Preventing polypharmacy in older adults. Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension. Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Among older adults, polypharmacy is a common problem.
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Many diseases affecting older adults have similar symptoms. What you need to know about five commonly misdiagnosed conditions for people over 50. The real world can become very small for older adults who cannot travel or attend family events. But they may be able to escape through virtual reality.
Currently, 4. 4% of men and 5. These agents include both prescription and over- the- counter (OTC) preparations, such as vitamin and mineral supplements and herbal products. The most commonly used drugs—acetaminophen, ibuprofen, and aspirin—are available OTC and contribute significantly to adverse drug reactions in the elderly. Generally, the more drugs a person takes, the greater the risk of adverse reactions and drug interactions. The drug categories most commonly involved in adverse reactions are cardiovascular agents, antibiotics, diuretics, anticoagulants, hypoglycemics, steroids, opioids, anticholinergics, benzodiazepines, and nonsteroidal anti- inflammatory drugs. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. This article explores potential problems related to multiple drug use in the elderly, including age- related alterations in response to drugs, drug- drug and drug- herbal interactions, and nonadherence with the medication regimen.
Another factor to consider is the value of older adults and children spending time together, as well as elders being mentors to young adults, struggling parents and.
Reducing medication risks in older adults; Here are strategies you can use to help patients reduce the risk of polypharmacy.Information. Discuss with patients the. Get the latest Alzheimer's Disease Facts and Figures report. Learn annual statistics on the impact of Alzheimer's and dementia. Learn how many Americans are living. Depression in older adults is associated with an increased risk of death and disability Cognitive and functional impairment and anxiety are more common in older than.
It also identifies strategies to minimize these risks. How aging affects response to drugs. Older persons react differently to medications than younger persons.
Although absorption rates for most drugs don’t change with age, aging alters body fat and water composition: fat stores increase while total body water decreases. These changes can alter therapeutic drug levels, causing greater concentrations of water- soluble drugs and longer half- lives of fat- soluble drugs. Also, because the liver metabolizes many drugs, such age- related changes as reduced hepatic blood flow and liver size alter drug clearance. Drug elimination also may be affected by age- related decreases in renal blood flow, kidney size, and glomerular filtration rates, as well as changes stemming from chronic diseases. Additionally, digoxin and certain other drugs are bound to plasma proteins so that only the unbound or free portion of the drug is biologically active. Therefore, decreases in serum albumin levels—common in older adults with chronic illnesses, malnutrition, or severe debilitation—can lead to higher drug blood levels. Subsequently, older patients may be more sensitive to some drugs and less sensitive to others.
Adverse reactions to drugs. Adverse reactions are common in older adults and often manifest differently than in younger patients. An estimated 3. 5% of ambulatory older adults experience an adverse drug reaction each year; 2. What’s more, some adverse reactions are identified incorrectly as health problems.
For instance, falls, dementia, and urinary incontinence are common in the elderly and can result from a health problem or a medication. In a prescribing cascade, an adverse reaction to one drug goes unrecognized or misinterpreted, causing the healthcare provider to inappropriately subscribe a second drug to treat signs and symptoms. This can lead to potentially dangerous situations and overprescribing. Dietary and herbal preparations.
Dietary supplements (such as vitamin and mineral supplements) and herbal preparations have become popular. For instance, ginkgo biloba, St. John’s wort, echinacea, ginseng, garlic, saw palmetto, kava, and valerian root are promoted for their purported use in preventing or treating various health problems, including depression and the common cold. A person may start taking these preparations after hearing about them from friends, family, or the media. Mall Plymouth Meeting. And because they’re available OTC, patients may not think they should mention them to healthcare providers. Yet these preparations can interact with prescribed medications and lead to serious adverse effects.
So be sure to ask the patient about all preparations—not just prescription drugs—he or she is taking. Poor adherence to the medication regimen. Poor adherence to the medication regimen is an ongoing problem among older adults. Although most patients are motivated to take their medications as prescribed, some may fail to comply due to lack of understanding, confusion, or simple forgetfulness.
