More advice and information

I. The Statistics

A. Currently, approximately one out of eight (12%) people are 65 and over; by the year 2030, approximately one out of five (20%) will be in this age bracket.

B. People 65 and over have more illness, consume more drugs, and are more sensitive to adverse drug reactions than other age groups.

C. 1.5 billion prescriptions are written in the United States each year, 1/3 of which are written for those 65 and over.

D. Over the past 25 years, the average number of prescriptions per person in the general population has increased from 2.4 to 7.5 annually. People 65+ average 13 prescriptions per year.

II. The Problems

A. Adverse Drug Reactions

  1. Cost of medications
  2. Large # of medications ("polypharmacy")

B. Drug Interactions

  1. Drug-drug
  2. Drug-disease
  3. Food-drug interactions

C. Patient-Related Factors

  1. Decline in kidney and liver function with age
  2. Body composition changes (greater relative fat content, decreased relative free body water)
  3. Patient non-compliance

III. Common Signs and Symptoms

A. Anxiety

B. Confusion

C. Constipation

D. Depression

E. Falling

F. Fatigue

G. Incontinence

H. Malnutrition

I. Memory loss

J. Poor appetite

K. Restlessness

L. Weight Loss

IV. The Solutions – General Strategies

A. The Doctor

  1. "Start low, go slow"
  2. "When in doubt, leave it out"
  3. SCRUTINIZE AND RESCRUTINIZE MEDICATIONS…
    1. …AT OFFICE VISITS
    2. …UPON HOSPITAL ADMISSION
    3. …AT HOSPITAL DISCHARGE
    4. …UPON ADMISSION TO A NURSING HOME
    5. …AT ALL NURSING HOME VISITS
  4. Look for UNDIAGNOSED DISEASE AND CONDITIONS THAT ARE COMMON IN THE ELDERLY – treat diseases and conditions, not symptoms (e.g. thyroid disease, B12 deficiency, malnutrition, social isolation)
  5. Patient education

B. The Nurse

  1. Patient education
  2. Coordination of care
  3. Nursing approaches to care

C. The Pharmacist

  1. Patient education
  2. Drug interaction/compliance surveillance

D. The Patient

  1. Keep an eye on yourself!
  2. Involve your family and friends
  3. Keep an eye on your doctor!
  4. Ask questions until you get a good answer

E. Regulatory Approach

  1. JCAHO
  2. "Drug Utilization Evaluation (DUE)" Monitoring
  3. "Adverse Drug Reaction (ADR)" Monitoring
  4. Federal/DOH
  5. Mandated Psychotropic Dose Reduction Trials (Nursing
    Facility Regulations)

V. The Solutions – Other Strategies

A. Medication questions "Hotline"

B. "Brown bag" programs

C. Computerized medication profile analysis

D. Formal research

Copyright 1996-2011 Robert Stall MD / Stall Geriatrics LLC – originally written 5/10/94; posted 5/25/96; last update 1/19/2000

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