geri week 7

• Effect on concentration of bioactive substances
• decreased clearance of water soluble medication
• Consider medications with a narrow therapeutic range

• Serum concentration of medications affected by liver metabolism
• Volume of distribution also affected

• Enzymes responsible for metabolism of medications
• Clearance of medications is delayed in older adults

• Higher serum concentrations
• Lower serum concentrations
• prolonged duration of action
• therapeutic versus adverse effects

• Receptor sensitivity in the brain
• thermoregulation
• fluid regulation
• baroreceptor control of blood pressure
• body size
• gender

• Age related changes
• functional impairments

• Attitudes of the older adults
• Level of knowledge
• Socioeconomic issues
• health care providers
• myths

• Medication -disease interactions: effect of the disease on medications, therapeutic effect of medications can be affected by the disease process
• Potential for adverse effects
• Pathologic conditions themselves can affect adherence to medication regimens.

• medications are a quick fix for symptoms
• over the counter medications are safe
• prescribing patterns of health care practitioners
• Nurses should always consider the beliefs of the older adult related to treatment of illness and disease

• Reluctance of older adults to question treatment and medications
• lack of confidence in communication skills
• hearing difficulties
• attitude of the health care practitioner
• language barriers

• beers criteria: identification of medications that are not appropriate for use in the older adult
• anticholinergic drugs, tricyclic antidepresseants, antipsychotics, barbiturates, and benzodiaazepines
• psychoytropic drug use in long-term care
• recent research utilizing the beers criteria

• Use of multiple medications with the increased prevalence of multiple chronic conditions
• Potential for drug interactions and adverse side effects
• need for medication monitoring - barriers in the older adult population

• Medication nonadherence/noncompliance
• factors contributing to nonadherence
• cost of medications
• lack of health insurance for prescription medication
• medicare part d prescription drug program

• multitude of potential causes for adverse medication effects in the older adult
• prescribing cascade
• adverse effects more common with advancing age
• often unrecognized

• Interact with almost any other substance
• prescription and over the counter medication
• consequences of medication interactions
• - altered therapeutic effects
• - risk for adverse effects

• number of medications taken
• serum levels affected
• ex. warfarin
• medication-herb interactions also common

• Interactions may affect the nutrient itself of the medication effects
• Common nutrients that affect medication
• Serious consequences in the older adult
• altered absorption in the stomach

• CNS depression
• health care providers often do not accurately assess an older adult's alcohol consumption
• over-the counter preparations may have alcohol as an ingredient
• older adults are more susceptible to interactions between alcohol and medications
• increased risk for adverse effects

• Medications and caffeine: caffeine not only in beverages, affects action of medication
• Medication and nicotine: affects therapeutic action of the medication, dosages of medications may need adjustment

• increased potential for altered therapeutic action with risk factors
• Consequences of adverse effects
• medication interactions with other substances

• residents long term care facilities
• anticholingeric toxicity
• altered mental status
• tardive dyskinesia

Identify clues to problems or complaints

Assess for residual adverse effects

Expected versus actual outcomes of medication interventions

Functional ability to take medications

Assessment of the living environment

Risks for nonadherence

• Instrumental self-care deficit
• noncompliance
• other nursing diagnoses for adverse effects of medications are also appropriate
• readiness for enhances therapeutic regimen mangamen

• adherence to therapeutic regimens
• identification and prevention of adverse effects
• compliance behavior
• health promoting behaviors
• knowledge
• self-care

Teaching about medications

• identification of methods to improve adherence
• address factors that interfere with adherence
• support independence
• address potential financial barriers
• -generic medications
• - prescription assistance programs

• reduces the risk for adverse effects
• evaluation of all medications used
• communication with prescribing practitioners
• utilize hospital admissions to evaluate medication
• evaluation of PRN medications
• evalution of medications for behavioral management in longterm settings

• Safety
• effectiveness
• medication-taking behaviors
• therapeutic effects