Week 3 Flashcards
Exam 1
1
Q
Variability Among Older Adults:
includes:
A
Physiological, cognitive, and psychosocial health
Levels of functional ability
Dependence vs. independence
A reduced ability to respond to stress, the experience of multiple losses, and the physical changes associated with normal aging –high risk for illness and functional deterioration
2
Q
Variability Among Older Adults:
When developing a Nursing POC, what should be included?
A
–Strengths and abilities, encourage independence
3
Q
Nurses’ Attitudes Toward Older Adults
What must nurses assess about attitude?
A
Nurses must assess their own attitude toward older adults and their own aging.
4
Q
Nurses’ Attitudes Toward Older Adults
What do nurses need to gain knowledge about?
A
Nurses need to gain knowledge about aging and health care needs of older adults:
5
Q
Nurses’ Attitudes Toward Older Adults
Nurses need to gain knowledge about aging and health care needs of older adults including:
A
Respect
Dignity
Involvement in care decision and activities
Address ageism:
6
Q
Nurses’ Attitudes Toward Older Adults
Address ageism:
A
Older adults are: Ill, disabled, and unattractive, Forgetful, confused, rigid, bored, unfriendly,
Unable to learn and understand new information
—-These ideas demonstrate ageism, which is discrimination against people because of increasing age.
7
Q
Nurses’ Attitudes Toward Older Adults:
What should be a priority for all nurses?
A
Forming positive attitudes toward them and gaining specialized knowledge about aging and the health care needs of older adults are priorities for all nurses.
8
Q
Nurses’ Attitudes Toward Older Adults
What happens when nurses hold negative stereotypes about aging?
A
When health care providers hold negative stereotypes about aging, their actions often negatively affect the quality of patient care.
9
Q
Nurses’ Attitudes Toward Older Adults
Some people equate worth with productivity- what does this mean?
A
Some people equate worth with productivity;
therefore they think that older adults become worthless after they leave the workforce.
Others consider their knowledge and experience too outdated to have any current value.
10
Q
Nurses’ Attitudes Toward Older Adults
What does ageism do to older adults?
A
Ageism typically undermines the self-confidence of older adults, limits their access to care, and distorts caregivers’ understanding of the uniqueness of each older adult.
11
Q
Nurses’ Attitudes Toward Older Adults
What should you always do for older people?
A
Always promote a positive perception regarding the aging process when you establish therapeutic relationships and show respect to older adults.
12
Q
Nurses’ Attitudes Toward Older Adults
What are the importance of older adults?
A
Older adults are a significant proportion of the consumer economy.
As voters and activists in various issues, they have a major influence in the formation of public policy.
Their participation adds a unique perspective on social, economic, and technological issues because they have experienced almost a century of developments.
13
Q
Nurses’ Attitudes Toward Older Adults
What may older people have trouble with?
What should you take into account when planning care?
A
Even though older adults may be slower and may have troubles with vision, hearing, and dexterity, when you plan care, you will take into account their positive attributes.
14
Q
Nurses’ Attitudes Toward Older Adults
What are older adults considered? (Having to do with learning)
A
Although reduced energy and endurance sometimes affect the process of learning, older adults are lifelong learners.
15
Q
Nurses’ Attitudes Toward Older Adults
What are examples of how older adults have dealt with coping? Why is this realization important?
A
Older adults have been through the depression, wars, and changes in health care throughout their lives.
Living through all of these events and changes, they have stories and examples of coping with change to share.
16
Q
Developmental Tasks for Older Adults
What is it associated with?
A
Associated with varying degrees of change and loss
17
Q
Developmental Tasks for Older Adults
Associated with varying degrees of change and loss
Like what?
A
Health, significant others, a sense of being useful, socialization, income, and independent living
18
Q
Developmental Tasks for Older Adults
Associated with varying degrees of change and loss
What are they coping with?
A
Retirement
Residence change
Death
19
Q
Developmental Tasks for Older Adults
What happens to adult children?
A
Adult children - changing roles
(control of decision making, dependence, conflict, guilt, and loss).
20
Q
Developmental Tasks for Older Adults
What is often a priority for older adults?
A
Helping older adults maintain their quality of life is often a priority.
