test 1 Flashcards
What are considerations when determining if meds are appropriate?
- Extensive assessment
- Patients med history
- Clinicians knowledge
When meds are appropriate, what should you consider?
Dose- make sure its appropriate and acceptable to client, remember that elderly have diff doses than adults
Medication- review the meds they’re on, see what can be reduced or eliminated or any med interactions
Treatment plans- educate pt on drug and non drug options, all the side effects and how to manage/ take action
what is Pharmacokinetics
the movement of drugs through the body, may be defined as what the body does to the drug, as opposed to
what is pharmacodynamics
what effects the drugs has on the body,
which may be defined as what the drug does to the body.
how is absorption different in the elderly
delayed gastric emptying,
intestinal mobility decrease,
decrease gastric pH,
drugs sitting in syst long
how is distribution different in the elderly
less muscle mass after 35y/o, a lot harder, meds stored diff.
increased fat to muscle ratio, fat lipids sit
how is metabolism different in the elderly
decrease liver size, metabolize enzymes effected
how is excretion different in the elderly
renal capacity becomes poorer
Centrally acting medicines
are meds that lower your heart rate and Bp, need to be careful in elderly bc it can cause slower heart rate, dizziness and headaches causing them to be lethargic & have a sedating fx
pharmacokinetics of centrally acting meds
one med affects the plasma concentration of the other medication
what are 2 syndromes of concern
anticholinergic
serotonin
and both are common in people w multiple meds
what are some strategies for safer med use?
- Avoid and reduce use of meds when possible
- Teach clients and families about alternative ways to manage the challenges & illnesses
- Create a culture where medications are not always the answer or the only answer
- Use a pharmacisy as a resource
- Client education regarding safe administration
- Old people in facilities, med reconciliation should be utilized
- Blister packs
- Med diaries
- Regular med review
what is poly pharmacy
5 or more medications , its associated with risk of adverse outcomes like falls, facility, disability and mortality in older adults
what is The Beers Criteria
- A list of potentially inappropriate meds for in older adults, they’re guidelienes for HCP to improve the safety or prescribing meds
what’s the argument FOR meds
Management of behaviours that pose risk for themselves or others
Deemed incompetent to make decisions about meds
Quality of life
Indication that it was needed
argument AGAINST med use
effect appetite, potential sedation
Better quality of life? – memories from past, sings,
One med to fix side effect of others
Provide good care first before taking an easy route out cause it might cause more harm
Treating underlying causes of behaviour
what leads to poly pharmacy
as people age, they get more doctors for more
what are symptoms of psychosis
Hallucinations
Delusions
Disordered or confused thoughts
Disorganised behaviours
Negative symptoms (reduction in motivation ,interest and or verbal expression)
what is psychosis
Some loss of contact with reality’. This might involve hallucinations or delusions. in elderly it can present like hallucinations, delusions, disorganized thought & speech pattern
what is hallucinations
hearing voices/ seeing things/ sensation that someone is touching them/ experiencing smells that are not there
what is delusions
unshakeable belief in something untrue
what are some primary psychiatric causes of psychosis
Schizophrenia
Very-late onset schizophrenia like psychosis (VLOSLP)
Delusional disorder
Schizoaffective
Depression
Bipolar affective disorder
what are some secondary causes to psychosis
Delirium
Neuropsychiatric conditions (e.g. stroke, MS, epilepsy, encephalitis)
Certain prescribed medications
Alcohol and drug misuse/ withdrawals
Dementia
Alzheimer’s
Lewy body
Vascular
what’s age appropriate assessment for psychosis
- thorough assessment
- lab results
- rule out: delirium, med and substance interference
- MSE
- comorbidities of med interactions
- MRI
- CT scan
how does psychosis differ from younger individuals
more somatic and visual hallucinations and delusions in older. bc vision and auditory changes happen as you age, need to rule out titans and stuff
how do you manage psychosis
typical antipsychotics- becareful of EPS
atypical antipsychotics be careful of metabolic changes and Anticholinergic effects
- titrate meds overtime
- re-evaluate psychosis, individual risk assessment, goal setting, care planning
how does It differ from the young
1/2 the dose is prescribed for older people bc metabolism in elderly.
- monitor cardiac and metabolic events due to higher susceptibility bc of age and manage different meds ( bc of poly pharmacy)
- if clozapine is prescribed for everyone, monitor WBC , infections and sepsis
what is dementia
a decline in intellectual functioning sufficient enough to disrupt functioning in other areas of daily life
how does dementia progress
Dementia may progress from communication difficulties and limited attention span in early stages, to delusions and hallucinations, restless behaviour such as wandering, or even losing the ability to walk, sit up, or swallow in later stages
how do you assess for dementia
MMSE,
MOCA,
the GERRI which can be done by relatives
clock drawing test
ADL assessment
fall risk assessment
comprehensive geriatric assessment
what’s the most common type of early onset dementia
alhzlmers
how does general alhzlmers dementia present
memory dysfunction
executive dysfunction
prominent apraxia
what are other ways EOD can develop
HIV, MS, huntingtons disease, Parkinson’s disease and Down syndrome
compare EOD to LOD
EOD
- more diagnosed w mood disorder
- longer time between onset of symptoms and receiving a diagnosis (4.4years)
LOD
- higher rates of heart disease and BP
how do you manage dementia?
no cure, maintaining cognitive ability where possible, safety, and adapting to the ongoing progression
- aiding in ADLs
- medications
- behavioural management
- modifying diet textures and nutrients for maximized nutrition,
- memory reinforcement/ training to slow the cognitive decline,
- modifying environments to manage the occurrence of delusions and hallucinations
- psychosocial supports and building community and belonging
additional difficulties EOD has compared to LOD
employment
more likely to have a spouse and living in the same home
- more caregiver burden
what are the 8 A’s in dementia
- Attentional deficit
- anosognosia
- agnosia
- aphasia
- apraxia
- altered perception
- amnesia
- apathy
what are the types of dementia
alhzlmers
Lewy body
vascular dementia
front-temporal dementia
mixed dementia
characteristics of dementia in elderly
cognitive decline
- memory loss, language deficits, issues w/ spatial awareness
behavioural changes
- anxiety, depression, personality changes
difficulties with ADL’s
how does dementia present in younger vs older
younger
- loss of executive functioning first
- impulsivity, mood swings, aggression
- faster progression
- causes (traumatic injury, genetics infection/ disease)
older
- memory loss first
- confusion, social withdrawl
- slower progression
- cause: age related
what does depressive disorder present as in elderly
lack of energy
feeling numb
no interest in activities they used to enjoy
not too open about it
tired
grumpy
irritability
social isolation
age appropriate assessment for depression
MSE
MoCa- used for dementia but can help rule out dementia so u can give a proper depression diagnosis
mini MSE- screening for cognitive impairment
Geriatric depression scale ( 60+) self-reporting
beck hopelessness scale (17-80)
life satisfaction index
how do u manage depression
SSRI
CBT
interpersonal therapy
active lifestyle
avoid alcohol
how does depression differ from younger
older adults demonstrate more agitation but they experience similar symptoms
does managing depression differ from younger ppl
older ppl often go with medical illnesses and conditions
what is depression
mental health condition that includes a persistent depressed mood and loss of interest in everyday activities and relationships
why is depression overlooked in older ppl
inaccurate beliefs about aging, stigmas, and a differing presentation of symptoms.
This can lead to a misdiagnosis, such as dementia, and a lack of support for the elderly.
depression in young people
