PIM Use In Geriatric Care

“Contratheraputic is when an individual experience unintentional or unanticipated adverse effects while the individual is on a drug regimen that is not closely monitored by a doctor” (Understanding and Managing Polypharmacy in Elderly, 2004). Screening elderly for polypharmacy is crucial because adverse side effects of some medications can imitate other problems such as confusion, incontinence, urinary retention, and falls which may cause a physician to prescribe another medication to help treat those symptoms. The Beers criteria is a list of drugs that may be inappropriate for elderly patients as the risks outweigh the benefits, an example is the use of urinary anticholinergic which could prevent one episode of incontinence every 48 hours but can cause constipation, dry mouth, dry eyes, impaired cognition and increased risk of

Hello Professor. I agree that medications are the magic solution to treat diseases if they are used appropriately. For example, when antipsychotic medications are not used correctly could lead to functional decline and cognitive impairment. The health care professionals’ knowledge of safe medication use, risks and benefits, and the drug-related problem are important when taking care of elderly patients. “In 2015, the AGS Beers Criteria were again updated by an expert panel of healthcare and pharmacy experts to help prevent potential medication side effects and other medication-related problems in older adults” (Health in Aging, 2015). It is pivotal to use the guidelines of Beers Criteria in our daily practice to prevent inappropriate use of

3) advocates autonomy and independence of the residents. According to the guideline states that medication review is an evidence-based intervention and this review should be performed regularly (ACSQHC 2009, p. 72). A meta-analysis was conducted in aged care facilities and the relationship polypharmacy and falls, and fall injuries were found out. Residents taking cardiovascular medications, including diuretics, antiarrhythmics, digoxin, have higher fall risks. But, by reviewing their medication, the risks of fall were reduced up to 66% (Baranzini et al. 2009, p. 228). A randomise controlled trial was conducted targeting residents in aged care facilities, and a comparison between medication-reviewed population and non-reviewed population performed. The effectiveness of medication review was statistically confirmed that reviewed population showed 38% lower number of falls than the non-reviewed population (Zermansky et al. 2006, p. 589). Therefore, in aged care facilities, falls are obviously a big problem and often harm the residents. Medication is a major factor for falls because the vast majority of residents are taking multiple medications. However, reviewing their medications, fall risks are significantly reduced. As a nurse, careful observation for the residents and frequent collaboration with pharmacists or doctors should be performed to ensure the residents

Senior citizens are the people who are most likely to take multiple medications due to the occurring chronic conditions as the aging process continues. Given the several medicines they take, they are ironically the age group that is very much sensitive to medication side effects, both therapeutic and negative.

Nearly half of seniors do not take their medications when or how they were prescribed. There are mistakes on dosages, methods of delivery, time of delivery, what they should be taken with, and even if they should still be taken. Compounding the issue, most seniors over the age of 65 are taking between 8 and 13 different medications. Put these numbers together and it is no wonder that problems with medication management are one of the leading reasons seniors end up in the emergency room, and is the number one reason seniors end up back in the hospital after being recently discharged. According to a study published in "Pharmacotherapy", nearly 70 percent of hospitalized seniors suffered from at least one

Perhaps the most challenging aspect of older adult pharmacology is the concomitant use of multiple medications. Among community-

The average 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 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 (Galavis, RN BSN & Wooten, PharmD)

They continue taking drugs that may be unnecessary or unsuitable. According to Gayathri J. Dowling, Susan R. B. Weiss and Timothy P. Condon, authors of “Drug Abuse and the Aging Brain”, the dynamic nature of the brain suggests that drug abuse in older adults may have unique consequences that influence drugs’ effects in the brain. The abundant amount of medication found in the everyday lives of elderly patients is alarming and can do much more harm than good. The U.S. Department of Health and Human Services stated in a 2014 action plan that older adults account for 35% of all hospital stays and more than half of those visits are marred by drug-related

As the population continues to live longer the older adult has had an increase in chronic conditions develop, resulting in an increase in multimorbidity. This causes the older adult to be more vulnerable to disability, poor quality of life, risk of death and adverse drug reactions (Salive, 2013). In general, the older adult is vulnerable to having an adverse reaction to medications. The older adult not only has a higher risk of an adverse reaction to any particular medication given, there is an increase in risk of reactions associated with the multiple medications older adults are frequently prescribed due to multi-chronic conditions (Hubbard, O’Mahony, & Woodhouse, 2013). Adverse drug reaction and multimorbidity can benefit from additional research to better understand the older adult reaction to medications and dosages, as well as management of multimorbidity. Until then physicians, nurses, the older adult, and the family need to collaborate to find the treatment plan that works best with the least amount of side effects from medications. Often times starting low with medication dosing and increasing to the dose to achieve therapeutic levels is done with the older adult to help decrease an adverse reaction to medication. Management of multimorbid conditions in which maximizing the quality of life the older adult has is the goal. This can be done by frequent assessment of the treatment plan and making

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

For older adults, nurses should recognize that dosage of these drugs may need to be decrease due to their toxic effects. Baseline renal and liver function tests should be done

In elderly people, polypharmacy is known to be associated with adverse drug events otherwise defined as “presence of untoward and unintended symptoms, signs or abnormal laboratory values arising from the appropriate or inappropriate use of prescription or over-the counter medications” (13).

According to the Health Care Finance Administration (HCFA), on July 1, 1999, established a quality indicator that residents taking nine or more medications will be used to identify long-term facilities where medications potentially are overused and residents may be at increased risk for adverse drug reactions (ADR). However, this approach can be controversial because the medication is essential for older people health safety. There are many factors on the overuse of medication which can include age, health and the number health care visits. Especially on home care and long-term facilities, most of the elderly in this facilities are forced to take these medications due to facility policies (Hanlon, 2001). Another

Polypharmacy is the use of multiple medications in one individual and usually refers to when more drugs are being taken than medically necessary. According to the article, many factors contribute to the development of polypharmacy including “new drug treatments, wider indications for older drug treatments, lower thresholds for treating risk factors in preventative medicine, and an ageing population with increased amounts of chronic illness or physical ailments” (Gorard, 2006). The elderly appear to be an especially vulnerable population to this issue and are the prime target for increased prescribing practices. Unfortunately, polypharmacy is responsible for many severe adverse drug events, drug-drug interactions, and contributes to problems with nonadherence amongst older adults.

The University of Alabama Biomedical Library was searched for relevant studies . This search included COCHRANE Database of Systematic Reviews, OVID database and EBSCO database. Another search was done using Google search, National Guidelines Clearinghouse, and Agency for Health Research. Reviewed articles references were used to obtain more studies. Keywords for all searches included: medication, medication cost, drug, drug cost, elderly, aged, nonadherence, and noncompliance ( See Appendix A). All the studies were less than 5 years old, expert opinions, practice guidelines were reviewed and those related to interventions to assist the elderly with medication cost were selected.