In other cases, prescribers may advise a patient to cut tablets in half to lower the dosage—but this task may be difficult or impossible for elderly patients with decreased vision or poor manual dexterity. Also, some patients may attribute unpleasant symptoms to a medication and, without consulting the prescriber, decrease the dosage or even stop taking the drug.
Virtual Reality for Older Adults. For older adults who cannot travel or attend family events, the real world can become very small and stifling. But they may be able to escape their isolation to a degree through virtual reality (a technology that generates visuals and sounds making users feel as if an artificial world is real) — and a number of entrepreneurs are developing programs to make that possible. Rendever is a company that specializes in creating virtual reality (or VR) for older adults by using algorithms that convert 3.
We’re aggregating tons of wonderful content, like beach scenes,” says Dennis Lally, CEO of the company. They can go to a Maui beach and watch the waves come in for 3. They could sit in the front row of a concert that they wouldn’t otherwise be able to attend. We also provide educational stuff, like historical tours or architectural exhibits.”Missing Out on Memories. But the most important thing is for families to connect with their loved ones, Lally says. When he went away to college, Lally tried to stay in contact with his beloved grandmother.
He knew his phone calls meant so much to her, since she was confined to her home. But he noticed that she struggled to stay focused on the present. Her world was slipping away from her. The thought of being able to actually see her, or for her to be a part of my life, is really important to me,” he says.
Immersing patients in virtual reality may stimulate the brain .. Rendever co- founder and COO Reed Hayes had similar experiences with family members who were residents of assisted living communities and memory care units. Every time I went there, no one really had a smile on their faces. It was quite depressing, and it made it seem like the aging process was pretty scary,” he says. Years later, he visited his mother- in- law in an elder care community.
Her diminished quality of life as a result of dementia touched him deeply.“It affected the whole family,” says Hayes. She wasn’t able to go out or do the things she loved to do.
It caused her to miss some important life moments.”A World at Their Doorstep. Lally and Hayes met as MIT graduate students. During one conversation, they got onto the subject of their older loved ones.
We thought we could do something by leveraging some new technologies like virtual reality to help stimulate the minds of these older folks,” says Hayes.“I was on board pretty quickly,” says Lally. My background is in health care, and I have always had a passion [for that]. I actually thought of going into practicing medicine, but when I met Reed, this idea sort of bubbled to the top.”Created in 2.
Rendever offers a subscription- based service to individuals and facilities to offer older adults immersive, engaging experiences through VR headsets. Hayes recalls a recent visit to a facility in Massachusetts where an older woman put on the VR goggles. She started telling us, ‘Oh, this is Yosemite Park!’ She told us about how, when she graduated college, she went there by herself to go camping.
The only things she had were a tent and a . Hayes,Rendever can even capture a family event on a camera and then create a virtual reality experience of it for family members who could not attend. Lally plans to record his upcoming wedding in Greece and share it with his grandmother through virtual reality, so she can feel as though she is a part of the event. Virtual Reality: A Distraction from Pain. The virtual reality technology may also have a physically therapeutic effect. Immersing patients in virtual reality may stimulate the brain and reactivate some neuropathways by taking away other distractions — or serve as a distraction from confusion or pain, studies suggest.
University of Washington research scientist Hunter Hoffman and psychology professor David R. Patterson have used immersion VR for pain control in burn patients of all ages.
Developed in 1. 99. Snow. World takes individuals through a simulated ice canyon where participants throw snowballs at each other as a distraction from their pain. The project, at the University of Washington HITLab in collaboration with Harborview Burn Center, was the first immersive virtual world designed for reducing pain. Brooke Army Medical Center Institutes of Surgical Research is examining the use of VR as a pain distraction for wounded soldiers. Therapy for Dementia Patients.