21
Q
Developmental Tasks for Older Adults
How do older adults adjust to the changes of aging?
A
How older adults adjust to the changes of aging is highly individualized.
22
Q
Developmental Tasks for Older Adults
What should you be sensitive to?
What should you be prepared to do?
A
Be sensitive to the effect of losses on older adults and their families and be prepared to offer support.
23
Q
Developmental Tasks for Older Adults
What do older adults need to adjust to?
A
Older adults need to adjust to the physical changes that accompany aging.
24
Q
Developmental Tasks for Older Adults
What does acceptance of aging mean?
A
Acceptance of personal aging does not mean retreat into inactivity, but it does require a realistic review of strengths and limitations.
25
Developmental Tasks for Older Adults
Coping with:
Retirement
Residence change
Death
What do they all require?
All require an extended period of adjustment, during which assistance and support from health care professionals, friends, and family members are necessary.
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Developmental Tasks for Older Adults
What does death represent?
Deaths represent both losses and reminders of personal mortality.
Coming to terms with them is often difficult.
By helping older adults through the grieving process.
27
Developmental Tasks for Older Adults
As adult children and aging parents negotiate the aspects of changing roles, nurses are in the position to do what?
As adult children and aging parents negotiate the aspects of changing roles, nurses are in the position to act as counselors for the entire family.
28
Developmental Tasks for Older Adults
As adult children and aging parents negotiate the aspects of changing roles, nurses are in the position to act as counselors for the entire family.
What is the priority for everyone?
Helping older adults maintain their quality of life is often a priority.
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Assessing the Needs of Older Adults
Nursing assessment to ensure an age-specific approach
30
Assessing the Needs of Older Adults
Nursing assessment to ensure an age-specific approach
What is there an interrelation between?
The interrelation between physical and psychosocial aspects of aging
31
Assessing the Needs of Older Adults
Nursing assessment to ensure an age-specific approach
What effects functional status?
Effects of disease and disability on functional status
32
Assessing the Needs of Older Adults
Nursing assessment to ensure an age-specific approach
How should the nursing assessment be tailored?
Tailoring the nursing assessment to an older person
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Assessing the Needs of Older Adults
What is it important to recognize?
It is important to recognize early indicators of acute illness in older adults
34
Assessing the Needs of Older Adults
What kind of changes and physiological things can happen in older adults?
changes in mental status, occurrence and reason for falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence
35
Assessing the Needs of Older Adults
When do mental status changes commonly occur in older adults?
Mental status changes commonly occur as a result of disease and psychological issues.
36
Assessing the Needs of Older Adults
What often causes injury in older adults?
Falls are complex and often cause injury.
37
Assessing the Needs of Older Adults
What must you do about falls?
You need to investigate every fall carefully to find out if it was the result of environmental causes or the symptom of a new-onset illness.
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Assessing the Needs of Older Adults
What may sometimes present with a fall?
Problems with the cardiac, respiratory, musculoskeletal, neurological, urological, and sensory body systems sometimes present with a fall as a chief symptom of a new-onset condition.
39
Assessing the Needs of Older Adults
What is a common symptom in adults? Why?
Dehydration is common in older adults because of decreased oral intake related to a reduced thirst response and less free water as a consequence of a decrease in muscle mass.
40
Assessing the Needs of Older Adults
What is a common symptom with an onset of pneumonia, heart failure and UTIs?
Decrease in appetite is a common symptom with the onset of pneumonia, heart failure, and urinary tract infection (UTI).
41
Assessing the Needs of Older Adults
What are common causes of functional decline?
Thyroid disease, infection, cardiac or pulmonary conditions, metabolic disturbances, and anemia are common causes of functional decline.
42
Assessing the Needs of Older Adults
What kind of role do nurses play in health problems?
Nurses play an essential role in early identification, referral, and treatment of health problems.
43
Assessing the Needs of Older Adults?
Can you differentiate age-related from illness-related signs and symptoms?
Illness indicators include change in mental status, falls, dehydration, decrease in appetite, loss of function, dizziness, and incontinence.
44
Physiological Changes
Older adults’ concepts of health depends on what?
Older adults’ concepts of health generally depend on personal perceptions of functional ability.
