5 - Safe Medication Use in Older Adults

Question 1

What are 3 interventions to support medication adherence?

Answer 1

1) Teaching & Learning
- understand the reason for taking each medication
- Importance of taking vs. not taking
proper administration technique to him and/or his family

2) Goals (adherence)
- identify any adverse side effects that may be impacting adherence
- evaluate his ability to manage his medications (memory, hand-eye coordination, eyesight, etc.)
- implement strategies (dosette, schedule, or logbook)

3) Monitor/Evaluate regular follow-ups/monitoring e.g.?
​​- Checking vitals
- Checking meds (are they being taken)

Question 2

What are the benefits of medication?

Answer 2

• Medications are helpful!

Medications can be used to:
- Treat the symptoms of a condition
- Prevent a condition from getting worse
- Reduce the risk of getting a new medical condition

Question 3

What is Polypharmacy?

Answer 3

• Polypharmacy: the use of 5 or more medications

Question 4

Appropriate VS. Inappropriate Polypharmacy

Answer 4

Appropriate polypharmacy
- medication therapy has been optimized & all medications are prescribed to achieve the therapeutic objective

Inappropriate polypharmacy
- the use of more medications than are needed or using medications where the risk of harm outweighs the benefits

Question 5

Polypharmacy is a concern for older adults because they tend to:

Answer 5

• Take more meds
• Have higher risk of being frail
• Responds to drugs differently
• Be underrepresented in medical research

Question 6

As we age, the body becomes less efficient at processing medications bec:

Answer 6

Brain
- brain is more sensitive to drug effects
- effects of meds on brain can last longer

Muscle and Fat
- some meds stay longer in the body due to less muscle ad mroe body fat

Liver
- liver is less efficient at eliminating some meds

Kidneys
- removes meds from body less efficiently

Body Water
- body contains less water and some meds can become more concentrated, increasing their effects

Question 7

Polypharmacy increases the risk of:

Answer 7

• Drug interactions
• Drug side effects
• Difficulty adhering to the medication regimen
• Falling and obtaining a fracture
• Admission to the hospital

Question 8

___/10 hospital admissions in older adults are the result of a medication side effect.

Answer 8

1/10

Question 9

Factors contributing to Inappropriate Polypharmacy

Answer 9

• Increased availability of medications
• Increased life expectancy (more diseases = more medications)
• Guidelines help providers determine when to start medications but often do not tell them when to stop medications
• Increased hospitalizations where multiples individuals are prescribing medications
• Fear of upsetting a balanced medication regimen
• Lack of understanding of medication risks
• ‘Culture of pharmacy’ - instead of a non-drug solution (e.g. exercise, massage therapy)

Question 10

What is depresribing?

Answer 10

• the planned and supervised process of dose reduction or stopping of medication that may be causing harm or no longer providing benefit

Question 11

Some strategies would you use to minimize the risks associated with polypharmacy?

Answer 11

• Advocate for medication reconciliation during transitions in care
• Understand why patient is on each of the medications
• Explore non-pharmacological options for symptom management with the care team

Question 12

What is Medication Reconciliation?

Answer 12

• Comparing the prescribed medications to the medications the patient is actually taking
  E.g. Mr. Smith is prescribed Sertraline 50mg PO daily. Is he taking this medication every day?
• Helps prevent adverse drug reactions that occur because of mis-communication at times of transition in care
  E.g. Mr. Smith should have received a medication reconciliation when he transitioned from home to LTC

Question 13

Who is Involved in the Interprofessional team

Answer 13

• Pharmacist
• Doctor
• NP
• Nurse
• Fam/Caregiver

Question 14

5 Nursing Roles of Safe Medication Use in Older Adults

Answer 14

1) Comprehensive medication assessment

2) Monitoring the effectiveness of prescribed medications

3) Identifying any side effects or adverse reactions to the medications

4_ Providing patient and caregiver education about medication use

5) Engaging in safe medication administration practices

Question 15

List of Meds and what they are used for

Answer 15

Lisinopril - hypertension

Metformin - diabetes (type 2)

Aspirin - stroke prevention

Vitamin D - prevents osteoarthritis

Donepezil - mild cog impairment

Sertraline - major depressive
disorder)

Acetaminophen - pain

Furosemide - heart failure (also increases urine output)