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Objectives:

1. Describe the problem of drugs with the older adult.

2. Discuss the need for nurses to evaluate the current drugs the older adult patient is taking.

3. Describe the nursing goals for the accurate administration and   the comprehensive assessment of drugs in older adults.

4. Identify the age-related changes in absorption with the older adult.

5. List how nurses can promote the safe use of drugs in the older adult.

 

The number of Americans 65 years old and older is growing rapidly. IT is estimated that by the year 2030, every fifth American will be over the age of 65. It is important that nurses keep up on the most recent findings regarding care of the older adult. The five most common cognitive diagnoses seen in the older adult are referred to as the “five D’s”. The five D’s include: dehydration, drugs, depression, dementia and delirium.  This course will review drugs and the older adult.

 

The Older Adult and Drugs

The average community based older adult has 12-17 prescriptions filled yearly and routinely take 4.5 prescription medications and 2 over the counter (OTC) drugs daily. These drugs are often filled using several different pharmacies (polypharmacy). The nursing home resident averages 8 prescriptions and 2 OTC drugs daily. The older adult uses one-third of all prescription drugs and one-fourth of all OTC drugs.

The nursing goals for the accurate administration and the comprehensive assessment of drugs in older adults are to:

 

1. Identify the actual medication-taking behaviors. Make sure they are taking their medication in the correct dose, correct time and with the correct instructions.
2. Identify any factors that interfere with the prescribed regimen.
3. Determine the effectiveness of the medication regimen.
4. Ascertain risks for adverse effects or alter therapeutic actions.
5. Detect the presence of adverse medication effects.
6. Identify opportunities for health education about medication regimens for staff and patient.
7. Maintain and encourage open communication between the nurse and the physician.

 

Nurses need to evaluate the current drugs their patients are taking. Both prescription and OTC drugs need to be included. Discussions need to be made regarding the use of polypharmacies. The problem with using multiple pharmacies is that the pharmacist is unable to identify drug interactions or contraindications effectively when they do not know what other medications the person is taking from other pharmacies. Drug to drug interactions need to be addressed to ensure patient safety. The nurse should identify if the patient is self-administering their medication correctly. Other questions to ask the older adult include:

• Who administers the medications?
• What times per day are they taken? (So there can be a limit put on this)
• Where does the patient keep their drugs?
• What are the indications for the drugs?

 

The discussion of cost may be significant in that some older adult can not afford their prescribed medication and will either not get the medication or they will cut the dose in half in an attempt to save money.

The response of older adults to medication is different than with the younger adult. The risk of adverse drug reactions is higher in older adults because of age-related differences in pharmacokinetics and pharmacodynamics.

Age-related changes in absorption with the older adult are caused by: decreased intracellular fluid, increased gastric pH, decreased gastric blood flow & motility, and reduced cardiac output and circulation. Slower metabolism will slow absorption. The inhaled, topical or IV route of administration of medication are better absorbed in the older adult.

As we age, the liver decreases in size and function, which affects the distribution of drugs. Certain enzymes are not excreted and detoxification and conjugation are reduced. To promote the safe use of drugs nurses must be aware of the following:

• Indication for the drug
• If the smallest possible dosage has been ordered
• If the patient allergic to the drug
• If this drug interacts with other drugs, herbs, or nutritional supplements being used
• Special instructions for this drug
• If the most effective route of administration is being used
• Dosing should be 2 times per day or less
• Regular review of a drug’s ongoing necessity and effectiveness is essential
• Large print instructions should be provided
• Immediate discontinuation of a drug is a concern for older adults; In some instances titration is necessary

 

References:

Olesen, C., Harbig, P., Barat, I., & Damsgaard, E. M. (2014). Correlation between the use of ‘over-the-counter’medicines and adherence in elderly patients on multiple medications. International journal of clinical pharmacy,36(1), 92-97.

Lee, D. S., de Rekeneire, N., Hanlon, J. T., Gill, T. M., Bauer, D. C., Meibohm, B., ... & Jeffery, S. M. (2012). Cognitive Impairment and Medication Complexity in Community-Living Older Adults: The Health, Aging and Body Composition Study. The Journal of pharmacy technology, 28(4), 156-162.

Olesen, C., Harbig, P., Barat, I., & Damsgaard, E. M. (2014). Correlation between the use of ‘over-the-counter’medicines and adherence in elderly patients on multiple medications. International journal of clinical pharmacy,36(1), 92-97.

Tamura, B. K., Bell, C. L., Lubimir, K., Iwasaki, W. N., Ziegler, L. A., & Masaki, K. H. (2011). Physician intervention for medication reduction in a nursing home: The polypharmacy outcomes project. Journal of the American Medical Directors Association, 12(5), 326-330.

Eliopoulos, Charlotte. Gerontological nursing. Wolters Kluwer Health, 2013.

 

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