45
Physiological Changes
General survey
Begins during initial nurse-patient encounter
Quick, but careful, head-to-toe scan
Eye contact and facial expression
Presence of universal aging changes
46
Functional Changes
What does functional status include?
Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains.
47
Functional Changes- What are changes related to?
Changes are usually linked to illness or to disease and degree of chronicity.
48
Functional Changes:
What is a sensitive indicator of health or illness?
Performance of ADLs is a sensitive indicator of health or illness.
49
Functional Changes
A change in ADL's could be a sign of what?
Change in ADL’s -sign of onset of an acute illness or worsening of a chronic illness.
50
Functional Changes
What is used to assess?
Geriatric Assessment tools.
51
Functional Changes
Nursing interventions for Older Adults: What are they aimed at?
Aimed at maintaining, restoring, or maximizing their functional status, while maintaining independence and preserving dignity.
52
Functional Changes
Factors that promote the highest level of function:
Factors that promote the highest level of function include a healthy, well-balanced diet; paced and appropriate activity; regularly scheduled visits with a health care provider; regular participation in meaningful activities; use of stress-management techniques; and avoidance of alcohol, tobacco, or illicit drugs.
53
Functional Changes
Domains of geriatric assessment include:
Medical functional-physical,
functional-social,
Affective,
social support,
environmental,
economics,
QOL,
Career ,
personal
53
Functional Changes
What could have a profound effect on functional status?
It may be difficult for older adults to accept the changes that are occurring in all areas of their lives, which in turn have a profound effect on functional status.(***
54
Functional Changes
When planning and implementing care for older adults, what kind of interventions should be put in place?
When planning and implementing care for older adults, you will want to develop interventions aimed at maintaining, restoring, or maximizing their functional status, while maintaining independence and preserving dignity.
55
Case study: What is part of normal aging with eyes?
Yellowing of the lens
56
Case study:
Yellowing of the lens: Why does this occur?
What effects does this have?
As people age, the lens of the eye naturally becomes more yellow. This is due to the accumulation of pigments in the lens, which is a normal part of aging and can cause subtle changes in color perception.
57
Case study:
Whitening or clouding of the lens: What is this typically associated with?
This is typically associated with cataracts, which are not considered a normal part of aging but rather a common age-related condition.
58
Case study:
What do cataracts involve?
Cataracts involve the lens becoming cloudy or opaque, which can lead to vision impairment and usually requires surgical intervention.
59
Psychosocial Changes
Retirement
Social isolation-
Sexuality
Housing and environment
Death
60
Psychosocial Changes
Retirement: What are factors that influence a retired person's satisfaction?
--Factors that influence a retired person’s satisfaction with life are health status and sufficient income.
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Psychosocial Changes
Social isolation: What is available to older adults to avoid this?
--Outreach programs are available, including Meals on Wheels, daily telephone calls, and volunteer opportunities.
62
Psychosocial Changes
Sexuality:
--Knowing an older adult’s sexual needs allows you to incorporate this information into the nursing care plan.
63
Psychosocial Changes
Housing and environment: What influences an older adult's housing choices?
--The extent of an older adult’s ability to live independently influences housing choices
64
Psychosocial Changes
Death:
Death--the death of family, friends, and their spouse.
65
Psychosocial Changes
What else should you assess in older adults?
also assess older adults’ family situation, intimate relationships, past and present occupations, finances, housing, social networks, normal activities, health and wellness, and spirituality.
66
Psychosocial Changes
What are major adjustments for older adults?
Adjustment to retirement (lower income), chronic illness, housing (relocation), own mortality.
67
Psychosocial Changes
When helping patients consider housing, what should you plan for?
When helping patients consider housing, plan for the future.
68
Psychosocial Changes
What is important about the environment?
The environment supports or hinders physical and social functioning, enhances or drains energy, and complements or taxes existing physical changes such as vision and hearing. Furniture needs to be comfortable and safe.
69
Psychosocial Changes
Older adults have to deal with the death of family, friends, and their spouse. Nurses need to help them cope with loss.
What are older adults concerned with?
They are concerned with being a burden, experiencing suffering, being alone, and the use of life-prolonging measures.
70
Psychosocial changes:
What do they revolve around?