Dr. Sonya Kim, founder and CEO of One Caring Team in California, realized there was a link between the isolation of older adults and the diminished quality of life. She developed the One Caring Team organization to address the issues and needs of older adults by building relationships, connecting through phone calls, and offering support to caregivers. Kim was giving a talk about one of her programs at an assisted living facility, when a man asked her if she had a solution for his mother, who had dementia.“Because of her dementia, she could not participate in our care call program,” Kim says.
Drug prescribing for older adults. Literature review current through. This topic last updated. May 2. 6, 2. 01. 7. INTRODUCTION — Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient's physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation. Avoidable adverse drug events (ADEs) are the serious consequences of inappropriate drug prescribing.
The possibility of an ADE should always be borne in mind when evaluating an older adult individual; any new symptom should be considered drug- related until proven otherwise. Prescribing for older patients presents unique challenges. Premarketing drug trials often exclude geriatric patients and approved doses may not be appropriate for older adults .
Many medications need to be used with special caution because of age- related changes in pharmacokinetics (ie, absorption, distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the drug). Particular care must be taken in determining drug doses when prescribing for older adults. An increased volume of distribution may result from the proportional increase in body fat relative to skeletal muscle with aging.
Decreased drug clearance may result from the natural decline in renal function with age, even in the absence of renal disease . Larger drug storage reservoirs and decreased clearance prolong drug half- lives and lead to increased plasma drug concentrations in older people. As examples, the volume of distribution for diazepam is increased, and the clearance rate for lithium is reduced, in older adults.
The same dose of either medication would lead to higher plasma concentrations in an older, compared with younger, patient. Also, from the pharmacodynamic perspective, increasing age may result in an increased sensitivity to the effects of certain drugs, including benzodiazepines [3- 6] and opioids . Hepatic function also declines with advancing age, and age- related changes in hepatic function may account for significant variability in drug metabolism among older adults . Especially when polypharmacy is a factor, decreasing hepatic function may lead to adverse drug reactions (ADRs).
A stepwise approach to optimized prescribing of drug therapy for older adults will be reviewed here. Drug treatments for specific conditions in the older population are discussed separately. MEDICATION USE BY OLDER ADULTS — Medications (prescription, over- the- counter, and herbal preparations) are widely used by older adults. Prescription medications — A survey in the United States of a representative sampling of 2. At least one prescription medication was used by 8. Five or more prescription medications were used by 3. In a sample of Medicare beneficiaries discharged from an acute hospitalization to a skilled nursing facility, patients were prescribed an average of 1.
Herbal and dietary supplements — Use of herbal or dietary supplements (eg, ginseng, ginkgo biloba extract, and glucosamine) by older adults has been increasing, from 1. One study in over 3.
United States found that almost three- quarters used at least one prescription drug and one dietary supplement [1. Often, clinicians do not question patients about use of herbal medicines and patients do not routinely volunteer this information. In one United States survey, three- quarters of respondents aged 1.
Herbal medicines may interact with prescribed drug therapies and lead to adverse events, underscoring the importance of routinely questioning patients about the use of unconventional therapies. Examples of herbal- drug therapy interactions include ginkgo biloba extract taken with warfarin, causing an increased risk of bleeding, and St. John's wort taken with serotonin- reuptake inhibitors, increasing the risk of serotonin syndrome in older adults [1. A study of the use of 2.
See "Overview of herbal medicine and dietary supplements", section on 'Herb- drug interactions'.)Many older adults receive their information about herbal products from the internet. Eighty percent of 3. St. John's wort, echinacea, ginseng, garlic, saw palmetto, kava, and valerian root) made at least one health claim suggesting that the therapy could treat, prevent, or even cure specific conditions [1. QUALITY MEASURES OF DRUG PRESCRIBING — Multiple factors contribute to the appropriateness and overall quality of drug prescribing. These include avoidance of inappropriate medications, appropriate use of indicated medications, monitoring for side effects and drug levels, avoidance of drug- drug interactions, and involvement of the patient and integration of patient values [1.
