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Terms in this set (21)
Are all old people frail?
But frailty + Chronic conditions= bad combination
What is a strong determinant of older adults' abilities to tolerate drugs?
Are Americans using more or fewer medications each year?
MORE (Money, older people, quick fix, more availability)
Polypharmacy is seen in:
- All age groups
- with combination of a bunch of diseases
- With multiple doctors
- multiple pharmacies
- Those who are in isolation
- advanced age
- Less ability to eliminate medications
- Impaired cognitive function
- Transitions of care
- Challenges with ADLs
- Health literacy
High risk in the elderly
Are people with acute or chronic conditions more likely to use their medications?
ACUTE!!!! 50% of people with chronic conditions will stop taking their meds
What is the goal for treating older adults?
An individualistic approach
What are some challenges to that goal?
Number of Meds a patient is taking
Assessment of side effects
Consequences of polypharmacy:
MALNUTRITION (especially with 10 + meds... Reduced fiber, fat soluble vitamins, glucose, cholesterol, and sodium)
Risk for drug reactions
Multiple geriatric syndromes
What is the "prescribing cascade"?
When one drug causes a side effect that needs to be treated by another drug and so on...
Often a problem when a patient has multiple doctors
Medication reconciliation does not always happen when admitted to a hospital
Why can meds be dangerous in elderly patients?
Muscle turns to fat which makes distribution weird
Decreased blood flow to the liver
Lower Albumin levels
Renal system/gi system
Cholinesterase inhibitors + Anticholinergic drugs=
5 D's of anticholinergic drugs
Dry brain= confusion
Dry Mouth= Can't eat
Dry eyes= blurry vision
Dries up urine= urinary retention
Dries up bowels= Constipation
What is done annually to ensure that all medications are accounted for and taken properly?
Brown bag assessment
Other nursing assessments:
Ability to swallow
Gait and frailty
What tool helps to identify which medications put older adults at risk?
START criteria (Screening Tool to Alert doctors to the Right Treatment)
STOPP criteria (Screening Tool of Older People's potentially inappropriate Prescriptions)
How do you diagnose polypharmacy?
Rule out other causes
Patient compliance to meds
Assess renal clearance
(Maybe trial halting certain drugs to see if symptoms improve)
LABS (CMP/BMP, Folate, B12, TSH)
Make sure other people aren't taking the patient's meds
Should you stop multiple drugs at once?
Assess for unnecessary medications
Assess allergy list for true allergies
Assess dosages "start low and go slow"
Match the diagnosis to the drug to help sort out unnecessary meds
Scan med list for meds that are known to be problematic in the elderly
Use Beers Criteria, START or STOPP criteria
Do any drugs on the med list cause electrolyte imbalances? Confusion?
Use resources (Epocrates, Lexicomp, Micromedex)
Can the patient afford the medications? Are they able to pick them up from the pharmacy? Can they open the bottle?
Foster Medication Literacy
Patients may skip medication doses or cut the pills in half to make the supply last longer
Assess if they can afford their medications
Skipping of meds often occurs during the "doughnut hole" time of the year (July-end of the year)
Pharmacies that offer a $4 prescription list or discount formulary
Patient assistance programs through pharmaceutical companies
Copay assistance programs & low-income subsidy programs that patients can apply for online
Access to meds
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