Barriers to effective medication management among older adults include cognitive impairment, poor vision, and financial burden.
These include patient factors (eg, old age, male gender, low education level, physical and mental status, and health literacy [HL]), medication factors (eg, complexity of medication regimen, high medication costs, and poor labeling instructions), patient–provider relationship factors (dissatisfaction with health care
Side effects that worsen thinking and balance Sedatives / tranquilizers – usually prescribed for sleep issues or anxiety. Medications that affect memory, increase fall risk, or cause confusion.
One of the recommendations to reduce medication errors and harm is to use the “ five rights”: the right patient, the right drug, the right dose, the right route, and the right time.
Warfarin is one of the most common causes of medication -related hospitalizations in older adults . To reduce the risk of serious problems , one may need to apply extra care in monitoring warfarin effect (via the prothrombin blood test) and extra care in checking for interactions when a new drug is prescribed.
AVOID products that contain the antihistamines diphenhydramine (Benadryl) and chlorpheniramine (AllerChlor, Chlor-Trimeton). These medications are often included in OTC remedies for coughs, colds, and allergies. AVOID OTC sleep products, like Tylenol PM, which contain antihistamines such as diphenhydramine.
Successful strategies to improve medication adherence include 1) ensuring access to providers across the continuum of care and implementing team-based care; 2) educating and empowering patients to understand the treatment regimen and its benefits; 3) reducing barriers to obtaining medication , including cost reduction
Nine Tips for Improving Medication Adherence Educate patients about what to expect. Nurture relationships with patients. Team up with prescribers. Engage the staff. Learn about and use available technologies. Help patients customize their support tools. Schedule appointments. Synchronize medications .
To help improve adherence: Discuss matters such as a patient’s ability to pay for medications and their access to a pharmacy during each appointment. Recommend generic medications . Provide information about prescription assistance programs (e.g., NeedyMeds).
4. Increased Sensitivity to Many Drugs : The problems of decreased body size, altered body composition ( more fat, less water), and decreased liver and kidney function cause many drugs to accumulate in older people’s bodies at dangerously higher levels and for longer times than in younger people.
Common examples are oversedation, confusion, hallucinations, falls, and bleeding. Among ambulatory people ≥ 65, adverse drug effects occur at a rate of about 50 events per 1000 person-years. Hospitalization rates due to adverse drug effects are 4 times higher in older patients (about 17%) than in younger patients (4%).
Higher levels of care are for residents who need more hands-on assistance from caregivers. These residents may not be able to ambulate independently and need help walking or wheeling from one place to another. Residents need more extensive help dressing, bathing, or managing their toileting or incontinence.
During hourly rounds with patients , our nursing and support staff ask about the standard 5 Ps : potty, pain, position, possessions and peaceful environment. When our team members ask about these five areas, it gives them the opportunity to proactively address the most common patient needs.
The “rights” of medication administration include right patient, right drug , right time, right route, and right dose. These rights are critical for nurses.
Ensuring the following rights : right PATIENT . right MEDICATION. right REASON. right DOSE – for the patient’s weight. right ROUTE. right FREQUENCY. right TIME. right SITE.