Psychosocial changes revolve around life transitions and loss.
The longer we live, the longer we have to cope with losses. Remember that this group makes up a large part of the U.S. population, as was previously stated.
71
Psychosocial Changes:
During assessment, what should you ask older adults?
During your assessment ask how an older adult feels about self, self in relation to others, and self as one who is aging and which coping methods and skills have been beneficial.
72
Psychosocial Changes:
Psychosocial stresses of retirement are related to what?
The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role.
73
Psychosocial Changes
What is a important task for retirement? Why? Who else does retirement effect?
Preretirement planning is an important advisable task.
People who plan in advance for retirement generally have a smoother transition.
Retirement also affects the spouse, adult children, and even grandchildren.
74
Psychosocial Changes
How should older adults adjust to retirement?
In the adjustment to retirement an older adult has to develop a personally meaningful schedule and a supportive social network.
Factors that influence a retired person’s satisfaction with life are health status and sufficient income.
75
Psychosocial Changes
Factors that influence a retired person's satisfaction with life are what?
Factors that influence a retired person’s satisfaction with life are health status and sufficient income.
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Psychosocial Changes
Social isolation: How can this occur?
Social isolation can occur voluntarily or involuntarily.
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Psychosocial Changes
Social isolation: How do nurses assess for social isolation?
The nurse assess patients’ potential for social isolation by identifying their social network, access to transportation, and willingness and desire to interact with others.
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Psychosocial Changes
Sexuality involves what?
involves love, warmth, sharing, and touching, not just the act of intercourse.
79
Psychosocial Changes
Housing and environment: What is the goal of assessing a patient's environment?
The goal of your assessment of a patient’s environment is to consider resources that promote independence and functional ability.
80
Psychosocial Changes
How can the environment be for older adults?
The environment supports or hinders physical and social functioning, enhances or drains energy, and complements or taxes existing physical changes such as vision and hearing. Furniture needs to be comfortable and safe.
81
Psychosocial Changes
When assessing retirement, social isolation, sexuality, housing and environment and death,
what else must nurses assess?
When assessing these five changes, make sure to also assess older adults’ family situation, intimate relationships, past and present occupations, finances, housing, social networks, normal activities, health and wellness, and spirituality.
82
Learning Needs
What are challenges in teach older adults?
Cognitive and sensory changes are challenges for teaching older adults
Learn at a slower rate
Difficulties processing multiple bits of information at one moment
83
Learning Needs
During assessment, what does the nurse need to do?
During assessment, the nurse needs to determine additional needs for teaching and limitations of the older adult in their capability to learn
84
Learning Needs
How long does it take to complete a geriatric assessment? Why?
Obtaining a complete Geriatric assessment takes time;
older adults have longer life and medical history.
85
Learning Needs
What should you allow for during an assessment? What should you review? What should you take into account?
Allow rest periods; be sure to review prescribed and over-the-counter medications.
Take into account vision and hearing constraints.
86
Learning Needs
Take into account vision and hearing constraints when doing an assessment. WHy?
If an older adult is unable to understand your visual or auditory cues, your assessment data will likely be inaccurate or misleading, leading you to incorrectly conclude that the older adult is confused.
87
Learning Needs
When patient has a hearing impairment, how should you speak to them? What should you always encourage?
When a person has a hearing impairment, speak directly to the patient in clear, low-pitched tones and move to a quiet area to reduce background noise.
88
Learning Needs
When patient has a visual impairment, how should you speak with them? What should you always encourage?
When caring for people with visual impairments, sit or stand at eye level and face them.
Always encourage the use of assistive devices such as glasses and hearing aids.
89
Learning Needs
What may effect the accuracy and completeness of the assessment? What may you need to do? What does this extra thing provide?
Memory deficits, if present, affect the accuracy and completeness of your assessment; may need to enlist help of family member or caregiver.
The additional person supplements information with the consent of the older adult, but the older adult remains the primary source of the interview.
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Learning Needs
What must you provide to the older adult?
Provide culturally competent care.
91
Learning Needs
What is it important to recognize in older adults?
It is important to recognize early indicators of acute illness in older adults.
92
Healthy People Objective and Measures:
What is the vision?
