Medicating the Elderly
This paper discusses the theories and concepts of medications. Specifically, it provides literature-based references on the notion of medications among elderly, legal considerations, usage, general advice on medication, as well as compliance, noncompliance, and adherence.
The World Health Organization’s (WHO) study suggests that only about half of people with chronic illnesses regularly take their medication (2003). With this fact alone, there is a constantly great need for health care practitioners as well as people to pay particular attention to patient’s observance to proper medications. The worldwide standards in health care practice are overly affected with various mechanisms that emerged form the modern ways of living today. Globalization and technological advancements are among the phenomena that contribute to the changes in the mainstream principles and practices of health care. As the world progresses and explores wider and better horizons in all areas of human life, the concern for health and well-being is also preferential. The continuous development of scientific and medical explorations and experimentations are apparent evidences that health is still important. One of the most sought-after areas of research and inquiry is medication and its related aspects like administration, compliance, noncompliance, and adherence. On this case, it is medication among the elderly patients.
Medication have been known and used since antiquity (2006). It has been widely accepted that medication is the ultimate response to the curative needs of known diseases. The purposes of medication are directed to the lessening if not curing the suffering brought about by such diseases. Over the centuries, the number of drugs available for people has increased greatly, and knowledge about these drugs has become correspondingly more accurate and detailed. As people recognized the importance of medication, a variety of chronic illnesses are also growing. Thus, several standards and underlying principles about medication like the idea and practice of proper administration, compliance and adherence are taken into strict consideration.
Medication – its definition
Patients with specific illnesses can restore or maintain their health through a variety of strategies aided by a health care provider (e.g. nurse, physician, etc.). From time to time, patients require medications to maintain or stabilize their health. A medication is a substance used in diagnosis, treatment, relief, cure, or prevention of health alterations ( 2004). It is a approved drug that is taken in various ways for the purposes of reducing symptoms of a given illness or any medical condition. Medications include whether it is likely to relieve symptoms, cure disease, or have unpleasant side effects (1994). Also, it can be prescribed by a health care professional or simply purchased over-the-counter (OTC).
Types of medication
Medication can be usually categorized in various ways, for instance by its chemical properties, mode of administration, or biological system affected, or plainly according to age (for children, adult or elderly). In this case, the type of medication to de discussed is generic and brand name medications.
- Generic – Generics are types of drug that are not patented. Popularly gives the thought that they are cost effective, generic drugs have the equivalent active medicinal ingredients, value, potency, purity, and strength as brand name drugs ( 2003). Generic drugs are copies of brand name drugs. Generics are generally assumed to be equal in dose, strength, route of administration, safety, efficacy, and intended use. Generic drugs typically cost pharmacies 50 to 80 percent less than brand-name counterparts (1991). Examples of generic name are chloramphenicol, paracetamol, phenylpropanolamine, etc. or any other name that refers basically to the chemical component of the drug.
- Brand name – These drugs are manufactured by pharmaceutical companies and are often patented. They are given specific brand names. An example of a generic drug for diabetes, for instance, is metformin, while brand name for metformin is Glucophage. Another practical reminder to identify a generic from brand drug is that most brand names start with capital letter.
Legal considerations
Medications are generally divided into two groups by mostly all laws governing medication administration and application – prescription only medicine (POM) and over-the-counter (OTC).
- Prescription only medicines (POM) are drugs that are essentially prescribed or approved by licensed health care professionals. Parrott noted the four issues guided consideration of the general knowledge exchanged about the prescribed medications were the name of the medication, other references to the medication (e.g., “the prescription,” “the medicine”), dosage, and appearance (e.g., pill, lotion).
- Over-the-counter (OTC) medicines are often available in pharmacies and supermarkets without the need of presenting prescription order or particular restriction.
Medication Standards
Standards are those actions that ensure safe medication practice. For instance, 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 mental health 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. Generally, these six rights are applied to almost all medication administration processes. These six rights are as follows:
- The right medication
- The right dose
- The right patient
- The right route
- The right time
- The right documentation
Medication usage among the elderly
The administration of drugs to the elderly patients require the understanding of physiologic and pharmacokinetic changes that may alter appropriate drug usage, cause common adverse reactions, or create compliance problems (Abel et al., 2003). Abel and colleagues noted the following considerations particularly on physiologic changes affecting drug action on elderly.
- Body composition – It is noted that body composition varies from person to person. These changes in the body composition affect the relationship between a drug’s concentration and distribution in the body.
- Gastrointestinal (GI) function – In the elderly patients, decrease in gastric acid secretion and GI motility slow the emptying of stomach contents and movement through the entire intestinal tract. Similarly, research suggests that elderly patients may have more difficulty absorbing drugs than that of younger patients. This is particularly significant problem with drugs that have a narrow therapeutic range in which any change in absorption can be crucial.
- Hepatic function – The patient’s liver ability to metabolize certain drugs decreases with age. This decrease is caused by diminished blood flow to the liver that results from an age-related decrease in cardiac output and from the diminished activity of certain liver enzymes. Decreased hepatic function may cause more intense drug effects caused by higher blood levels, longer-lasting drug effects caused by prolonged blood levels, and a greater risk to drug toxicity.
- Renal function – Although an elderly person’s renal function is usually sufficient to eliminate excess body fluid and waste, the ability to eliminate some drugs may be reduced by 50% or more. Many drugs commonly used by elderly patients are excreted primarily through the kidneys. Also, drug dosages can be modified to compensate for age-related decreases in renal function. Aided by laboratory tests, prescribers may adjust drug doses so the patient receives therapeutic benefits without the risk of toxicity. Observe the patient for evidence of toxicity.
