In the United States today, the elderly make up approximately 13% of the population but use 30% of all prescriptions written. On average, the elderly patient takes approximately four to five prescription medications and two over-the-counter medications. It is also likely that one of their prescribed medications is unnecessary, ineffective, or even potentially dangerous, and the patient suffers an adverse drug reaction (ADE). In a study of more than 150,000 elderly patients, 29% had received at least one of 33 potentially inappropriate drugs. A study of approximately 27,600 Medicare patients documented more than 1,500 ADEs in a single year. ( ) Most ADEs come from drug interactions. Therefore, the more drugs a patient takes, the more likely …show more content…
an ADE is to occur. It is estimated the incidence of drug interactions rises from 6% in patients taking two medications daily as high as 50% in patients taking five medications daily. As the elderly population increases so will the occurrences of ADEs. It is important to protect the elderly patient from these negative consequences of polypharmacy. This is accomplished by understanding how the aging body reacts to medications, understanding which drugs are the most problematic for the elderly patient, and how to spot a drug-related problem and intervene. Physiological changes occur within the aging body making it more sensitive to the effects of medications.
These changes affect what the body does to a drug, pharmacokinetics, and what a drug does to the body, pharmacodynamics. The three components of pharmacokinetics are absorption, distribution, and clearance, and each is affected by aging. Absorption is the least affected change. It is a slower process, but complete. If the absorption is the skin, it can actually increase as the skin is thin and frail. The more medications a patient takes, however, the higher the risk it will interfere with the absorption of another medication. Distribution of medication also changes with age. Medications are distributed into either fat or water, depending on its chemical characteristics. As a patient ages, their percentage of body fat increases, so a drug that is fat soluble may stay in the body longer because there are more fat stores. Because elderly patients have less body water than younger patients, blood levels of a water soluble medication would be higher than expected. It is also difficult to anticipate the effect that changes in fat stores or body water will have on drug distribution because other body functions, such as protein binding, can also complicate drug …show more content…
distribution. Clearance is significantly affected because it produces changes in the liver, where drugs are metabolized, and in the kidneys, through which drugs are excreted.
As the body ages, blood flow through the liver decrease, which reduces the clearance of certain drugs by 30%-40%. Alos, the major enzyme system by which the liver metabolizes drugs, P450, becomes easily overwhelmed, so certain medications are metabolized more slowly and not as well. The size of the kidneys and renal blood flow both decrease with age as well. Aging also affects pharmacodynamics. Changes to drug receptors can make a patient more or less sensitive to certain medications. Drugs that interact with the CNS may have a greater impact in an elderly patient than a younger as a result in changes in the blood-brain barrier. A good way to protect an elderly patient from polypharmacy is by knowing which drugs frequently cause problems in this age group. Many healthcare institutes use the Beers Criteria, a list of potentially inappropriate medications for the elderly, to evaluate the drug regimens of their patients. Another way to protect the elderly patient is to take a thorough drug history of the patient. Document and examine all medications the patient including prescription, over-the-counter, and herbal products. Confirm the names, generic and brand, the drug class, and the clinical indication are correct as ordered. Find out if the patient is seeing another health care providers and if they have prescribed medications
as well. Know the side effects for each medication the patient is taking. Also be aware of any conditions the patient may have that could increase drug-drug reactions. For example, sildenafil (Viagra) may be appropriate for an elderly patient with erectile dysfuntion, but if the patient has heart disease and is taking any form of nitrate such as nitroglycerin (Nitrostat, Nitro-Dur) or isosorbide (Isordil, Sorbitrate) sildenafil could cause his blood pressure to drop to dangerously low levels, and is therefore, contraindicated.
