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Tuesday, December 9, 2008

Counseling, Old Age and Medication

Summarize the following factors that are associated with the use of medication for the treatment of mental disorders in the elderly. Write two sentences for each summary:
Polypharmacy.
Drug compliance.
Side effects.
Drug metabolism.
Drug costs.
Food-drug interactions.
Other factors that you view as important.

My Answer:
1. Polypharmacy or the use of multiply medication is critical for the Elderly patients. They use more medications than younger patients and the trend of increasing drug use continues through 80 years of age. Studies conducted in a variety of settings have shown that patients over 65 years of age use an average of 2 to 6 prescribed medications and 1 to 3.4 non-prescribed medications (Stewart and Cooper, 1994).

2. Drug compliance. The consequences of drug noncompliance or the correct following of medical advice may be serious in older patients. Estimates of the extent of noncompliance in the elderly vary, ranging from 40% to a high of 75%. Three common forms of drug treatment noncompliance are found in the elderly: overuse and abuse, forgetting, and alteration of schedules and doses (Salzman and Kupfer, 1995).

3. Side effects or problems that occur when treatment goes beyond the desired effect especially antipsychotic medications are particularly problematic in elderly patients, who experience many age-related changes that may exacerbate medication side effects. Side effects of particular concern in the elderly include anticholinergic reactions, parkinsonian events, tardive dyskinesia, orthostatic hypotension, cardiac conduction disturbances, reduced bone mineral density, sedation, and cognitive slowing (Masand, 2000).

4. Drug metabolism or the set of chemical reactions of drugs is significant with the elderly. Aging is accompanied by marked changes in the physiology of many organs, as well as in their constituent cells. These nonpathological alterations in structure and/or function may affect normal physiological processes in the elderly (individuals >65 years) (Schmucker, 2001).

5. Drug costs particularly to elderly have not only had economic impact but health is affected. The increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions (Tamblyn, 2001).

6. Food-drug interactions. Interactions between food and drugs may inadvertently reduce or increase the drug effect. The majority of clinically relevant food-drug interactions are caused by food-induced changes in the bioavailability of the drug (Schmidt, Lars and Dalhoff, 2002).

7. Many elderly needs further assistance in monitoring their taking of medication. As age progress so does the number of prescription drugs is taken. The difficulty is not just in keeping track of the right medication and the side effects due to polypharmacy but the elderly has lesser capacity to scrutinize and avoid jeopardizing their health due to all the above cases as they keep themselves healthy and live longer.

References:

Masand PS (2000).Side effects of antipsychotics in the elderly. Department of Psychiatry, State University of New York, Syracuse 13210, USA. Retrieved on December 2, 2008 at: http://www.ncbi.nlm.nih.gov/pubmed/10811243

Salzman C, Kupfer D, Frank E. Medication compliance in the elderly. The Journal of clinical psychiatry. Wallingford CNS Academy, New York NY 1995, vol. 56. Physicians Postgraduate Press, Memphis, TN. Retrieved on December 2, 2008 at: http://cat.inist.fr/?aModele=afficheN&cpsidt=3457179

Schmidt, Lars E.; Dalhoff, Kim (2002). Food-Drug Interactions. Review Article on Drugs. 62(10):1481-1502, 2002. Retrieved on December 2, 2008 at: http://drugs.adisonline.com/pt/re/drugs/


Schmucker, Douglas (2001). Liver Function and Phase I Drug Metabolism in the Elderly: A Paradox. Review Article on Drugs & Aging. Retrieved on December 2, 2008 at: http://aging.adisonline.com/pt/re/dra/abstract

Stewart RB, Cooper JW (1994).Polypharmacy in the aged. Practical solutions.
Department of Pharmacy Practice, College of Pharmacy, University of Florida. Retrieved on December 2, 2008 at: http://www.ncbi.nlm.nih.gov/pubmed/8075473


Tamblyn, R. (2001). Adverse events associated with prescription drug cost-sharing among poor and elderly persons. Journal of the American Medical Association Volume: 285 Issue: 4 Pages: 421-429 Published: Jan 24 2001. Retrieved on December 2, 2008 at: http://jama.ama-assn.org/cgi/content/abstract/285/4/421

Last edited on: December 2, 2008 11:43 AM
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