MEDICATING THE ELDERLY
The care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Older adults also vary widely in their levels of functional ability. Addressing the health concerns of the elderly specific for their age should be a health care priority. For this paper, medicating the elderly would be the focus of discussion. Given the developmental differences and changes, the elderly patients would somehow require a different approach in medication administration.
Introduction: The definition of medication – what is medication?
Medications are drugs that are used to treat a disease or illness. Medications administered to elderly patients are used, almost exclusively, to prevent, diagnose, or treat disease. The administration of medication varies depending on the patient. Medications as well as dosages that could be used by children can not work for adults, or any other age. There are specifics for every age and for every disease or illness that is being treated. Thus, it is important for healthcare professionals and even the patients themselves to be aware of the medications that they are prescribing or taking.
Types of medication – Medications for different conditions and body systems – Generic vs. Brand Name
A medication may have as many as three different names (2004). A medication’s chemical name provides an exact description of the medication’s composition and molecular structure. Chemical names are rarely used in clinical practice.
The manufacturer who first develops the medication gives the generic or nonproprietary name, with an approval from a high naming council. The generic name becomes the official name that is listed in official publications. The trade name, brand name, or proprietary name is the name under which a manufacturer markets a medication. The trade name has a symbol TM on the upper right of the name, indicating that the manufacturer has trademarked the medication’s name.
Manufacturers have chosen names that are easy to pronounce, spell, and remember so that laypersons will recognize their trade names. Many companies may produce the same medication, so similarities in trade names can be confusing, especially for the older adults. In fact, similarities in trade names are a common cause of medical errors. Hospitals and clinics pharmacies attempt to consistently dispense medications with the same trade names so that health care professionals can become familiar with them.
Although it is not necessary for the patients to categorize medications, they might still be given a background about this. Health care professionals learn to categorize medications with similar characteristics by their class. Medication classification indicates the effect of the medication on a body system, the symptoms the medication relieves, or the medication’s desired effects. One medication may also be part of more than one class ( 2004).
Legal Considerations – over the counter and prescription use in the elderly
There has been past interest in the value of written materials, especially package inserts, in communicating with older patients. The items asking about written materials in the prescription or Rx drug survey found that patients reported receiving them often, reading them, and finding them useful. They did not believe, however, that most people read the instructions supplied with over-the-counter medicines. Given the strong preference for doctor communication throughout, one would expect written materials to be most effective when presented by physicians (1994).
On the whole, communication about Rx medicines appears better than for over-the-counter medicines. The burden of communicating about over-the-counter medicines falls squarely on the patients in these studies, although they see the pharmacist as playing a stronger role in communicating about Rx medicines. Still, if patients do not introduce the topic it is unlikely to be discussed. Given the potential of over-the-counter drugs to interact with Rx drugs, more attention to the topic of over-the-counter drugs seems warranted. Patients reported that their doctors did not talk to them enough about over-the-counter drugs, although patients did agree that most doctors mentioned over-the-counter drugs when prescribing Rx drugs (1994).
Use of OTC medications is widespread among the general population. According to a recent survey, a large percentage of adults ages 18 and older have used over the counter pain relievers at least once, often without consulting a pharmacist. Furthermore, that although adults frequently use over the counter medications, many consumers fail to read the product warning labels. Finally, consumers frequently are unaware of the type of medication they take (e.g., NSAID or analgesic). For example, only one in three adults are familiar with the product names acetaminophen, aspirin, or ibuprofen and are able to link these product names to specific brand names. As a result, many consumers are not fully aware of the potential risks of taking these products, particularly in combination with other prescription medications or alcohol (1999).
Another factor contributing to an increasing risk of medication-medication interactions is that many medications that previously were available only by prescription are gaining over the counter status. Over the counter marketing strategies, however, often lead the consumer to think that these medications are safe to use on an “as-needed” basis, even though they can be potentially dangerous when used with alcohol. For example, the message that “acid blocker” medications can be used before or during a spicy meal to prevent heartburn symptoms may lead consumers to believe that this practice is also acceptable when they drink alcohol with their meal (1999).
Because of the potential risks related to medication administration, the patient is also given rights. It is the patient’s right to be informed of the medication’s name, purpose, action, and potential undesired effects. The patient, even if it is an elderly patient and his or her health depends largely on the medication, can still also refuse medication regardless of consequences. The patient also has the right to be properly advised of the experimental nature of medication therapy and to give written consent for its use. The patient has the right to receive appropriate supportive therapy in relation to medication therapy. However, in the case of the mental health patient or an elderly patient who may have impaired reasoning due to degeneration, the family of the patient can decide instead and take over the right of the patient.