A society in which all people can achieve their full potential for health and well being across the lifespan.
93
Healthy People Objective and Measures:
Overall Health and Well being Measures
LOOK AT SLIDE 14
8 broad global outcome measures intended to assess the health people 2030 vision
94
Healthy People Objective and Measures:
What is the Healthy People 2030 Framework?
The framework encompasses the central ideas and function of Healthy People 2030.
95
Healthy People Objective and Measures:
The framework encompasses the central ideas and function of Healthy People 2030.
The purpose of the framework is to:
Provide context and rationale for Healthy People 2030’s approach
Communicate the principles that underlie decisions about the initiative
Situate the 2030 initiative in Healthy People’s history
96
Healthy People Objective and Measures:
In addition to the Healthy People 2030 vision and mission, the framework includes:
Foundational principles
Overarching goals
Plan of action
History and context
97
Healthy People Objective and Measures:
What is the mission?
To promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.
98
Healthy People Objective and Measures:
The following foundational principles guide decisions about Healthy People 2030:
The health and well-being of all people and communities is essential to a thriving, equitable society.
Promoting health and well-being and preventing disease are linked efforts that encompass physical, mental, and social health dimensions.
Investing to achieve the full potential for health and well-being for all provides valuable benefits to society.
Achieving health and well-being requires eliminating health disparities, achieving health equity, and attaining health literacy.
Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being.
Promoting and achieving health and well-being nationwide is a shared responsibility that is distributed across the national, state, tribal, and community levels, including the public, private, and not-for-profit sectors.
Working to attain the full potential for health and well-being of the population is a component of decision-making and policy formulation across all sectors.
99
Read slide 14
100
Older Adults Workgroup Objectives (7)
What should be increase?
Increase the proportion of older adults with physical or cognitive health problems who get physical activity — OA‑01
101
Older Adults Workgroup Objectives (7)
What should be reduced?
Reduce the proportion of older adults who use inappropriate medications — OA‑02
Reduce the rate of emergency department visits due to falls among older adults — OA‑03
Reduce the rate of pressure ulcer-related hospital admissions among older adults — OA‑04
Reduce the rate of hospital admissions for diabetes among older adults — OA‑05
Reduce the rate of hospital admissions for pneumonia among older adults — OA‑06
Reduce the rate of hospital admissions for urinary tract infections among older adults — OA‑07
102
Medication use with older adults
What percent of older adults use at least 1 prescription med? What percent uses three or more prescription meds? What percent takes 5 or more?
More than 88% of older people using at least one prescription and more than 66% using three or more in any given month (National Center for Health Statistics, United States (NCHSUS)
39% of older adults take 5 or more medications
They consume over 1/3 of prescription drugs
103
Medication use with older adults
What percent of older adults use over the counter meds?
90% take over the counter drugs (OTC)
104
Medication use with older adults
What is increasing in older adults adults?
Herbal and dietary supplement use is increasing in older adults:
105
Medication use with older adults
During hospital admission, what can occur?
During hospital admission, errors occur in up to 67% of all patients when reporting medication history and 83% of patients when reporting nonprescription drug use
106
Age-Related Changes That Affect the Actions of Bioactive Substances in the Body
include:
Diminished Renal Function
Decline in Hepatic Blood Flow
Decrease in total body water
Increase in proportion of body fat to lean body mass
Decreased serum albumin levels
Receptor sensitivity in the brain:
Thermoregulation
Fluid regulation
Baroreceptor control of blood pressure
Body size
107
Effects of Aging on Pharmacokinetics:
What is pharmacokinetics?
what the body does to a drug. how drug is absorbed, distributed, metabolized, and excreted –changes with age
108
Effects of Aging on Pharmacokinetics:
What is pharmacodynamics?
Pharmacodynamics: how body is affected by the medication: biochemical and physiological effects of drugs and their mechanisms of action on the body.
109
Effects of Aging on Pharmacokinetics:
Elimination half time?
Elimination half-time or serum half-life, the time it takes for the concentration of a drug in the bloodstream (or serum) to decrease by half.
110
Effects of Aging on Pharmacokinetics:
Elimination half time?Importance
: It gives an estimate of how long a drug stays in the body and helps in determining appropriate dosing intervals.
