Drug Challenges When Dealing Older Patients

Geriatric Pharmacotherapy and Medication Challenges
Prescription Problems in Elderly Patients
In elderly patients, prescriptions, over the counter (OTC), and herbals may cause problems because they suffer from several chronic disorders resulting in the excessive use of drugs compared to any other age group. It can be understood by the diminished physiological reverse, which is mostly associated with aging and can further be depleted by the chronic or acute state of diseases and drug effects. OTCs like sedatives among the elderly patients are said to cause an increase in the number of falls. These are the major concerns for the older adults because the use of multiple medications increases the risk of drug-drug counteractions and other adverse effects (Adams & Urban, 2016).
Major Physiological Changes of Aging
Pharmacokinetic changes
· Renal functioning experiences potential decrease
· Hepatic drug metabolism is also affected by aging.
Pharmacodynamics changes
· Older patients become more sensitive to effects of medications
· Some elderly patients may demonstrate decreased responses to certain medications and their adrenergic system.
Hypoglycemia unawareness
· The response of an elderly’s central nervous system decreases resulting in decreased neural density.
· The sensory, motor and autonomic fibers of an older adult are lost.
· Aging results in the decrease of tonic parasympathetic outflow while their sympathetic tone will increase.
Pros and Cons of Beers Criteria
A Beers criterion is a well-established method that provides the status of every drug being used by an elderly patient and categorizes them as either appropriate or inappropriate for given conditions. Therefore, the method is useful when evaluating the appropriateness of prescribing. The other advantage of Beers Criteria is that it gives information of each drug formulation that has been prescribed to elderly patients as it assesses its appropriateness. In geriatric patients, Beers criterion is a method used in evaluating the rationality of prescriptions. The con of this criterion is that it consumes much time (Adams & Urban, 2016).
Beers Criteria is an Evidence-based Medicine (EBM). The excessively rigid application of clinical guidelines and evidence in patient care has resulted in ‘cookbook medicine’ practice. Moreover, the clinical practice applied by Beers Criteria may be appropriate resulting in the suboptimal care given to patients. In the process, encountering inappropriate care that leads to harming some patients. Furthermore, part of physicians will become discouraged and eventually lead to the downgrading of good clinicians regarding their reasoning capacity and judgment (Adams & Urban, 2016).
Age-Related Physiological Changes on Drug Response in Older Adults
Age-related physiological changes alter pharmacokinetics because the variability in renal decline implies that dosing decisions for such patients should not be based on their age factor alone. On pharmacodynamics changes, age-related issues to psychological changes will imply that older patients become more sensitive to medication such as the orthostatic effects arising from antihypertensive therapies (Adams & Urban, 2016).
Incidence of Hepatitis C
People born from 1945-1965 (52+ years) are called baby boomers, and their chances of having hepatitis C is more compared to other adults, thus the need for testing. Hepatitis C is a condition that one can live with for decades because there is no noticeable symptom. Most of the baby boomers might have been infected in the 1960s through to the 1980s when hepatitis C transmission was at its highest. The spread of Hepatitis C is through blood contact with an infected individual; baby boomers could have been infected with procedures or medical equipment. All this would have happened before universal procedures had been put in place and infection control procedures had not been adopted. Still, others could have gotten the infection from contaminated blood and its products, and even sharing of needles facilitated the spread of hepatitis C virus (Adams & Urban, 2016).
Hepatitis C can be managed or prevented using medications such as interferon and ribavirin which amps up a patient’s immune system to enable it to fight the virus. Ribavirin is a drug taken orally that stops the virus from replicating and spreading to other parts of the patient’s body. Interferon is known to prevent complications and normally injected by healthcare professionals. The other form of treatment is the injection-free treatment option (Adams & Urban, 2016).
Reasons for Non-Adherence of Medication Therapy
Patient, medication, and socioeconomic factors are the most common reasons for non-adherence of medication therapy for the elderly population. The patient factors brought to light include physical health, past medical history, mental state, behavior/attitudes/habits, past medical history, and demographics among others. Medication factors include drug regimen, formulating and packaging, and drug handling issues. Other factors mentioned include drug interactions, the adverse presence of drug reactions, and poor labeling, especially on prescription instructions. The socioeconomic factors in question may include the lack of caregivers resulting in the overburdening of the few existing ones (Adams & Urban, 2016).
The role of nurses in promoting medication compliance is the use of a holistic care that is a biopsychosocial model as it involves the client through education. This encourages self-management and spiritual support of their patients. The nurses can improve treatment follow-up by involving their patients in decision-making especially on the treatment methods used. Through the collaboration in decision-making, communication will also be enhanced thereby facilitating the quick recovery of the patients (Adams & Urban, 2016).


References
Adams, M. P., & Urban, C. Q. (2016). Pharmacology: Connections to nursing practice (3rd ed.). Boston, MA: Pearson.