Pharmacology and the Older Adult

Geriatric Nursing

Topics
Cultural Diversity & Medication Safety Pharmacokinetics: Alteration in the Older Persons Polypharmacy Alteration and Complementary Medicine Promoting Adherence & Compliance Assessing Older Patients Appropriate Use of Medication Medication Management

Cultural Diversity
Patients whose culture is taken into consideration have better outcomes than those whose culture is not considered A key strategy for achieving cultural competence is to learn about different cultural and religious preferences, customs, and restrictions

Characteristics to Be Considered
Heritage Ethnicity Nationality Religion Culture

Five Major Ethnic Groups

European Americans
Christians Less likely to rely on spirituality (God) and turn to science Turns to the government to take care of the elderly Does not have close family ties doers does not want to be a burden to others Retirement they lose their self-worth Follows the advice of health care providers than other groups

Top 5 Health Concerns

1. 2. 3. 4. 5. Smoking by pregnant women Drug-induced deaths Deaths from poisoning Deaths from melanoma Deaths from chronic lower respiratory disease before age 45

African Americans
Most are Protestant, some are Muslim More spiritual especially in health and wellness Close family ties Does not trust authorities much Distrustful of Medical personnel

Top 5 Health Concerns

1. 2. 3. 4. 5. & New cases of gonorrhea Congenital syphillis New cases of AIDS Deaths due to HIV infection

Hispanic Americans
Mostly Catholics Places a high value in family, religion, and community Will seek homeopathic remedies with religious artifacts before seeking health care Illnesses are also due to their sins

Top 5 Health Concerns

1. 2. 3. 4. 5. Congenital syphillis New cases of tuberculosis New cases of AIDS Exposure to particulate matter Cirrhosis deaths

Asian Americans
Earliest settlers are from China Most are Buddhism, Confucianism, Taoism Basic concept: all things are composed of opposing forces (yin-yang) Should be balanced, if not, diseases manifest Some elderly clients forgo life-sustaining treatment because of Ren

Top 5 Health Concerns

1. 2. 3. 4. 5. New cases of tuberculosis Congenital syphillis No Pap test among females older than 18 Exposure to particulate matter other than 18 Carbon Monoxide exposure

Native American
Mostly Indians/Alaskan Americans Naturalistic approach to health and illness

Top 5 Health Concerns

1. 2. 3. 4. 5. Fetal alcohol syndrome Smoking by pregnant women Alcohol-related motor vehicle deaths Cirrhosis deaths New cases of gonorrhes

Ethnicity and Obesity

African American 35% Hispanic 33% European American 22% Others 30%

African American & Hispanic : Poverty European American : Higher Income & Less Education; or Excess in Living

Pharmacokinetics
Time course by which the body absorbs, distributes, metabolizes, and excretes drugs How drugs move through the body and how quickly this occurs

Absorption
Movement of a drug from the site of administration, across the biological barriers, into the plasma Least affected by age, although drug movement decreases

Distribution
Movement of a drug from the plasma into the cells As people age, water declines and fat stores increase
Affects distribution phase of water-soluble & fat soluble drugs

Hepatic & Renal mass, & hepatic & renal blood flow decrease
Hepatic metabolism of drugs is reduced Renal excretion is also decreased

Pharmacodynamics
Time course a and effect of drugs on cellular and organ function. Is what drugs do when they are inside the body Ex.
Benzodiazepines increased sedation Opiates increased analgesia and respiratory suppression Warfarin increased anticoagulant effect

Polypharmacy
Prescription, administration, or use of many medications than are clinically indicated in a given patient

Screening for Polypharmacy

Is the medication necessary? Do the benefits outweigh the risks? Is this the safest drug available? Is the frequency of the medication prescribed properly? Is the medication prescribed in the most appropriate dose, route, and/or form?

Complementary & Alternative Medicine (CAM)

Is a group of diverse medical and health care systems, practices, and products that are not presently considered part of conventional medicine

Classifications of CAM
1. 2. 3. 4. 5. Whole Medical Systems Mind-body medicine Biologically Based Practices Manipulative and Body-based Practices Energy Medicine

Whole Medical Systems

Involves complete systems of theory and practice that have evolved independently from parallel to allopathic medicine Examples:
Homeopathy Naturopathic Medicine

Homeopathy
By German physician Dr. Samuel Hahnemann Natural law of like cures like or Principle of Similars Homeopathic Theory: when a persons vital force or self-healing process is out of balance, health problems will develop Goal: Stimulate the bodys own healing responses to prevent or treat illness

Naturopathic Medicine
Principles:
The healing power of nature Identification of the cause and treatment of disease The concept of do no harm Doctor as teacher Treatment of the whole person Prevention

Naturopathic Medicine
If the body is supported and the barriers removed, the body will heal itself Natural healing takes longer than allopathic medicine Examples:
Ayurveda Traditional Chinese Medicine

Ayurveda
A comprehensive system that encompasses the body, mind, and consciousness connection and seeks to restore a persons harmony or balance All things are made up of Five (5) Elements:
Space or ether Air Fire Water Earth

Types of Energy (Doshas)

Vata
Energy of movements and comes from ether and air

Pitta
Energy of digestion and comes from fire and water

Kapha
Energy of lubrication and structure and comes from water and earth Keeps cellular body together

 Disease is caused by an imbalance in the body or disorder Diagnosis is made through symptomatology rather than through traditional laboratory diagnosis Goal: to get the body into balance

Traditional Chinese Medicine

Includes acupuncture, herbal medicine, massage, and meditation The body is a balance of opposing forces: yin & yang YIN
Cold, slow, darkness or passive principle Female aspect

YANG
Fire, hot, excited, active principle Male aspect

Mind-Body Interventions
Among the most widely used of the complementary and alternative modalities Prayer, deep breathing, meditation, yoga, bidfeedback, tai chi, and guided imagery. Pet therapy and music therapy are also included Emotional, mental, social, spiritual, and behavioral factors affect health

Examples
Prayer Meditaton Tai Chi Guided Imagery Biofeedback Pet-assisted Therapy Music therapy

Biologically Based Therapies

Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, proteins, prebiotics and probiotics, whole diets, and functional foods

Manipulation & Body-Based Practices

Focuses on the structures and systems of the body Believes that parts of the body are interdependent and the body has the ability to heal itself Examples: Chiropractic Practice, Massage Therapy

Energy Medicine
Two types
Veritable Energy Field Putative Energy Field

Examples: Therapeutic (healing) Touch and Reiki; and Sound Energy Therapy

WHY CAM?
Pain relief Increase quality of life Maintain health and fitness Return to a kinder and gentler medicine

Nursing Interventions
Ask:
Why a particular method is used The source of the therapy Knowledge of the side effects