Unique Challenges to the Older Adult - Pharmacology across the Lifespan (Nursing)

by Prof. Lawes

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    00:01 Now let's talk about the unique challenges to the older adult.

    00:05 The first one that we have to talk about is Polypharmacy.

    00:09 Polypharmacy means poly, many; pharmacy, drugs.

    00:14 Because older adults are the favorite customers of every drugstore, CVS and Walgreens and any drugstore on the planet, because they're their largest consumer, the elderly population is most likely be on multiple drugs.

    00:28 And if you're on 2 or more drugs, you have a risk for drug to drug interaction.

    00:33 If you're on multiple drugs, there's a significant risk of drug to drug interaction.

    00:38 So, one of the main unique challenges to the older adult population is polypharmacy.

    00:44 The next is compliance.

    00:46 Because of finances, or how complex a plan of care is, or side effects, or seeing multiple doctors and multiple side effects, sometimes it's really hard for the patients to want to or to be able to comply with a medication plan.

    01:00 Now, comorbidities, that's a really long word to say.

    01:03 They don't come with just 1 disease process.

    01:06 Often, by the time a patient is elderly, they have, maybe some heart problems and some renal problems and some liver problems, they may be diabetic, hypertensive.

    01:15 They usually have more than one illness that they're dealing with.

    01:18 And sometimes, the medication treatment plans for multiple illnesses can conflict with each other and cause drug to drug interactions.

    01:25 Now, the pediatric population is at increased risk for adverse drug reactions, but so are the older adult patients.

    01:32 Now there's a Beers Criteria.

    01:34 You'll see that on the screen.

    01:36 That's a list that's been come up by the American Geriatrics Society that tells us that for inappropriate medication use in older adults.

    01:43 There are some medications that, because of their pharmacokinetics, the elderly population should not receive these medication.

    01:50 Now there's a list of them in Beers Criteria, and I encourage you to look that up and see some of the list of names that are challenging for older adults.

    01:59 Okay, now, it's your turn.

    02:01 Answer these 2 questions in the margins of your notes.

    02:05 What does polypharmacy mean? And how can a nurse minimize the risk of polypharmacy for elderly patients? Okay, good job taking the time to think through these 2 questions.

    02:19 Remember that polypharmacy means multiple drugs.

    02:23 Now, how can a nurse minimize the risk of polypharmacy for elderly patients? Well, one of the most important things you can do is do anything you can to get a complete and full medical history of medications that they're taking.

    02:36 So when you admit a patient or when you interact with a patient, asking them questions that are helpful, ask them what over the counter medications they take.

    02:44 Ask them what supplements or vitamins they take, and then ask them how many doctors they see.

    02:50 In case they don't have a complete med list with them, that's some of the ways that you can draw out the information that you need.

    02:56 So one of the most important ways a nurse can minimize the risk of polypharmacy for elderly patients is help their patients come up with a complete list of prescribed, over the counter, and supplements and vitamins that they take on a regular basis.

    03:13 Okay, now, let's talk about 7 medication strategies for elderly patients.

    03:19 Okay, the first one is just what we talked about.

    03:21 Be diligent to obtain a complete and current medication list, including over the counter and herbal supplements.

    03:28 Collaborate with a pharmacist to identify any possible adverse drug reactions.

    03:34 Use criteria to identify possibly inappropriate meds for the elderly.

    03:38 Remember, we talked early about Beers Criteria.

    03:42 Assess and accommodate age-related pharmacokinetic and physical changes.

    03:46 So, knowing what you know about the pharmacokinetic changes in absorption, distribution, metabolism, and excretion, you want to make sure that you assess for those possible changes and accommodate those.

    03:59 Now as far as the physical changes, elderly patients often have problems with hearing, vision, and actual manual dexterity.

    04:08 So you want to assess that and help them problem solve.

    04:11 If the patient has a difficult time hearing, make sure you figure out what is most helpful to them.

    04:17 Some people have more hearing loss on 1 side or the other, so always speak to their more effectively hearing side.

    04:24 Vision problems. Don't provide paperwork that has tiny, tiny print. Make sure it's a print that the font size is large enough that the patient can read.

    04:33 And as far as manual dexterity, work with a patient, particularly if you're sending them home with medications that they can't open, or types of administration routes that they can't handle, like if they have to give themselves a SubQ injection and they just don't have the manual dexterity to do that.

    04:48 So make sure that you assess and accommodate for age-related pharmacokinetic and physical changes in your elderly patients.

    04:57 The next important assessment is to assess their ability to follow the medication plan, including their ability to actually acquire the prescribed medications.

    05:06 Some medications that are prescribed are phenomenally expensive and far outside the range of elderly adult resources.

    05:14 So help them narrow that down and make sure they can acquire those medications that have been prescribed for them.

    05:19 If they can't, work with a team member, like a licensed case social worker to help provide that medication for them.

    05:25 Notify the health care provider so another medication can be prescribed.

    05:29 Look for other alternatives or options that are appropriate and work with the whole team to do that; the health care provider, the social worker, and the patient.

    05:39 Utilize return demonstration in patient education versus just talking at them.

    05:44 You explain something in person, that's very helpful.

    05:47 You're already aware of their vision problems or possible vision problems, or hearing problems, or manual dexterity problems, but as you educate the patient, it's not enough for them to just tell you that, yes, they understand.

    06:00 Most of the elderly population is very compliant when they're talking with a nurse.

    06:04 And if you ask them if they understand they will say, "Yes," just because they want to please you or they want to be polite, or they're embarrassed that they don't understand.

    06:13 So return demonstration, asking the patient to show you how they would take that medication.

    06:19 Asking the patient simple, encouraging questions about their program -- medication plan that allow them to be successful, will help you assess how much they truly understand what we're talking about.

    06:30 Now, I want you to think of your favorite elderly person, because this is what nursing is all about.

    06:36 You want to treat every patient that you come into contact like they're somebody that you feel is your very favorite person.

    06:43 You want that kind of respect and care given to each 1 of them.

    06:47 So, thinking of that favorite elderly person in your world, which one of these 7 strategies would be the most helpful to keep them safe? I just want you to circle it in your notes.

    07:01 Now, keep in mind, whenever you take care of a patient, that we should treat everyone with that same kind of respect and care.

    07:08 Thank you for watching our video for Pharmacology Across the Lifespan for our elderly clients.

    About the Lecture

    The lecture Unique Challenges to the Older Adult - Pharmacology across the Lifespan (Nursing) by Prof. Lawes is from the course Pharmacology across the Lifespan (Nursing).

    Included Quiz Questions

    1. Concurrent use of multiple medications
    2. Use of different pharmacies to obtain medications
    3. Availability of the same drug in different preparations
    4. Multidisciplinary team led by a pharmacist
    1. Polypharmacy
    2. Compliance
    3. Comorbidities
    4. Increased risk of adverse reactions
    5. Memory impairment
    1. A list of potentially inappropriate medications to be prescribed to the elderly
    2. A list of medications that have adverse effects when taken with alcohol
    3. A set of guidelines to treat common diseases in elderly clients
    4. A comprehensive source of information regarding supplements
    1. Compiling a comprehensive list of medications, supplements, and vitamins taken by the client
    2. Recommending that all medications be taken at the same time
    3. Assessing the ability to pay for the medication
    4. Using the teach back approach when educating

    Author of lecture Unique Challenges to the Older Adult - Pharmacology across the Lifespan (Nursing)

     Prof. Lawes

    Prof. Lawes

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