Keeping Seniors Safe in Their Own Homes: Medication Safety

As people age, they typically take more medicines. Seniors who take several different medications each day are especially vulnerable to the effects of adverse drug reactions. Home health nurses are in a pivotal position to promote the appropriate use of medications and to reduce the risk of harm from adverse drug events. This article contains useful information to promote medication safety among the older population.

Keeping Seniors Safe in Their Own Homes: Medication Safety

Elder Risk

As people age, they typically take more medicines. Seniors who take several different medications each day are especially vulnerable to the effects of adverse drug reactions.

An adverse drug reaction is defined as a harmful or unintended reaction to a drug treatment. Adverse drug events are responsible for over 177,000 geriatric emergency department visits each year. And, one third of hospitalizations among older people are related to medication-related problems. Suspect an adverse drug effect if an elder has confusion, dizziness, falls, constipation, nausea, or loss of appetite and weight.

Older persons are also at greater risk for adverse drug reactions because of differences in the body's utilization of drugs (in other words, altered pharmacokinetics and pharmacodynamics). Pharmacokinetics is what the body does to the drug. It refers to the movement of a drug in the body through absorption, distribution, metabolism, and excretion. Pharmacokinetics may differ in an older adult by changes in drug concentrations, prolonged half-life, and drugs staying active in the body longer, thereby producing heightened sensitivity to medications.

Pharmacodynamics, on the other hand, is what the drug does to the body. The older a person gets, the more likely there will be an alteration, paradoxical, or unreliable response of the body to the drug. Some medications, such as anticholinergics, antihistamines, barbiturates, benzodiazepines, digitalis, and warfarin, produce increased drug effects in the elderly. And other medications, such as amphetamines and beta-blockers, exert decreased effects.

Prevention and recognition of drug-related problems in the elderly has become a public health priority. Nurses are in a pivotal position to promote the appropriate use of medications and to reduce the risk of harm from adverse drug events in the older adult population.

To promote medication safety, the home health nurse should instruct the elderly patient to do the following

  • Follow directions. Read and save all written instructions that come with your medications.
  • Keep an up-to-date list of your medications (prescribed medications, vitamins, OTC medications, dietary supplements, and herbal remedies). Show it to all health care providers. Give a copy to a family member for safe-keeping.
  • Let all prescribing clinicians know all medications you are using.
  • Obtain all prescriptions from the same pharmacy.
  • Use a pill organizer.
  • Take your medications (especially pain relievers) in the exact amount and time as directed.
  • Call your prescriber immediately if you experience any side effects with your medications.
  • Do not skip doses of medication.
  • Take your medicine (especially antibiotics) until it is finished.
  • Don't take your medications in the dark. Turn the light on before attempting to take your pills.
  • Check the expiration dates on medication bottles and throw away outdated medicines.
  • If you have arthritis, request medication containers without childproof packaging or caps.
  • Keep up with any blood testing recommended by your provider.

The principles for pharmacological management for older persons include

  • "Start low, go slow" (low initial doses followed by slow and cautious upward titration). The provider should wait twice as long as recommended before increasing the dose.
  • Use the least invasive medication route (usually oral).
  • Use round-the-clock dosing for persistent pain.
  • To help avoid polypharmacy, encourage the discontinuation of one drug when another is added. One drug should not be used to treat the side effects of another drug. It is much better to change the offending drug. Decrease the dosage in order to decrease the side effects.
  • Avoid the use of medications on the Beers Medication List. The Beers Criteria identify medications noted by an expert consensus to have potential risks that outweigh potential benefits in the elderly.

References

Signs and Symptoms of Adverse Drug Reactions

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

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VickyRN

About VickyRN, MSN, DNP, RN

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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Thank you for this article. It's helpful and very informative.

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Great article. I recently read that some clinics are hiring nurses to screen for polypharmacy in the elderly as well as ensuring that they know how to take their meds properly.

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Specializes in Gerontological, cardiac, med-surg, peds.
Great article. I recently read that some clinics are hiring nurses to screen for polypharmacy in the elderly as well as ensuring that they know how to take their meds properly.

Thank you for this information. This is an awesome utilization of nurses in a much-needed role. And, one that will keep seniors out of the emergency room and also help prevent hospital readmissions. This can help significantly with the new Medicare reimbursement regs.

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for elders with some cognitive problems -- memory, decision-making-- there are some wonderful gadgets to help them with medications.

some can be loaded with 30 days of meds and will dispense up to 4x/day. and send an email if the med is not taken out of the slot.

others are simpler; some people get by with a wristwatch-like gadget that gives them an alarm and a verbal cue: "take digoxin pill now."

there are services that you can order for about $250/year that will allow you to have reminder messages sent to any cell phone or pager, too. lots of good links in the following article:

mayer, d. technology and medication management. journal of nurse life care planning, vol. xi, no. 1, spring 2011, page 316 ff.

link to journal at aanlcp | american assocation of nurse life care planners

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Specializes in Hospice, Homecare, Recruiting, Psych.

Thank-you for the article. As a hospice RN for 19 years and home care RN for 7 years before that, medication safety was always an issue. I had to be creative and find ways that worked with their lifestyle to make sure meds were taken appropriately. It was always of utmost importance to check the OTC meds because of the potential interactions with prescriptions. It was a challenge but I always loved a challenge...still do!

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Thank you for the Article..it is rich with valuable information..

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