Measures of the quality of prescribing often focus on one or some of these factors, but rarely on all.
Ageing and older adults International Federation of Social Workers. February 2. 01. 2Introduction. Older adults comprise a growing proportion of the global population. This population shift has far- reaching socioeconomic and political implications for people of all ages. Older adults make valuable contributions to society, both material and immaterial, and younger generations benefit from their experience (1).
Increased longevity and the growing presence of older adults create new opportunities for both individual and societal development. At the same time, social and economic policies, services, and research are needed to enhance the well- being of older adults and to eliminate the ageism that prevents older people from living with dignity, realizing their full potential, and accessing resources (2). Social workers are well positioned to collaborate with older adults in creating and advocating for ageing- friendly policies and programmes, and to provide culturally competent services to older adults. Global Trends in Ageing. The global population is ageing at a rapid rate. In 1. 95. 0, just over five percent of the world’s population was 6.
By 2. 00. 6, that number had jumped to eight percent. By 2. 03. 0, experts anticipate that older adults will comprise 1.
While developing countries will experience the most rapid growth in ageing, with increases of up to 1. Women, who tend to outlive men, will comprise the bulk of the older adult population [4, 5].) Simultaneously, overall population is declining in many countries due to low fertility rates, HIV/AIDS, and international migration (6). The United Nations estimates that the number of adults 6.
Not only is the world ageing, but it is also ageing differently. Life expectancy is increasing, with people 8.
Notable exceptions include South Africa, where life expectancy dropped from 6. HIV/AIDS (6). Globally, more people are dying from noncommunicable diseases and chronic, degenerative conditions than from infectious and parasitic diseases, a trend expected to grow in the next couple of decades. Whether increased life expectancy will be associated with increases or decreases in disability status remains an open question.) At the same time, communicable diseases—especially HIV/AIDS—remain prevalent, particularly in low- and middle- income countries (3). In considering the benefits and consequences of population ageing, therefore, it is essential to consider not only longevity but also healthy life expectancy, or expected years of life free of illness, disease, and disability (8). These demographic and epidemiological shifts, combined with increasing urbanization, modernization, and rural- to- urban and international migration, profoundly affect family structures, health and long- term care provision, work and retirement patterns, and financial security (9).
In revising the international policy on older persons, IFSW has drawn upon the Madrid International Plan of Action on Ageing (MIPAA), a product of the Second World Assembly on Ageing in Madrid (2. Approved by the 1. Assembly, MIPAA outlines three priority directions for policymakers: (a) older persons and development; (b) advancing health and well- being into old age; and (c) ensuring and enabling supportive environments (1. Older Adults and Development.
Although older adults serve as essential resources to their communities, they face a great risk of marginalization. Older adults often experience both social devaluation and poverty upon leaving the labour market; financial market fluctuations contribute to income and social insecurity regardless of employment history, especially in countries with developing and transitioning economies.
Groups particularly vulnerable to poverty and social devaluation in old age, due to cultural and institutional biases which affect people throughout the lifespan, include women, people with disabilities, people with a migration background, and people who do not belong to the majority racial or ethnic group of any given society. Moreover, older adults seeking support to maintain independence and quality of life frequently encounter either a lack of social services, especially in rural and remote areas, or services that are poor in quality or unresponsive to linguistic and cultural diversity. Participation of older adults in societal development enhances the well- being both of older adults and of communities as a whole and depends on multiple factors, as outlined in MIPAA. Implementation of country- specific human rights legislation and international human rights instruments, such as the Convention on the International Protection of Adults (1.
Convention on the Elimination of All Forms of Discrimination against Women (1. Convention on the Rights of Persons with Disabilities (1. Social workers advocate for older adults’ human rights and fundamental freedoms by promoting older adults’ dignity and working to end all forms of discrimination.