribed for older adults, keep the dosing schedule as simple as possible, and limit the number of medication changes. Ballentine N. Polypharmacy in the elderly: maximizing benefit, minimizing harm.

Crit Care Nurs Q. Inappropriate prescribing in geriatric patients. Curr Psychiatry Rep. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med. Teaching older adults to self-manage medications: preventing adverse drug reactions. J Gerontol Nurs. Updating the Beers Criteria for potentially inappropriate medication use in older adults. Arch Intern Med. Accessed September 14, Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health.

Fulton M, Riley Allen E. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. Greenawalt K. How are all those medications affecting your older patient? Polypharmacy and the geriatric patient. Clin Geriatr Med. Hogan D, Kwan M. Patient Sheet: Tips for avoiding problems with polypharmacy. Planton J, Edlund BJ.

Drug-related problems in older people after hospital discharge and interventions to reduce them.

Strategies for reducing polypharmacy in older adults. Rochon PA. Drug prescribing for older adults. June 10, Accessed September 27, Simonson W, Feinberg J.

How aging affects response to drugs

Medication-related problems in the elderly: defining the issues and identifying solutions. Drugs Aging. Appropriate prescribing in elderly people: how well can it be measured and optimized? Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. It is the wau of limiting polypharmacy yet! I have in my practice tried to reduce doses for many meds after years of taking, and obvious changes in the patient.

It is very hard to reverse the big pharma and Medicare D partnership. Very comprehensive article! However, there is one important safety tip…patients should be encouraged to establish a relationship with their pharmacist. As drug experts, pharmacists can play a pivotal role in med misadventures.

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