Drugs are the most common medical intervention, especially crucial for older adults who suffer from chronic illnesses. Most seniors suffer from several chronic diseases, including high blood pressure, arthritis, and diabetes. While medications help older adults with maintaining their bodily functions and increasing their life spans, they could lead to various complications if not adhered to properly. Therefore, older adults need to be educated on medical adherence to reduce and manage the side effects of these medications.
Mrs. X’s Medication List
An initial look at Mrs. X’s list of medications shows her poor health status and also indicates that she could be deteriorating. A keener look at her medications indicates that she is suffering from several chronic illnesses, such as arthritis, congestive heart failure, hypercholesterolemia, hypothyroidism, hypertension, and coronary artery disease, in addition to depression and insomnia. Older adults are associated with co-morbid chronic illnesses (Accetta, 2010). Since Mrs. X is 80 years old, her age explains the number of drugs she is currently taking. These medicines enable her body to function; without these medications, Mrs. X could have died much earlier.
While the drugs have been fundamental in assisting Mrs. X to live better, it is also true that the more drugs she takes, the higher the risk of adverse drug reactions and interactions. In this regard, hypoglycemics, diuretics, benzodiazepines, anticoagulants, cardiovascular agents, antibiotics, steroids, and opium are some of the common medications that lead to adverse consequences (Planton & Edlund, 2010). Mrs. X is taking several medications that can be listed in two categories in the above list. Moreover, she is also taking a dietary supplement, particularly multivitamins. Research indicates that nutritional preparations might interact with prescribed medications, adversely affecting the patient (Accetta, 2010). Indeed, the fact that these medications can be bought over the counter increases the concern associated with their usage. Moreover, while the multivitamin is listed among Mrs. X medications, she might fail to inform her healthcare provider of the fact about taking the medication primarily because of the belief that it is of no consequence to her health, not to mention her other medicines.
Medication Criteria
The criteria set by the American Geriatrics Society (AGS) Beers 2015 updates the list of all the medications that may prove harmful to older adults. Among the several medicines that Mrs. X is taking, there are two that are registered with AGS. Of these two, one is oxazepam, which is listed as a potentially inappropriate medication for older adults under the benzodiazepines category (American Geriatrics Society, 2015). Older adults have increased sensitivity to benzodiazepines, in addition to a perceptible decrease in metabolism, especially for enduring agents. Benzodiazepines are associated with various risks, including increased falls, fractures, delirium, increased risk of cognitive impairment, and motor vehicle accidents (American Geriatrics Society, 2015). The other potentially inappropriate drug is amitriptyline, which is ranked under the antidepressants category as a standalone or in combination. Because it is highly anticholinergic, sedating can result in orthostatic hypotension (American Geriatrics Society, 2015). Amitriptyline is classified as potentially harmful if taken alone or in combination with other medications.
Medication Side Effects
The side effects of these medications, either alone or in combination, are evident in the multidimensional assessment tool, SPICES. SPICES lists five core risk factors to caring for adults: skin integrity, problems in eating, incontinence, confusion, evidence of fall, and sleep disturbance (Aronow, Borenstein, Haus, Braunstein, & Bolton, 2014). Oxazepam is associated with increased fall, fracture, and motor vehicle accidents, which come under the evidence of fall in the SPICES list. It is also linked to cognitive impairments and hallucinations, which come under the confusion sector. Similarly, amitriptyline increases sedation levels and, by extension, confusion. Indeed, the interaction of various medications is associated with extensive adverse consequences to the patients, mainly because each drug has different side effects.
Recommendations
As a nurse, I would use different strategies to assist Mrs. X to correctly manage her medications to prevent polypharmacy. Specifically, I will endeavor to provide her with adequate information on her diseases and encourage her to share all the medicines being consumed as well as those bought over the counter. I will discuss with Mrs. X the importance of keeping an accurate list of all the medicines, including the details associated with generic and brand names, dosage, and the reason for medication (Accetta, 2010). Similarly, I will point out the importance of keeping a complete list of all medical providers, including their contact information. I will focus on teaching Mrs. X potential adverse effects and interactions of medications, the importance of seeking a qualified medical provider in the event of any concerns, and the types of drug-associated issues that may warrant emergency care. Additionally, I will impress upon Mrs. X the importance of taking medications as prescribed and why it is vital to rely on a single pharmacy for sourcing her drugs (Planton & Edlund, 2010). Furthermore, I will urge her to better organize her medicines.
Apart from the general interventions to assist in medication management, I will recommend that her physician find alternatives to oxazepam and amitriptyline that are of the same utility but not listed as potentially inappropriate by the AGS. Primarily, as a nurse, I will ensure that Mrs. X is taking her medications as prescribed. This step is particularly essential, considering that she is taking several drugs at a time.
References
Accetta, R. (2010). Polypharmacy: Strategies for reducing the consequences for multiple medications. Today’sGeriatric Medicine, 9(3), 24–32. Retrieved from: https://www.todaysgeriatricmedicine.com/archive/MJ16p24.shtml
American Geriatrics Society. (2015). American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medications use in older adults. AGS, 63(11), 2227–2246. https://doi.org/10.1111/jgs.13702
Aronow, H. U., Borenstein, J., Haus, F., Braunstein, G. D., & Bolton, B. L. (2014). Validating SPICES as a screening tool for frailty risks among hospitalized older adults. Nursing Research and Practice, #846759. https://doi.org/10.1155/2014/846759
Planton, J., & Edlund, B. J. (2010). Strategies for reducing polypharmacy in older adults. Journal of Gerontological Nursing, 36(1), 8–12. https://doi.org/10.3928/00989134-20091204-03
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