Medication usage – - side of effects of medication – storage of medication – frequency of medication usage in the elderly
Approximately two thirds of older adults use prescription and non prescription drugs with one third of all prescriptions being written for older adults (2000). Most older adults use at least one drug daily; many use several drugs daily. The most commonly used medications are cardiovascular drugs, antihypertensives, analgesics, antiarthritic agents, sedatives, tranquilizers, laxatives, and antacids (1999).
Older adults are at risk for adverse reactions with the medicines that they are taking. These side effects of mediation could be largely attributed to the fact that the elderly have age-related changes in the absorption, distribution, metabolism, and excretion of drugs. As one is probably aware, most of the elderly usually take a lot of medications. Medications may interact with one another, adding or negating the effect of another drug. Medications of the elderly may also cause confusion; affect balance and mobility; cause dizziness, nausea, and vomiting; or lead to constipation, urinary frequency, or incontinence. Because of these side effects, there are some elderly patients who are not willing to take medications.
Self-management of prescriptive medications requires diverse knowledge, behaviors, judgments, and decisions ranging from those associated with obtaining medications to monitoring for medication side effects. Although most research on prescription medication use by older adults has focused on adherence, some findings indicate prescriptive medication use is often the result of deliberate decision making rather than automatically following the directives of health-care providers (1992).
Polypharmacy, or the concurrent use of many medications, increases the risk for adverse reactions. The use of several prescribing physicians or several pharmacies, and inadequate communication among the physicians and pharmacies is often implicated as the principal cause of inappropriate polypharmacy. Strategies for preventing the problem focus on improving-communication between physicians and patients with regard to the exact number and type of medications used, the use of a single pharmacy or pharmacy network and regular, comprehensive medication reviews (1998).
Complicating the assessment of medication affects and side effects, some of the elderly, perhaps as many as 50%, take their medications incorrectly because they do not understand the instructions about their medications (1998).
Older adults consuming prescriptive medications are a group at risk for negative health outcomes. Demographic trends of increasing numbers of older adults, increasing health-care costs for older adults, and fragmentation of care for older adults are factors stimulating efforts to identify effective alternative care systems. Although only one in five older adults will be admitted to a hospital during a given year, those who have been hospitalized are at increased risk for rehospitalization. Recently hospitalized older adults are especially vulnerable to problems with medications because they are likely to be on more prescriptive medications and are in poorer health than the general population ( 1992).
General advice regarding the elderly taking medications – take medications as prescribed by the doctor. – set up systems, such as a weekly pillbox, to remember medications – keep up to date record on all medications and dosages. – throw away discontinued out dated medications
Standards are those actions that ensure safe nursing practice. Registered mental health nurses should be aware of nursing standards called the six rights of medication administration in order to ensure safe medication administration to the elderly patients (2004). All medication administration errors can be linked in some way to any inconsistency in adhering strictly to the six rights of medication administration. These six rights are as follows:
- The right medication
- The right dose
- The right patient
- The right route
- The right time
- The right documentation
The dramatic increase in the number of new medications, including biotechnology products, makes it difficult to keep current on their proper use, and can overwhelm the best intentions of all health care practitioners, including doctors and nurses. Administration of the wrong drug is the most common error that occurs. Factors that contribute to wrong drug error include similar labeling and packaging of products, medications with very similar names and storage of these similar products together. In addition, poor communication is a common cause of administering the wrong drug.
The management of medications in the elderly is a very important component of maintaining and promoting good health in old age. For some older adults on large numbers of medications, safely managing medications can be a complex activity that can easily become overwhelming.
The health care professional must work collaboratively with the older adult to ensure safe and appropriate use of all medications that the elderly needs. This includes both prescribed and over-the-counter medications. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs. If for some reason the elderly cannot understand, then it is better that another family member or a caregiver must be taught. The health care professional must also teach the elderly patient how to avoid adverse effects or interactions of drugs and how to establish and follow an appropriate self-administration pattern.
Strategies for reducing the risk for an adverse medication reaction in the older adult include reviewing the medications with the older adult at each visit, examining for potential interactions with food or other drugs, simplifying and individualizing the drug regimen, taking every opportunity to inform the older adult and family about all aspects of medication use, and encouraging the older adult to question the physician, nurse, and/or pharmacist about all prescribed drugs and all over-the-counter drugs.
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