¶ … healthcare reforms that have taken place in the past decade that have led to the re-evaluation of the quality as well as the cost effectiveness of health care providers. A specialty that has evolved with this trend is that of mental health/psychiatric advanced practice nurse. There is an increase in the number of the elderly people in society today. Depression is a common mental health condition in this age group. Age related psychological, physiological and social change have to be taken into consideration when it comes to making decisions that are related to pharmacological or psychological treatments that are to be implemented.in the article we can see that the common causes of mental health problems in the elderly are institutionalization, loss of friends and family, lack of support networks, decrease in hearing, vision and memory and so on.
The article highlights some of the benefits and risks electro conclusive therapy.one benefit is that due to the severe nature of some depression episodes there can be contraindication of antidepressants by physical disease. It is mostly the only treatment choice in elderly depressed patients who have self-destructive behavior such as suicide attempts. ECT has been found to be superior to other pharmacological treatment of unipolar depression. Some of the side effects of the treatment in elderly include cardiac complications such as heart block, myocardial infarction asystoli, ventricular tachycardia; cognitive dysfunction, severe confusion, and falls. If ECT is used for depression among middle aged adults studies have shown that there are high rates of relapse within the first year.
The article also looks at some of the physiological age effects .it is indicated that an Advance practicing nurse must always have an in-depth understanding of the effect which ageing has on pharmacokinetic and pharmacodynamics of drugs.it is stated that when it comes to absorption the elderly have an increased gastric pH at the same time a decreased intestinal motility and gastric emptying that might affect the drug bioavailability. With ageing drug distribution is affected as a result of body and intracellular water decrease at the same time the adipose tissues increase. Drugs are lipophilic, in order for the drugs to pass the barrier between the blood and brain, the apparent volume of distribution has to increase for these drugs and hence they take long to be eliminated. Liver impairment as a result of age also increases the blood levels of a drug since smaller hepatic mass decreases drug amounts that are eliminated through fast metabolism changes in ageing. Changes in ageing also have an effect on the pharmacodynamics of psychotropic drugs. Receptor sites and neurotransmitters are affected.
The use of Clonazepam and other benzodiazepines in the elderly is also highlighted in the article. A high percentage of the elderly are usually prescribed benzodiazepines but this is very alarming since studies show that they are vulnerable to the side effects of these drugs such as cognitive suppression, drowsiness and psychomotor impairment. The long half life of their elimination among the elderly leads to accumulation of benzodiazepines that causes toxic effects like cognition impairment, increased injuries from falls depressive disorders and exacerbation of disturbances of sleep.clozazepam is one of the benzodiazepines.
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