Fifty-one percent die from these reactions; 70 to 80 percent of the adverse re-
actions are dose related.
There are several important reasons for such a high occurrence of adverse
response to medication. These include:- Polypharmacy (multiple medications are prescribed without discontinuing
current medication, causing an interaction between drugs); - Medication can impair the mental and physical capacity leading to acci-
dental injury; - Age can increase the sensitivity to drugs and drug-induced disease;
- Absorption of medication is altered due to an increase in gastric pH;
- Distribution of the medication is affected because of a decrease in lean
body mass, increased fat stores, a decrease in total body water, decreased
serum albumin, and a decrease in blood flow and cardiac output; - Metabolism changes as enzymatic activity decreases with age, and liver
function; - Excretion is impaired due to decreased kidney function.
ASSESSING THE ELDERLY
Begin assessing an elderly patient by obtaining a complete history of medications
used by the patient. This includes all prescription drugs, over-the-counter drugs,
home remedies, vitamins, and herbal treatments. Make sure that you determine
the medications that have been prescribed and medications that the patient actu-
ally takes. Include those that are taken at the patient’s discretion. Some patients
don’t take all of the medications that are prescribed to them because of the cost
of the medication or some unpleasant or undesirable side effects. Also note how
often the medications are taken.
List all practitioners who prescribed medications for the patient, including the
patient’s primary physician, orthopedist, and cardiologist. Create a list of all phar-
macies providing medication to the patient. Review the expiration dates for all
medications. Ask the patient how they self-medicate, if they maintain a medica-
tion schedule, and if they ever forget to take their medication. If they do, ask what
medications they’ve skipped and what they do when they forget or skip a dose.
Determine if the patient has any barriers to taking medication safely such as
allergies, physical handicaps, memory loss, cultural beliefs, and financial con-
straints. Also, learn if the patient has support from family, friends, and neigh-
bors. Most importantly, be aware of the cost of medication prescribed to the(^56) CHAPTER 3 Pharmacology and the Nursing Process