Protecting the Geriatric Client

I. RISK FOR INJURY

1. High-Risk Profile for Falls

  • Older adults are at higher risk for falls due to various reasons:
      - Age-Related Physical Changes:
        - Poor balance
        - Weak muscles
        - Slower reaction time
        - Decreased vision or hearing
        - Joint stiffness or arthritis
      - Environmental Risks:
        - Clutter
        - Poor lighting
        - Loose rugs
        - Slippery floors
      - Medical Conditions:
        - Stroke
        - Parkinson’s disease
        - Neuropathy
        - Low blood pressure
        - Incontinence (rushing to the bathroom)
      - Medications:
        - Sedatives
        - Blood pressure medications
        - Diuretics
        - Pain medications

2. Fall-Related Injuries in Older Adults

  • Falls can result in significant injuries, including:
      - Hip fractures
      - Head injuries
      - Internal bleeding
      - Loss of independence
      - Fear of falling, leading to reduced activity

3. Falls & Injuries Related to Medication Use

  • Medications can increase fall risk by causing:
      - Dizziness
      - Confusion
      - Low blood pressure
      - Drowsiness
      - Poor coordination

A. Age-Related Changes in Drug Therapy

  • Older adults process medications differently due to physiological changes:
      1) Absorption:
        - Slower GI motility
        - Decreased stomach acid
        - Medications take longer to start working
      2) Distribution:
        - Less body water, resulting in higher concentrations of drugs
        - Increased body fat causing fat-soluble drugs to remain longer in the body
        - Lower protein levels leading to a greater amount of “free drug” in the bloodstream
      3) Metabolism:
        - Decreased liver function
        - Medications metabolize more slowly, increasing toxicity risk
      4) Elimination:
        - Slower kidney filtration
        - Drugs remain in the body longer, raising overdose risk

B. Other Factors Influencing Drug Responses

1) Multiple Chronic Illnesses:
   - More diseases lead to more medications and a higher risk of drug interactions.
2) Self-Administration of Medication:
   - Challenges such as poor eyesight, memory problems, difficulty opening bottles, and misunderstanding instructions.
3) Medication Errors:
   - Errors include taking the wrong dose, taking medications at wrong times, or mixing medications incorrectly.

4. Attitudes of Health Care Providers

  • Some providers may:
      - Prescribe excessive medications (referred to as “polypharmacy”).
      - Assume symptoms are due to aging rather than side effects of medications.
      - Neglect to review all medications regularly.

5. Common Drug-Induced Problems in Geriatric Clients

  • Confusion:
      - Frequently caused by sedatives, opioids, and anticholinergics.

  • Incontinence:
      - Linked to the use of diuretics and sedatives (unable to reach the bathroom in time).

  • Immobility:
      - Can be exacerbated by sedatives, antipsychotics, and opioids.

6. Drug Classes Frequently Associated with Adverse Reactions

  • High-risk drug classes include:
      - Sedatives/hypnotics (e.g., benzodiazepines)
      - Opioids
      - Anticholinergics
      - Antipsychotics
      - Antihypertensives
      - Diuretics
      - NSAIDs (risk includes bleeding and kidney damage)
      - Anticoagulants (also associated with increased risk of bleeding)

7. Adverse Outcomes of Multiple-Drug Regimens (Polypharmacy)

  • Potential adverse outcomes include:
      - Increased risk of drug interactions
      - Higher chances of side effects
      - Confusion and falls
      - Poor medication adherence
      - Need for hospitalization
      - Potential organ damage (e.g., to the liver or kidneys)

II. NURSING PROCESS & DRUG TREATMENT OF THE GERIATRIC CLIENT

A. Assessment

1) Drug Inventory:
   - Compile a comprehensive list of all medications, including prescriptions, over-the-counter (OTC), vitamins, and herbal supplements.
2) Client’s Understanding of Purpose:
   - Query the client about each medication: “Why do you take this medication?”
   - Identify any misunderstandings in their answers.
3) Ability to Administer Safely:
   - Evaluate client capabilities such as opening bottles, reading labels, and remembering doses.
4) Review for Interactions:
   - Look for duplicate medications, high-risk combinations, and evaluate potential side effects.

B. Planning

1) Multiple Prescribers:
   - Stress the importance of communication between healthcare providers.
   - Encourage the use of the same pharmacy when possible.
2) Supervision of Drug Regimen:
   - Involve family members in the medication management process.
   - Recommend the use of medication organizers and home health support when needed.

C. Intervention

1) Administration:
   - Adhere to the “rights” of medication administration which include verifying the right patient, drug, dose, route, and time.
   - Monitor patients for any emerging side effects.
   - Teach the client to report any incidents of dizziness, confusion, or falls promptly.
2) Alternatives to Drug Use:
   - Explore non-drug approaches to pain relief such as heat therapy and exercises.
   - Promote sleep hygiene practices instead of relying on sedatives.
   - Use behavioral strategies to address anxiety rather than pharmacological treatments.

D. Evaluation, Documentation, Reassessment

  • Continuously monitor for improvement or any deterioration in health status.

  • Document any observed side effects meticulously.

  • Reassess the medication list regularly for relevance and safety.

  • Ensure communication of any changes in patient status to the healthcare team efficiently.