Chapter 7 Medications and Older Adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of...

Chapter 7

Medications and Older Adults

Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1

Lesson 7.1


Objectives

Identify factors that increase the risk of medication-related problems.

Discuss the reasons each of these factors increases health risks for the aging person.

Describe how pharmacokinetics changes with aging.

Discuss the pharmacologic dynamic changes observed in the aging person.


Objectives (cont.)

Identify the risks related to aging and pertinent nursing observations for specific drug categories.

Explain specific precautions necessary when administering medications to older adults in an institutional setting.


Risks Related to Drug-Testing Methods


Geropharmacology

The study of how older adults respond to medication is a new but growing area

Drug testing and establishing of therapeutic dosages does not take into account the unique characteristics of older adults

Older adults normally have some change in body function and are more likely to suffer from at least one disease process; they are not physiologically the same as younger adults


Risks Related to the Physiologic Changes of Aging


Pharmacokinetics

Study of drug actions in the body: absorption, distribution, metabolism, and excretion

Drug absorption Gastric acid secretion decreases as we age When the concentration of acid is lower than

normal, drug absorption is reduced Decreased acidity also affects the breakdown of

capsules and tablet coatings in the stomach, resulting in a variable absorption rate depending on the way a drug is manufactured


Pharmacokinetics (cont.)

Drug distribution Water-soluble drugs tend to remain in higher

concentrations in the bloodstream because there is less total body water

Fat-soluble drugs become trapped in the fatty tissue because of decreased muscle mass and increased adipose tissue

A decrease in hemoglobin and the plasma protein albumin results in fewer available sites for protein-bound drugs



Drug metabolism Aging often results in decreased activity of liver

cells Reduction in perfusion decreases the liver’s

effectiveness in metabolizing drugs When drugs are not metabolized effectively by the

older adult’s liver, the risk for toxicity increases


Audience Response SystemQuestion 1

The organ that is the primary site of drug metabolism is the:

A.kidney.

B.pancreas.

C.lungs.

D.liver.



Drug excretion Aging kidneys are significantly less effective at

removing waste products, including the byproducts of medications

As the kidneys become less effective in the excretion of drugs, more drug remains in the circulation, leading to elevated drug levels and symptoms of drug toxicity


Pharmacodynamics

Polypharmacy The prescription, administration, or use of more

medications than are clinically indicated, is a common problem in older adults

The more medications taken, the greater the risk for untoward reactions, drug interactions, and drug toxicities


Polypharmacy


Risks Related to Cognitive or Sensory Changes


Cognitive Changes

Lack of the literacy skills needed to read the labels and directions

Inability to understand and comply with directions

Inability to make correct judgments about medications

May not recognize that they have to take medication


Sensory Changes

Vision changes may render an older person unable to read a medication label or to recognize the different sizes, shapes, or colors of the various medications

Adequately assessing the person’s ability to read labels accurately, proper teaching, and using special labels or magnifying devices may help reduce the risks


Risks Related to Inadequate Knowledge


Sharing Medications With Friends or Relatives

Practice is common and persists because many older adults are unaware of the dangers

All people, particularly older adults, must be aware that it is not safe to take a medication prescribed for someone else


Over-the-Counter (OTC) Preparations

Many do not think of OTC medications as “real” drugs, because no prescription is needed to purchase them

OTC medications are capable of potentiating or interfering with the effects of prescription medications, possibly resulting in serious harm

Can also create or mask symptoms of disease


Alcohol

The most commonly consumed nonprescription drug used by adults

Most older adults do not think of alcohol as a drug, so they do not think about it when taking medications

Alcoholic beverages can cause adverse reactions when taken in conjunction with many prescription and OTC drugs


Prescription Medications

The directions provided may be very clear to a knowledgeable health care professional, but they are often misunderstood or misinterpreted by older adults

Even simple misunderstandings can lead to improper self-medication and result in serious consequences

To reduce the risks, older adults often require additional instruction


Risks Related to Financial Factors


Saving Money

Older adults living on limited incomes may fail to take their medications or may make changes in the amount or frequency to conserve their supply

Many frugal older adults save medications that were prescribed in the past, even if the drugs are no longer part of their therapy

Often reluctant to discard costly medications, holding on to them “just in case.”