111
Effects of Aging on Pharmacokinetics:
Clearance rate:
measurement of volume of blood from which medication is eliminated per unit of time ( ml/min)
112
Effects of Aging on Pharmacokinetics:
What is effected?
Drug receptor interaction
Metabolism
Absorption
Circulation
Excretion
Distribution
113
Effects of Aging on Pharmacokinetics:
Drug-receptor interaction
Brain receptors more sensitive making psychoactive drugs very potent
114
Effects of Aging on Pharmacokinetics:
Metabolism: What happens to enzymes and metabolism?
Metabolism drops to 1/2 to 2/3 the rate of young adults
Enzymes lose ability to process some drugs, thus prolonging drug half life.
115
Effects of Aging on Pharmacokinetics:
Metabolism: What happens to liver?
Liver mass shrinks
Hepatic blood flow and enzyme activity decline
116
Effects of Aging on Pharmacokinetics:
Absorption: How is gastric emptying?
Gastric emptying rate and gastrointestinal motility slow
117
Effects of Aging on Pharmacokinetics:
Metabolism: What happens to cells?
Absorption capacity of cells and active transport mechanism decline
118
Effects of Aging on Pharmacokinetics:
Circulation: nerve? What happens if antihypertensive drugs are given or digoxin?
Vascular nerve control is less stable
Antihypertensives, may overshoot, dropping BP too low
Digoxin may slow the HR too much
119
Effects of Aging on Pharmacokinetics:
Excretion: In kidneys, renal blood flow GFR, renal tubular secretion and reabsorption, and nephrons?
In kidneys, renal blood flow GFR, renal tubular secretion and reabsorption, and nephrons decline
119
Effects of Aging on Pharmacokinetics:
Excretion: What happens to drug half life
Age related changes increase half life for renally excreted drugs
120
Effects of Aging on Pharmacokinetics:
Distribution: What happens to lean body mass? Adipose tissue? Total body water? Plasma protein levels?
Lean body mass falls
Adipose stores increase
Total body water declines, raising the concentration of water-soluble drugs, which can cause heart dysfunction.
Plasma protein level decrease, reducing sites available for protein bound drugs and raising blood levels of free drugs
121
Nursing Management
Medication use Changes that affect medication-taking behaviors
Causes of Medication Errors by Older Adults
Decreased vision
Forgetting to take drugs
Use of nonprescription over the counter drugs
Use of medications prescribed for someone else
Lack of financial resources to obtain prescribed medication
Failure to understand instructions or importance of drug treatment
Refusal to take medication because of undesirable side effects
122
Nursing Management
Medication use Changes that affect medication-taking behaviors
Factors affecting the use of medications
Motivation, knowledge, cultural and psychosocial influences, cost, accessibility, correct container, read and comprehend directions, hear and remember verbal directions, correct time for medication, correct dosage, ability to remove medication from container and administer, ability to swallow, and ability to administer per appropriate route.
123
Medication nonadherence
refers to medication-taking patterns that differ from the prescribed pattern,
124
Mrs. N. is prescribed a complex medication regimen for the chronic condition of diabetes mellitus. In addition to the prescribed regimen, another factor for nonadherence may include:
A. Living with her daughter
B. Understanding of the medication regimen
C. Adverse effects of the medication
D. Cognitive wellness
C. Adverse effects of the medication
125
Medication nonadherence refers to medication-taking patterns that differ from the prescribed pattern,
including missed doses, failure to fill prescriptions, or medications taken too frequently or at inappropriate times.
126
Factors that contribute to nonadherence include:
Factors that contribute to nonadherence include depression, isolated living situation, financial considerations, disease category, adverse medication effects, complex medication regimen, and inadequate understanding of the medication regimen
127
Cultural Considerations in Medication Assessment
Culturally based beliefs about health, illness and remedies
Medications that are not readily available or that are available only by prescription in US are available OTC in other countries
Cultural Considerations
128
Behaviors based on myths and misunderstandings
Influence attitudes of older adults and caregivers
Harmful belief that over-the-counter (OTC) medications are always safe
Medications as “quick-fix”
Identification of older adults’ beliefs about illness and treatment guide with the teaching process
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Medication Use in Older Adults
To evaluate the appropriateness of a medication prescription:
When making decisions about dosage of medications for older adults…
Rule of thumb: start low and go slow
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Medication Use in Older Adults
To evaluate the appropriateness of a medication prescription:
When making decisions about dosage of medications for older adults…Rule of thumb: start low and go slow
Start with about ½ recommended adult dose
131
Medication Use in Older Adults
To evaluate the appropriateness of a medication prescription:
When making decisions about dosage of medications for older adults…Rule of thumb: start low and go slow.
