Minimizing Adverse Drug Events in the Elderly
By CareerSmart Learning Contributor, May 14, 2015, as published by Healthcare Hot Spot
Medications do some wonderful things. They can cure disease, prevent worsening of chronic disease, lessen uncomfortable symptoms and improve quality of life. Unfortunately they can also cause harm. Although problems related to medication use may occur in any patient at any age, the elderly are more susceptible for many reasons. For example, the pharmacokinetics (how the body processes a specific drug) changes due to the effects of aging. The absorption, distribution, metabolism and elimination of a drug is altered in this population. This must be kept in mind when managing an elderly patient.
Fortunately, almost 90% of adverse drug events in the elderly are preventable. Many times they are even predictable. Examples of preventable problems include:
- Drug interactions – use of a drug results in drug-drug, drug-food or drug-disease interaction which leads to adverse effects
- Inappropriate treatment – patient taking a medication for no medically valid reason
- Over-prescribing or under-prescribing – too much or too little of the correct drug is prescribed
- Inadequate monitoring – patient is not monitored for compliance, complications or effectiveness of drug
- Lack of patient adherence – patient is not taking the drug or not taking the drug correctly
- Poor communication between care providers about patient conditions, symptoms and medication usage
Even though you may not be the prescriber of medications, it is important to work closely with the prescribers to consider the following in order to minimize adverse drug events for your patient:
- Consider nondrug treatment when possibles
- Use the fewest drugs necessary
- Monitor the patient for signs of adverse drug effects, request for routine measuring of drug levels and other lab tests as necessary
- Explain use and adverse effects of each drug; provide clear, written instructions to the patient (or caregiver if there are cognitive challenges) about the reason for the medication and how to take the drug safely. Asking the patient or caregiver to explain what was taught (a â€œteach-backâ€) is an effective way to ensure understanding.
- If patient has started a new medication, assume a new symptom may be drug-related until proven otherwise
- While computerized programs alert clinicians about potential problems when ordering (such as allergies, need for reduced dosage in patients with impaired renal function, drug-drug interactions), it is good practice to regularly review all drugs taken by the patient and to keep a list of all current medications including non-prescription medications such as vitamins or herbal supplements. Review with the physician is each drug still necessary? Is there a safer alternative? Has there been a change in patient condition that warrants a change in medication? Questions like these and related discussions with the other healthcare professionals involved can help to ensure the risk of adverse drugs events is minimized.
While medications can be beneficial it is imperative that clinicians provide ongoing oversight to minimize the potential for adverse drug events in the older adult. Since many of these adverse events are preventable and even predictable, we can have a significant impact on our patient’s wellbeing by our continued vigilance. Clinicians can utilize tools and prescribing criteria, such as the Beers Criteria, for assisting in determining the best choice for medications in older adults. To review additional information and a list of potentially inappropriate medications, refer to the Journal of the American Geriatrics Society.
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J. Mark Ruscin, PharmD, Sunny A. Linnebur, PharmD, FCCP, BCPS, CGP (2014) Drug-Related Problems in the Elderly. Retrieved 05-07-2015 fromhttp://www.merckmanuals.com/professional/geriatrics/drug-therapy-in-the-elderly/drug-related-problems-in-the-elderly
AGS (The American Geriatrics Society) / The American Geriatrics Society 2012 Beers Criteria Update. Retrieved on 5/12/15 fromhttp://www.americangeriatrics.org/