Medication Administration in the Institutional Setting


Safe Drug Administration

Before administering a medication, nurses should have the following information The therapeutic effects of the medication The reasons this individual is receiving the

medication The normal therapeutic dosage of the medication The normal route or routes of administration Any special precautions related to administration The common side effects or adverse effects of the

medication


Lesson 7.2


Objectives Discuss how medications fit into the nursing

plan of care. Describe specific nursing interventions and

modifications in technique related to medication administration in older adults.

Describe the older person’s rights as they relate to medication administration.

Discuss the impact of age-related changes on self-administration of medications.

Identify information that should be provided to older adults regarding medications.


Nursing Assessment and Medication


Assessment Nurses must be sure to assess older

residents thoroughly before administering any medications

After administration, nurses should monitor older adults continually to determine whether the medication is having the desired effect

Residents should also be observed for any untoward effects or significant changes in medical condition or behavior

Nurses should be particularly watchful for any signs of overdose or toxicity


CARE Acronym for Medication Assessment

C – Caution/compliance A – Adjust R – Review regimen regularly E – Educate


Drug Categories with Precautions Related to Aging

There are many drug categories that have precautions related to their use among the elderly.


Medications and the Nursing Care Plan


Nursing Interventions and Precautions

Could include the use of safety devices, call signals, behavior monitoring, or any other specific precaution related to medications

The care plan should indicate when it is necessary to check vital signs, monitor laboratory values, or make any other special observations

All parameters specified by the physician should be readily identified in the care plan


Nursing Interventions Related to Medication Administration

Right resident Right medication Right amount Right dosage form Right route Right time Right documentation


Right Resident



The most accurate way to verify identity is to compare the medication record with the identification bracelet.

A.True

B.False


Patient’s Rights and Medications


Patient’s Rights

Right to know what medication they are receiving and why they are receiving it

Right to refuse to take medication Right to privacy during injections or any other

such procedures Use of psychotropic drugs as chemical

restraints presents a risk to the rights of older adults


Self-Medication and Older Adults


In an Institutional Setting

Under OBRA legislation, residents of care facilities should have the option of self-medication if they are capable of doing so safely

A physician’s order stating that self-medication is permitted is usually required

The nurse remains responsible for monitoring the resident’s compliance and response to the medications


In the Home

Because medications are a significant part of the medical plan of care, older adults who live independently must learn to take them properly

The responsibility of assessing medication-taking behaviors and teaching safe self-administration often falls to the home health care nurse


Teaching Older Adults About Medications


Safety Alert

Identification must be checked (following agency policies) each time a medication is administered

Failure to do this can result in serious errors and harm to older adults


Safety and Noncompliance Issues


Risk for Noncompliance

Cognitive and sensory limitations Special precautions and complicated time

schedules To reduce the risk for noncompliance, nurses

should encourage older adults to talk to the physician and/or the pharmacist to see whether there is any safe way to reduce the number of medications or simplify the medication schedule


Techniques That Improve Safety and Compliance

Associating medication schedules with regular daily events

Explain the importance of preparing medication in a well-lit area

Ensure that containers are properly labeled Apply color codes, tape strips, pictures, or

textures to containers to help older adults recognize them


Techniques That Improve Safety and Compliance (cont.)

Modify containers for ease of use Establish measures to distinguish and

separate similar containers Teach older adults to store medications

properly Obtain or devise a system to promote

compliance Stress the importance of being alert when

taking medications



Why do older persons sometimes fail to ask questions about their medications?

A.They are illiterate.

B.They are afraid of being judged as ignorant or bothersome.

C.They already know everything they need to know.

D.They know the nurse is not the person to ask about their medications.


Chapter 7 Medications and Older Adults Copyright © 2012, 2008 by Mosby, Inc., an affiliate of...

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