How long should you wait before increasing dose?
Wait twice as long as recommended in the literature before increasing the dose.
132
Medication Use in Older Adults
To evaluate the appropriateness of a medication prescription:
When making decisions about dosage of medications for older adults…Rule of thumb: start low and go slow.
What functions should be assessed?
Assess renal and liver function
133
Which statement is true about age-related changes affecting the action of medications in the older adult?
A. Renal changes may affect the concentrations of medications in the body
B. Liver metabolism of medications is increased in older adults
C. Water-soluble substances have a less intense effect in the older adult
D. Fat-soluble substances may have a decreased duration of action
Renal changes may affect the concentrations of medications in the body
134
Diminished renal function can...
can decrease the clearance of water-soluble medications and the consequences will be greater on substances such as digoxin that readily reach toxic levels because they have a narrow therapeutic index
135
(*The therapeutic index is
the range of doses at which a medication appeared to be effective in clinical trials for a median of participants.)
136
Inappropriate prescribing practices:
What are major causes of illness in older adults?
Polypharmacy, overdose, and addiction to prescription drugs are major causes of illness in older adults.
137
Inappropriate prescribing practices:
Errors from:
(1) administration of both brand and generic medications
(2) refilling medications too soon or too late resulting in taking the medication incorrectly AND
(3) drug-drug interactions can be prevented by having a pharmacist review the medication regimen regularly.
(4) inadequate monitoring of medications
(5)Insufficient recognition of adverse medication effects
(6) Prescribing cascade: adverse drug reaction mistaken as new medical condition
138
Inappropriate prescribing practices
Why do older adults face an increased risk of adverse medication effects?
Nursing: Older adults experience nonadherence to medications and therefore face an increased risk of adverse medication effects.
139
Inappropriate prescribing practices
What is designed to reduce medication problems in older adults?
The American Geriatrics Society Beers Criteria are designed to reduce problems with medications in older adults.
140
Inappropriate prescribing practices
What are potentially inappropriate medications?
Potentially inappropriate medications: medications that pose more risks than benefits
141
Inappropriate prescribing practices
What does Beer's criteria do?
Beer's criteria is a valuable tool for managing potential medication risks for older adults.
142
Polypharmacy:
use of more medications that are clinically indicated (usually 5 or more medications is the most common definition)
143
Beers Criteria:
Overall goal?
Beers Criteria:
Overall goal : Reduce adverse drug events and improve prescribing practices for older adults.
144
What published and maintained the Beer's criteria?
American Geriatrics Society (AGS).
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What is the focus of the Beer's criteria?
*Focus: Identifies medications that are considered potentially inappropriate for older adults, particularly those that pose high risks for adverse drug events. It provides a list of drugs that should generally be avoided or used with caution based on the risks they pose to older adults due to issues like decreased metabolism or higher sensitivity to drugs.
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What does the Beer's criteria emphasize?
It emphasizes individual drug classes (e.g., anticholinergics, sedatives, etc.) and provides recommendations for dose adjustments or alternatives.
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What does the Beer's criteria provide?
provide recommendations for medication use, adjustments, and alternatives specifically tailored to the physiological changes and risks associated with aging.
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AGS Beers Criteria®
Five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:
Avoided in what conditions?
Avoided by most older people (outside of hospice and palliative care settings);
Avoided by older people with specific health conditions;
Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions;
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AGS Beers Criteria®
Five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:
Used with caution in what conditions?
Used with caution because of the potential for harmful side effects; or
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AGS Beers Criteria®
Five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:
Dosed differently or avoided in what conditions?
Dosed differently or avoided among people with reduced kidney function, which impacts how the body processes medicine.
