Polypharmacy and the Elderly

by Patricia Elder, RN

Although the elderly population constitute on 12.7% of the U.S. population, they consume 34% of all prescription medication and 40% of all non prescription medication. The average person 65 to 68 years of age has an average of 14 prescriptions per year. (Mauk, 2010). Medications are meant to improve the health and well being of the elder person, by relieving pain, discomfort and treating underlined disease processes. When the elderly have many medications to take it results in non compliance due to medication regiment or expense. (Smeltzer, 2008). Polypharmacy occurs when multiple medication are taken, which increases medication interaction, multiple medication effects and incorrect dosages are used. With each medication a person takes it increases the drug interaction which is responsible for many emergency room and doctors visits. Some of the side effects of drug interaction are nausea, constipation, gastrointestinal bleedings, urinary incontinence, muscle aches, sexual dysfunction, and confusion. Dizziness and increase risk for falls (Mauk, 2010).

When patients come in it is imperative to see all medications, dosage and supplements to identify potential problems and identify medications that contraindicated. In addition to teaching intervention to enhance the elderly compliance with medication by:

1. Explain medication, purpose, adverse effects and proper dosage
2. Write medication schedule
3. Teach and show how to use medication dispenser
4. Destroy or remove old unused medication
5. Instruct patient to report over the counter medications, including herbal products
6. Instruct patient to keep list of all medication, over the counter and herbal supplements
7. Recommend the use of only one pharmacy to prevent duplications and contraindications in medication regiment
8. Remind the patient of the importance of taking medication as prescribed

It is imperative that we provide patient teaching on medication as a preventive measurement and to continue to add onto there knowledge base. The cost of non compliance often leads to morbidity and mortality among the elderly(Smeltzer, 2008).

References

Mauk, K. (2010) Gerontological Nursing 2nd Edition, Jones and Bartlett Publishers, Massachusetts
Smeltzer, S. (2008) Textbook of Medication- Surgical Nursing 11th Edition, Lippincott Williams and Wilkins, Pennsylvania

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Pneumonia is the Leading Cause of Death in the Elderly

''Pneumonia is a leading cause of death in the elderly'' (Mauk, 2010, p. 402). Diagnosis of pneumonia in the elderly is often thwarted by difficulties in recognizing infection, as signs and symptoms differ from those observed in younger patients. ''In spite of the availability of potent antibiotics and sophisticated diagnostic techniques, pneumonia continues to be a serious problem among elders'' (Mick, 1997,p.100). Furthermore, the classic picture of high fever and chills, productive cough and pleuritic chest pain may not apply for elderly patients. Subsequently, ''confusion and deterioration in baseline function and performance of activities of daily living are the lone hallmarks of pneumonia among elderly patients'' (Mick,1997,p.99). Nursing observations and communications with the primary health care provider play a crucial role in the care and treatment of elderly patients with pneumonia. ''Although pneumonia may be a terminal event, recognition of symptoms, prompt diagnosis and administration of appropriate antibiotics can reduce complications and morbidity'' (Mick, 1997, p.101).Improvement is expected within 3 to 4 days of implementation of antibiotic therapy. Clinical deterioration and worsening chest radiograms indicate inadequate or inappropriate antibiotics and require reevaluation.
In addition, a number of steps can be taken to help prevent getting pneumonia. The elderly should stop smoking , avoid contact with people who have respiratory tract infections such as colds and the flu. Also, if the elderly have not had measles or chickenpox or gotten vaccines against these diseases, they should avoid contact with people who have these infections. They should wash their hands often. This helps prevent the spread of viruses and bacteria that may cause pneumonia. “Adults over 65 should get a pneumonia vaccine” (Mauk, 2010, p.403). Lastly, yearly vaccinations for influenza may prevent someone from getting the flu. Influenza often can lead to pneumonia especially in older adults.

REFERENCES
Mauk, K. L. (2010). Gerontological Nursing. Competencies for care. (2nd ed). Sudbury, MA: Jones and Bartlett Publishers.
Mick, D. J. (1997). Pneumonia in Elders. Geriatric Nursing, (18) 3, 99-102

NOTE: This blog post reflects the work of A registered nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.