Week 10 Presentation Med Older Adult

Chapter 14: Safe Medication Use for Older Adults

Glossary of Terms

• Adverse effect or adverse event: Undesirable or harmful effect resulting from medication use.

• Bioavailability: The degree and rate at which a drug is absorbed and becomes available at the site of action.

• Biotransformation: The chemical modification made by an organism on a chemical compound.

• Complementary and alternative medicine (CAM): Diversified medical and health care systems, practices, and products that are not considered part of conventional medicine.

• Delusion: A false belief or judgment held despite evidence to the contrary.

• Half-life: The time taken for the blood plasma concentration of a substance to halve.

• Hallucination: An experience involving the apparent perception of something not present.

• Iatrogenic: An illness caused by medical examination or treatment.

• Pharmacokinetics: The study of how drugs move within the body.

• Potentiation: The increase in effects of a drug when taken together with another drug.

• Regimen: A systematic plan for the administration of medication.

• Target tissue or target organ: The specific organs or tissues a drug acts upon.

• Therapeutic window: The range of dosages that produces therapeutic effects without causing significant adverse effects.

• Thought disorder: A mental health symptom characterized by disorganized thinking.

Medication Use for Older Adults

• In Canada, older adults (65+) represent the largest demographic of prescription and OTC medication users.

• Notably, 33% of older adults on prescriptions use 5 or more medications.

• A whopping 88% of older Canadians utilize CAM therapy.

• Adverse drug reactions (ADRs) become more common with polypharmacy (the use of multiple medications).

• Resources on medication safety are available from the Institute for Safe Medication Practices (ISMP).

Pharmacokinetics

• Definition: Study of drug movement within the body—includes absorption, distribution, metabolism, and excretion.

  • Absorption: How a drug enters the bloodstream.

  • Bioavailability: The amount of active drug that reaches systemic circulation.

  • Distribution: How the drug is transported in the bloodstream to its action site.

  • Metabolism: Transformation of drugs in the liver, making them easier to excrete.

  • Excretion: Removal of drugs/metabolites from the body, mainly through the kidneys.

Physiological Changes of Aging: Impact on Pharmacokinetics and Pharmacodynamics

• Absorption: Aging can lead to higher gastric pH, affecting drug solubility and absorption efficiency.

• Excretion: Renal function declines through reduced blood flow and glomerular filtration rate, impairing drug clearance.

• Metabolism: Reduced liver mass and enzyme functionality alters drug metabolism.

• Distribution: Aging can alter the percentage of body fat versus lean mass, impacting drug distribution and potency.

Pharmacodynamics and Altered Responses to Medication

• Pharmacodynamics: Examines how drugs affect the body; older adults often exhibit altered responses.

• Chronopharmacology: Studies the interplay between biological rhythms and medication effects.

• Medication interactions, particularly with certain foods (e.g., grapefruit), can modify drug bioavailability and absorption.

Polypharmacy

• Defined as the concurrent use of multiple medications, which heightens the risk for drug interactions and adverse effects.

• Over 37% of seniors are prescribed at least one inappropriate medication, potentially leading to significant health risks.

Medication Issues for Older Adults

• Adverse Drug Reactions (ADRs): These can range from mild to severe, including unexpected reactions like medication-induced delirium.

• Misuse of Medications: Patterns include overuse, underuse, or erratic usage stemming from confused communication or guidance.

• The Beers List identifies medications that older adults should approach with caution due to increased risk of adverse effects.

Risk Factors for ADRs in Older Adults

• Several factors including age, polypharmacy, health conditions, and social habits contribute to higher ADRs among older adults.

Implications for Gerontological Nursing and Healthy Aging

• Assessment Strategies: Collect comprehensive medication histories and ensure communication of actual patient usage.

• Monitoring and Evaluation: Observing and documenting any notable changes in a patient’s status is critical for safe medication management.

• Patient Education: Educating patients about their medication regimens and engaging them in discussions can empower safer practices.

Medication Administration Rights

1. Right Patient

2. Right to Refuse

3. Right to Education

4. Right Assessment

5. Right Drug

6. Right Reason

7. Right Evaluation

8. Right Dose

9. Right Time

10. Right Frequency

11. Right Route

12. Right Site

13. Right Documentation

Prescribing Tips for Older Adults

• Focus on minimizing medication numbers and prescribing only necessary treatments.

• Consider risks vs. benefits diligently, especially with medications that carry high alerts.

• Regularly review medications to identify potential side effects and avoid duplications or unnecessary medications.

Best Practices in Medication Management

• Medication Reconciliation: Involves collaborative communication between healthcare providers and patients to ensure accurate medication information.

• Best Possible Medication History: A comprehensive record created from multiple sources, including direct patient consultation.

• Clinical Medication Review: Analyzes a patient’s medication use concerning their overall health status to optimize therapeutic outcomes.