Reviewing An Elderly Patient S Medications

Medication review is the starting point for comprehensive rehabilitation of an elderly person in order to support physical or mental functional capacity.An elderly patient appreciates a clear diagnosis and an approach where the doctor both listens and discusses the matter before starting or reducing medication – this will also improve patient compliance. An improved quality of life as the aim of medication is emphasized in elderly patients. Problems encountered include both underuse, which is often associated with underdiagnosis (e.g. memory diseases, heart disease, disease prophylaxis, pain), and inappropriate medication (medication without a clear indication, or a drug for which the risk of adverse events outweighs the clinical benefit). It must be borne in mind that some of the patient’s symptoms may not be due to an illness but are an adverse effect of a medicine. Some medicines may often cause adverse effects in elderly patients (e.g. long-acting benzodiazepines, antipsychotic drugs, anticholinergic drugs, oral antidiabetic drugs and anti-inflammatory analgesics). The possibility of dehydration and undernourishment should be remembered both in patients living at home and those living in a care facility. Sufficient intake of protein from food is of particular importance for drug metabolism. Protein malnutrition and vitamin deficiencies develop easily and insidiously in elderly persons .

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Comprising a single repository of knowledge and scientific evidence in the field, this book provides strategies to mitigate fall risk by providing information on the complex interactions between aging processes, co-morbid conditions and prescribed medications in older patients. Geriatric health is becoming a more prominent issue as the population ages, and balancing the beneficial effects of medication against the potential and real side-effects in these patients involves a deliberate and thoughtful task: physiologic aging, the accumulation of co-morbidities, and the use of drugs to manage various conditions and symptoms generates a unique set of problems for each patient. Falls are a dreaded event in older people. The event can affect a person in a physical, and psychological manner, resulting in soft tissue and bony injury, fear of falling, and depression. The identification of and reduction in fall risks in older people is a worldwide concern, and reducing the incidence of falls is a ubiquitous quality measure of health care delivery. Heterogeneity amongst older people precludes a single solution. However, physicians and others involved in the care of geriatric patients will benefit from the presented insights into how medication use can be modified to limit its impact as a contributing factor.

This book will present available evidence on research interventions and strategies to reduce the incidence of medication errors. This will include discussion regarding common errors and present the best available evidence related to the identification and management of medication incidents (errors) associated with the prescribing, dispensing and administration of medicines in the older person in the acute, subacute, and residential care settings.

This book has two main purposes: formative case analysis and self-assessment of medicine in old age. It presents clinicians with a series of cases on which to base discussion of the investigation and management of patients. It also provides the trainee, or established doctor, with a medium to help prepare for post-graduate examinations and clinical practice. The authors have chosen 109 cases, a total of 250 questions/answers, illustrated by color photographs, diagrams, and tables. The cases cover the main modes of presentation of acute illness in old age, such as fall, confusion, incontinence, weight loss and immobility, with examples from all the major systems. These illustrate the complexity of diagnosis and treatment of medical illness in frail older people and the need to think widely and laterally when caring for such patients. The questions are mostly in best-of-five format to reflect the current style of multiple choice questions used in examination, though some are open questions as the basis for tutorials. Many of the clinical stems have been expanded to improve the educational function of the book and to test more rigorously the reader’s deductive thinking.

This book clearly explains when and how different rehabilitation techniques should be applied in the aging patient, thereby enabling readers to identify and apply those rehabilitation strategies that will maximize quality of life and functional independence in individual cases. It is specifically designed for ease of consultation and rapid retrieval of the information most relevant to clinical practice. Prominence is given to the benefits of a multidisciplinary approach to rehabilitation, with discussion of a very wide range of aspects of rehabilitation in different disease settings. The breadth of coverage is illustrated by the attention paid to less commonly addressed topics such as visual and hearing rehabilitation, the role of robotics and 3D imaging techniques, variations in approach among health care systems, and rehabilitation in end-of-life care. The authors are international academic experts in their fields, guaranteeing a high scientific standard throughout. This manual will be an invaluable tool and source of knowledge for geriatricians and physiatrists but will also appeal to a wider range of clinicians, practitioners, and students.

This book provides an overall introduction to the medical management of dementia with chapters dedicated to specific topics such as pain, epilepsy, vascular risk factors in dementia and review of medication, which are often not addressed in books on the subject, and thereby filling a gap in the field. Chapters are supplemented with cases to highlight key concepts and treatment approaches, and to provide the reader with the possibility to reflect on management options and the readers ́ own current practice. This book is aimed at clinicians of different specialties (mainly neurology, psychiatry, geriatric medicine and general practice/family medicine) who manage patients with dementia on a regular basis, and thus provides useful guidance to be used in the clinic.

Medication Management in Care of Older People is an accessible introduction to medication management and its role in the management of older people and their medicines. It addresses key issues in medication management, evaluates professional roles and clinical practice initiatives and explores healthcare policy and prescribing initiatives. This text explores the biology and neurobiology of ageing, pathological conditions such as Parkinson’s and Alzheimer’s disease, medication errors, issues of concordance, long term conditions and the older person, the principles of applied pharmacology and its relationship to older people. Medication Management in Care of Older People will be of interest to health care professionals who either have an interest in medication management and older people, or who are qualified independent or supplementary prescribers, and will enable them to comprehend the principles of applied pharmacology and medication management to enable them to use this knowledge in their daily practice. Illustrates the current issues, concerns and approaches used to manage older people and their medicines. Builds on pertinent current policy and research initiatives including the NSF for Older People and 'Building a Safer NHS for Patients: the role of medication safety' Each chapter features case studies, learning outcomes and implications for practice “I found this book to be interesting and highly relevant to OT practice. I would recommend this book as a learning resource to inform, review and support clinical therapy practice. Occupational Therapists could well appreciate many of the contributory factors relating to medication problems with Older People, using this resource could raise own standards, but also assist with reducing the negative impacts of medication issues on older people.” - Sarah Montgomery, A&E Occupational Therapist and Communications Officer, (COT Specialist Section Older People), London, UK