Medication and Older Adults

• Data from drug testing done by pharmaceutical companies to determine therapeutic dose ranges may not be appropriate for older adults

Drug Testing

• Testing is usually done on healthy young people
• Age-related changes in gastric acid concentration can delay the absorption of oral medications in older adults

Age-Related Changes in The Stomach

• These changes can cause increased drug absorption and possible toxicity related to decreased gastric motility
• Lithium toxicity in older adults can be prevented by increasing fluid intake to 3500 mL daily

Adipose Tissue

• As adipose tissue replaces muscle mass in older adults, fat-soluble drugs like diazepam (Valium) may have a hangover effect

Protein-Bound Drugs

• Reduced plasma protein levels in older adults taking protein-bound drugs like warfarin (Coumadin) can lead to unbound active drug molecules circulating in the bloodstream, increasing the risk of adverse reactions

Brain Receptors

• Brain receptors become hypersensitive in older adults

Polypharmacy

• The major risk of polypharmacy for older adults is being treated by more than one physician.

Self-Medicating Errors

• A home health nurse would be most concerned about self-medicating errors for an older adult living alone with type 1 diabetes who is visually impaired

Reliable Method of Patient Identification

• The most reliable method of patient identification for medication administration is an identification bracelet

Enteric-Coated Medication

• If converting an enteric-coated medication from pill to liquid form, inquire if the physician wants the dose to be the same as the pill

Pill Administration

• To facilitate administration when a patient has difficulty swallowing pills, offer a sip of water before and after each pill

Transdermal Patches

• When medicating with transdermal patches, fold and dispose of the used patch in the sharps container

What is the Medication

• When offering a pill to an older adult patient, the nurse's best response to "What is this and what is it for?" is "It's an antibiotic for the infection in your urine."
• When an 80-year-old patient refuses medication due to stomach burning, document the reason for refusal and report to the charge nurse

Theophylline Overdose

• For an older adult patient receiving the bronchodilator theophylline, assess for tachycardia as evidence of an overdose
• For a 75-year-old man on chlorpromazine (Thorazine) who begins to drool and complains of difficulty swallowing, notify the physician

Vitamin B12

• To administer 1 mL of vitamin B12 intramuscularly to an emaciated 82-year-old patient, choose a 1-inch needle to inject into the ventral gluteal site

Beers Criteria

• The Beers criteria provide guidelines for medications best avoided by the elderly, independent of diagnosis
• When preparing to crush oral medications, a nurse can crush a plain antihypertensive medication tablet

Self-Medication Program

• A self-medication program for a 70-year-old in extended care will ensure the delivery of an adequate supply of medication, locked medication storage at the bedside, and a medication administration record, but excludes payment for medication

Nursing Care Plan

• A nursing care plan for drug administration should include the patient's need for crushing medication, patient preferences for the medium in which to give crushed medicines, and the schedule of medication and dose times, but excludes the schedule for drawing blood values

Prescription Costs

• With the high cost of prescription drugs, older adults will probably not fill all prescriptions at once to get a discount

Risks for Older Adults

• Older adults are more at risk for medication-related problems related to drug-testing methodology

OTC Drug Self-Medication

• Self-medication with OTC drugs can be hazardous because OTC drugs can create symptomatology of their own

Iatrogenic Complications

• Illness developed due to medical treatment is commonly referred to as iatrogenic complications

Tools for Identifying Potential Problems

• STOPP is used to identify potential problems in older adult prescriptions

Assessment Risks

• Dry, scaly skin, poor skin turgor, and low fluid intake without feeling thirsty in a 73-year-old client are risk factors for dehydration

Nutritional Assessment

• Monitoring a patient's fluid intake and output, monitoring nutritional content, and stating the importance of keeping hydrated are required for nutritional assessment and planning
• Macronutrients included in a diet are carbohydrates, proteins, and fats

Nutrition Recommendations

• General recommendations for nutrition include avoiding oversized portions, increasing intake of fruits, veggies, and whole grains, and choosing low-fat or fat-free dairy products

Carbs

• Simple carbs are used most readily by the body because their bonds are easily broken

Protein Deficiency

• Factors affecting protein consumption for a patient advised to take protein-rich foods include the ability to procure and prepare food, the high costs of food containing protein, and the ability to chew common high-protein foods

Good Fats

• Good fats primarily composed of protein that protect against blood vessel disease are high-density lipoproteins

Malnutrition

• Disorder of nutrition resulting from unbalanced, insufficient, or excessive diet or from impaired absorption, assimilation, or use of food is malnutrition

Nutrition Factors for Older Adults

• Factors affecting nutrition in older adults include sensory changes, pain, chronic health factors, alcoholism, and medications, problems with chewing, swallowing, or digesting, and malabsorption
• Social risk factors affecting nutrition in a client who is a widow include depression, loneliness, and lack of motivation

Communication

• This is used when there is are inconsistencies in information or when verbal and nonverbal messages appear incompatible which is confrontation
• The willingness to attempt to understand the unique world of another person is empathy

Proxemics

• The analysis of the use of personal space in communication

Rapport

• Atmosphere of mutual respect and understanding helps build rapport
• Nurse never forgets to place her nursing cap, wear her apron and bring her nursing paraphernalia's before she makes her rounds in the geriatric ward. This is one way to help older adults distinguish nurses from other caregivers. This is signs

Interview Cues

• Patient appears relaxed and speaks with a melodic tone of voice

Intervention

• Nurse Paul will praise Juana on her attempt to speak and will avoid correcting errors

Therapeutic

• Mrs. Antonia take your time; it looks like you want to say something?

Communication for Nurses

• To have the daughter translate Explaining the routines of nursing care and orientation to the hospital room

Aphasia Communication

• The recommended method of communication for a patient with aphasia is open-ended interview

Social Space

• Social space is Between 4 and 12 feet
• This is for of communication is helpful nurses need to obtain specific for emergency situations in what nurses need is direct questioning
• Physical problems, pain or extreme fatigue, disease processes, diverse social and cultural back ground are among the barriers of communication

Communication for Hearing Impairment

• Nurse Paul should minimize background noise, stand at eye level in front of the patient, keep his mouth clearly visible, slowly and at a lower pitch, use visual cues, avoid exaggerated mouth motions
• Nurse Lester has been working in the geriatric ward for 20 years. He always emphasized communicating with older adults includes empathetic listening
• Emphatic listening is actively trying to understand the other person, not knowing them just but requires sensitivity of the weaknesses and limitations of aging
• Nurses Paul should determine how each older adult wishes to be addressed. It is not suggested to use the older adults title and name and clarifying which form of address the person prefers

Elements of Communication

• Tone of voice is the most influential elements of communication verbal communication is helpful for APHASIA Gestures are helpful for people who cannot use words. (APHASIA) The human face is most expressive, and have been shown to communicate across cultural and age barriers Movements is pace or speed of communication