Medications and Older Adults
Administering drugs to the elderly is tricky, medications do not work the same in a 20 year old body as they do in a 90 year old body. Here are some helpful tips.
Recognizing adverse drug events – The possibility of an adverse drug event (ADE) should always be borne in mind when administering medications to an older adult; any new symptom should be considered drug-related until proven otherwise. Pharmacokinetic changes lead to increased plasma drug concentrations and pharmacodynamic changes lead to increased drug sensitivity in older adults, thus older adults can see unwanted side effects from a much smaller dose.
●Role of herbal and dietary supplements – Healthcare workers must be alert to the use of herbal and dietary supplements by older patients, who may not volunteer this information and are prone to drug-drug interactions related to these supplements. Well meaning family members or friends may bring these in unknowingly that they could cause interactions with the elder's other medications. Always ask, and keep a keen eye out for any supplements in their area.
●Inappropriate medications – There are dozens upon dozens of medications that have been documented to be dangerous and should not be prescribed, or should be prescribed with great caution, in older adults, yet these medication are seen on MARs everywhere. Med-Aides need to be aware of these (Beer's list is just one example) as these drugs are well known to cause adverse effects.
●Underutilization of appropriate medication –Medicare does not cover all medications and some of the best medications are very expensive which if the resident does not have adequate coverage may leave them without a good alternative. It is important for the CMA to watch for and document symptoms that a resident might be experiencing so that a better medication can be found.
•Patients in long-term care settings – ADEs are a particular problem for nursing home residents; atypical antipsychotic medications and warfarin are the most common drugs involved in ADEs in this population. Remember, most of the antipsychotic medications our residents take ie.. haloperidol, olanzapine, chlorpromazine and more cause TD which are unwanted movements that may never go away. Many also raise the risk of early death. Warfarin takes much care to track and keep on top of lab values or the result could be hemorrhage or MI, CVA.