Meanwhile, aging is usually accompanied by decline in organ function that can profoundly affect drug administration and clearance. This physiologic decline is likely to be intensified by a disease or chronic disorder. Together, these factors can significantly increase the risk of adverse reactions and drug toxicity, as well as noncompliance. Be aware of these changes particularly in giving a drug to an elderly patient.
The following are important considerations in special administration of medications among the elderly specifically on the management of side effects or adverse reactions. Compared with the younger population, elderly patients experience twice as many adverse drug reactions relating to greater drug consumption, noncompliance, and physical changes. Signs and symptoms of adverse drug reactions, on the other hand, are often mistakenly attributed to senility or disease. If the adverse reaction is not identified, the patient may continue to receive the drug. Furthermore, he/she may receive unnecessary additional drugs to treat complications caused by the original drug. This regimen can sometimes result in a pattern of inappropriate and excessive drug use. Although any drug can cause adverse reactions, most of the serious reactions in the elderly are caused by relatively few drugs. Be particularly alert for toxicities from diuretics, antihypertensives, digoxin, corticosteroids, anticoagulants, sleeping aids, and OTC drugs.
Maintaining Patient’s Rights
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 can 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 who may have impaired reasoning, the family of the patient can decide instead and take over the right of the patient.
Ways to Prevent Medication Administration Errors
The table below can help serve as a guide for nurses in avoiding errors in medication administration.
PRECAUTION
RATIONALE
Read medication labels carefully.
Be aware of medications with similar names.
When new or unfamiliar medication is ordered, consult resource.
Do not administer medication ordered by a nickname or unofficial abbreviation.
Do not attempt to decipher illegible handwriting.
Know patients with same last names. Also have the patients state their full names, or ask their families if you cannot talk to the patient.
Many products come in similar containers, colors, and shapes.
There are many medication names that sound alike.
If prescriber is also unfamiliar with the drug, there is greater risk for inaccurate being ordered.
Many prescribers refer to commonly ordered medications by nicknames or unofficial abbreviations.
When in doubt, ask the prescriber. Unless nurse questions order that is difficult to read, chance of misinterpretation is very high.
It is common to have two or more patients in the hospital with the same or similar last names. Special labels n a medication book can warn off potential problems.
General advice on elderly medications
(1997) provided a general list of suggestions on effective drug administration among elderly patients as follows:
ü Don’t take a drug unless absolutely necessary. Try a change in diet or exercise instead. Ask your doctor if there’s anything else you can do besides drug therapy for the condition.
ü Tell your doctor about all the drugs you take. If you have several doctors, make sure they all know what the others are prescribing, and ask one doctor (such as an internist or general practitioner) to coordinate your drugs.
ü Ask for drugs that treat more than one condition. Blood pressure medicine might also be good for heart disease, for example.
ü Keep track of side effects. New symptoms may not be from old age but from the drug you’re taking. Try another medication if possible until you find one that works for you.
ü Learn about your drugs. Find out as much as you can by asking questions and reading the package inserts. Both your doctor and pharmacist should alert you to possible interactions between drugs, how to take any drug properly, and whether there’s a less expensive generic drug available.
ü Have your doctor review your drugs. If you take a number of drugs, take them all with you on a doctor’s visit.
ü Ask the doctor, “When can I stop taking this drug?” and, “How do we know this drug is still working?”
ü Watch your diet. Some drugs are better absorbed with certain foods, and some drugs shouldn’t be taken with certain foods. Ask a pharmacist what foods to take with each drug.
ü Follow directions. Read the label every time you take the medication to prevent mistakes, and be sure you understand the timing and dosage prescribed.
ü Don’t forget. Use a memory aid to help you — a calendar, pill box, or your own system. Whatever works for you is best.
The Issue of Compliance
With increasing numbers of medications and other medical interventions shown to do more good than harm when taken or implemented, as prescribed, low compliance is a major problem in health care. (no date) identified how big is the problem of medication noncompliance. According to him, an average of 60% of all prescribed medication is taken incorrectly or not at all. Aside from the previously mentioned factors influencing compliance and adherence, the British National Formulary (2003) specified some causes for poor compliance. Such include the following:
Similarly, various researches also identified the aforementioned causes of noncompliance (2005; 2004; 2001; 2001; 2001; 1990). There are also distinctions and exemptions as well as case-to-case basis in determining the causes of noncompliance. All in all, the provided list includes the most popular reasons on why people do not comply with prescribed medications.
Poor noncompliance can be a problem with patients of any aid. A significant number of hospitalization result to noncompliance with a medical regimen. In elderly patients, factors linked to aging such as diminished visual acuity, hearing loss, forgetfulness, the common need for multiple drug therapy, and socioeconomic factors can combine to make compliance a special problem. About one-third of elderly patients fail to comply with their prescribed drug therapy (2003). They may fail to take prescribed doses or to follow the correct schedule. They may take drugs prescribed for previous disorders, discontinue drugs prematurely, or indiscriminately use drugs that are to be taken as needed. Elderly patients may also have multiple prescriptions for the same drug and inadvertently take an overdose.
With this, review the patient’s drug regimen with him/her. Make sure he/she understands the dose amount, the time and frequency of doses, and why he/she is taking the drug. Also, explain in detail if a drug is to be taken with food, water, or without any other drugs. Help the patient avoid drug therapy problems by suggesting that he/she use drug calendars, pill sorters, or other aids to help him/her comply. Lastly, refer him/her to the prescriber or pharmacist if he/she needs further information.
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