Gero: Medication Use/Management

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People older than 65 experience medication-related problems for seven major reasons: 1

Age-related physiologic changes that result in altered pharmacokinetics (Movement of drug in the body from point of administration as it is absorbed, distributed, metabolized, and excreted) and pharmacodynamics (Interaction between drug and body).

People older than 65 experience medication-related problems for seven major reasons: 2

Multiple medications (polypharmacy) that are often prescribed by multiple providers.

People older than 65 experience medication-related problems for seven major reasons: 3

Incorrect doses of medications (over or under a therapeutic dosage)

People older than 65 experience medication-related problems for seven major reasons: 4

Medication consumption for the treatment of symptoms that is not disease-dependent or specific. (i.e., self-medication or prescribing cascades).

People older than 65 experience medication-related problems for seven major reasons: 5

Iatrogenic causes such as:
a. ADEs: drug-drug or drug-disease interactions.
b. Inappropriate prescribing for older adults.

People older than 65 experience medication-related problems for seven major reasons: 6

Problems with medication adherence.

People older than 65 experience medication-related problems for seven major reasons: 7

Med errors

Drug regimen unassisted grading scale (DRUGS)

This tool requires older adults to perform the following four tasks with each of their medications:
1. identify the appropriate medication,
2. open the container,
3. select the correct dose, and
4. report the appropriate timing of doses.
Typically used at time of transfer to other levels of care.

Adverse drug reactions

Unwanted pharmacological effect ranging from a minor annoyance to death; includes allergic reactions.
Predictable or unpredictable
Most common for older adults: Cardiac meds, diuretics, non-opioid analgesics, hypoglycemic agents, and anticoagulants
Check if the medications are on the Beers List

ADRs in older adults

Drug-induced delirium or confusion
Lethargy
Sensitivity to light
Sexual dysfunction
Drug toxicity - Life threatening

"drug misadventuring"

Misuse of prescription medications
Inappropriate prescribed medications
Inappropriate dosages
Overuse- Polypharmacy
Underuse - Self-prescribing
Erratic use- Contraindicated use
Nonadherence (noncompliance)

MASTER rules for rational drug therapy

Minimize number of drugs used
Alternatives should be considered
Start low and go slow....but go!
Titrate therapy
Educate the client
Review regularly

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