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AGS Beers Criteria®
How many individual medications or medication classes to avoid for most older people.
**30 individual medications or medication classes to avoid for most older people.
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AGS Beers Criteria®
How many medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions.
**40 medications or medication classes to use with caution or avoid when someone lives with certain diseases or conditions.
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AGS Beers Criteria®
Moderate to high quality of evidence to avoid:
1st Gen. Antihistamines (Anticholinergic) constipation, dizziness, confusion, dry mouth, dry eyes)
Alfa Blockers (orthostatic hypotension)
Tricyclic Antidepressants ( sedation)
Barbiturates ( phenobarbital)( dependence and OD)
Benzodiazepines ( Cognitive impairment/falls)
PPI’s ( infections, bone loss ,fractures)
Androgens ( testosterone) ( heart problems)
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AGS Beers Criteria®
What are special considerations?
Special considerations: Potentially inappropriate --Potentially inappropriate medications are just that—potentially inappropriate.
They merit special scrutiny but should not be misconstrued as universally unacceptable in all cases or for all people.
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AGS Beers Criteria®
Drugs for special considerations?
NSAID’s (GI bleed)
Antipsychotics ( increased risk of cognitive impairment, and falls)
Oral decongestants( insomnia ,blood pressure)
Vasodilators ( electrolytes abnormalities due to drug –drug interactions)
Anticoagulants ( sever bleeding from drug-drug interactions)
Antiemetics ( increase symptoms of Parkinson )
Anticonvulsants ( risk of falls/fainting)
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American Geriatrics Society (AGS) and other professional bodies, promote
deprescribing as a part of their guidelines for managing older adults
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Deprescribing
= Decreasing the Number of Medications
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Deprescribing allows for reduction in?
Reduces the risk for adverse effects
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Deprescribing allows for evaluating what?
Evaluation of all medications used
Evaluation of prn medications
Evaluation of medications for behavioral management in long-term care settings
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Deprescribing allows for communication with?
Communication with prescribing practitioners
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Deprescribing allows for utilization of what?
Utilize hospital admissions to evaluate medications
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Deprescribing is what kind of approach?
Deprescribing is ultimately a patient-centered approach aimed at reducing the number of unnecessary or harmful medications, improving quality of life, and promoting safe medication use in older adults.
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Which medication with moderate to high quality of evidence is inappropriate for use in the older adult population according to the Beers criteria?
A. Nonsteroidal anti-inflammatory drugs
B. Anticonvulsants
C. Opioid analgesics
D. Anticholinergic drugs
D. Anticholinergic drugs
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According to the Beer's criteria, why are anticholinergic drugs inappropriate to use in older adults?
Anticholinergic drugs and drugs with anticholinergic properties are inappropriate because of toxicity and serious side effects such as seizures, delirium, agitation, hallucinations, cardiac arrhythmias, cognitive impairment, and urinary retention
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Communication Barriers
Reluctance of older adults to question treatment with medications
Lack of confidence in communication skills
Hearing difficulties
Attitude of the health care practitioner
Language barriers
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Lack of Information: What is there a lack of knowledge about?
Lack of knowledge of the actual effect of medications in the older adult population
-Minimal research with older adults
Medication–medication interactions lacking
-Newly approved drugs
Recent trends in the pharmaceutical industry
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Concerns and Risks Associated with Polypharmacy:
Increased Risk of Adverse Drug Events:
Decreased Medication Adherence:
Increased Healthcare Costs:
Functional Decline:
Diminished Quality of Life:
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Medication Nonadherence: Financial Concerns and Other Contributing Factors
What does this lead to?
Medication non-adherence/noncompliance
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Medication Nonadherence: Financial Concerns and Other Contributing Factors
What insurance handles this costs?
Medicare Part D prescription drug program- formularies
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Medication Interactions
Medication--medication interactions -* Miller textbook
Medications and herbs
Warfarin
Insulin
Aspirin
Digoxin
Cyclosporin
Ticlopidine
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Medication Interactions
Consequences of medication interactions:
Altered therapeutic effects
Risk for adverse effects
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Medications and other substances
Alcohol –
Cannabis-
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Medications and other substances
Alcohol –
What is a major symptom?
Central nervous system depression
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