17). Dowieko (2015) points out that “methods of administration and routes of administration are important factors that affect the user experience” (p.17). There are thirteen different ways that a compound can be introduced to the body (Kamienski and Keogy (2006), Doweiko, 2015, p. 17). Compounds administered by the “enteral method enter the body by the gastrointestinal tract ”(Brody, 1994, Dowieko ,2015, p. 17). “Compounds administered by the parenteral method of drug administration involves the injection of a compound directly into the body” (Dowieko, 2015,
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
...teract. Many of the medications are very powerful in and of themselves. This article also presents additional approaches to medicating the elderly, including focus on reduction of number of medications prescribed. Both articles present the importance of considering the normal physiological changes within geriatric patients.
contamination, toxicity, and side effects. Most people believe these medications are compounded or mixed by a trained and licensed individual. However, this is inaccurate because the pharmacy technician actually compounds a large percentage of a patient’s medications. Compounding involves a techn...
and previous spouses at age sixty-five. For the most part, the Medicare population consists of
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
A search for current peer reviewed research studies was conducted using CINAHL, Medline, and PubMed. The research articles were generated by utilizing the search entry with the terms of polypharmacy, polypharmacy among the elderly, adverse drug reactions and polypharmacy, and consequences and polypharmacy. After receiving a few research articles, a new search was conducted replacing the term of polypharmacy with multiple medications. These searches yielded limited research articles pertaining to the topic of polypharmacy.
Drug use appears to negatively affect the health of the elderly at a higher rate than other populations (Benshoff & Koch, 2003). This may be a result of old age. So, it can be understood there is a biological effect of substance abuse among the elderly. The elderly are more susceptible to being admitted into the hospital for adverse effects of substances, while other populations of society are not. Benshoff and Koch asserts, “Intentional abuse of prescription medications to get high is thought to be rare, but over-use does occur among this population. Often this over...
When doctors prescribe medication for their patients, a local retail pharmacy is most likely to be utilized to fill the order. However, there is a growing population of older Americans that are no longer able to live independently and must reside in nursing homes or assisted living facilities. In order for this vulnerable population to receive their medications, a different kind of pharmacy is needed, these are known as LTC, long term care pharmacies. Within these specialized pharmacies there are highly trained employees called CPhTs, certified pharmacy technicians who are overseen by state licensed RPHs, otherwise known as pharmacists.
It is a fact; the older adult population is living longer. While many older adults are fit and healthy, others are frail and weak requiring necessary medication. It is more important than ever for all of the healthcare community to be conscious of safe prescribing and the proper use of medicine when taking care of older adults.
Thank you for that insightful post. As I mentioned in my post, the current deficit of geriatricians is projected to become more pronounced with expected growth of the elderly population. More geriatricians will be necessary to provide healthcare for this medically complex population. Several steps can be taken to increase the number of geriatric physicians including establishment of more geriatric departments in medical schools in the U.S., increase in the number of training positions for geriatrics and primary care as opposed to other medical specialties and increased reimbursement for physicians caring for the geriatric population. With regards to preventive care, there are already several recommended age appropriate screenings in place such
...otecting them from further dangerous exogenous substances, a price is later paid with a weakened dysregulated immune system, becoming susceptible to aging and age related diseases (DeVeale, Brummel & Seroude, 2004). Despite continued research into the complex aging process, humans are continually aging both physically and mentally. However, just as the immune system is a part of the complexity of the human being, so is aging (Effros, 2005).
Routes of administrating a drug all depend on how the medication is delivered to the patient. The most common and most frequently
Aging brings on the experience of senescence a process of aging. This is a time where the body begins to become a bit weaker and less efficient. (Berger, 2014, p.576) Interestingly enough the physiological factors of aging actually protects adults. The heart and lung begin to lose the reserve capacity each part of the body begins to accommodate the changes that are happening in the other parts of the body. Whether or not a person is old or young the lungs still maintain the oxygen capacity. The brain does however slow down with age and even shrink a bit, but most of the time this goes unnoticed. If there are any severe losses before the age of 65 most often it is attributed to one of these four factors; drug abuse, poor circulation, viruses and genes. The outward appearance also changes skin becomes more wrinkled (unless of course you try Botox regularly) and hair gets grayer and thinner along with may other things. (p.579) The body senses begin to compensate for each other the sight with the hearing and the taste with the smelling. After age 50, it is almost impossible to be able to reproduce without extra hormones. Besides sexual arousal usually begins to slow down or even stop at or after age 60. (p.580-581)
As you age, cognitive change is a normal process. Abilities like reasoning, memory, and the speed you process something gradually decrease over time. The reason cognitive functions decrease are because your blood vessels narrow and become less stretchy. This might cause blood flow to the brain and other important organs to decrease. An elderly person's blood pressure may also get higher or lower.