Polypharmacy in the Elderly: The Risks Often Outweigh the Benefits

“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of […]

2020-02-03T08:54:32-05:00February 3rd, 2020|Nursing|0 Comments
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Late January Friday Health Care and Nursing Stories of Note

Here’s a brief Friday update on health care news and nursing matters of interest.

Latest nursing workforce sample survey results.

The newly released results of the 2018 National Sample Survey of Registered Nurses (produced by the Health Resources and Services Administration) will interest nurses and others for a variety of reasons. A few details:

  • Telehealth becoming an essential tool: In 2018, 50.3 percent of nurses used telehealth in their practice in some capacity. This number will continue to grow.
  • Diversity increases: as summarized by the Campaign for Action, “the percentage of the RN workforce that is Hispanic has almost tripled, from 3.6 percent to 10.2 percent. There has also been a notable increase in the percent of black RNs and a decrease in the percent of white RNs in the past decade.”
  • Education level increases: Also, again according to the Campaign for Nursing, “RNs who have bachelor and higher degrees has increased from 50 percent in 2008 to 64 percent in 2018.”
  • More men: The gender imbalance in nursing has changed for the better, as well, though by no means radically: “Male RNs in 2018 represented 9.6 percent of the nursing population, up from 7.1 percent in the 2008 study.”

The novel coronavirus.

The […]

2020-01-31T13:03:15-05:00January 31st, 2020|Nursing|0 Comments
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February Issue: Contraception Options Update, Polypharmacy’s Dangers, Managing Urinary Incontinence, More

“Yes, we need to be fiscally responsible, but nurses’ main priority shouldn’t be patient throughput or implementing changes that save money while compromising care and patient outcomes. Nurses must be enabled to nurse.”—editor-in-chief Shawn Kennedy in her editorial, “Who Will Be Left to Care?”

The February issue of AJN is now live! Here are the highlights:

CE: An Evidence-Based Update on Contraception

A comprehensive review of the major characteristics of nonpermanent contraceptive methods, including combined hormonal contraceptives, progestin-only methods, nonhormonal methods, and recent innovations in contraception.

CE: Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults

The author explores the factors that contribute to polypharmacy in
older adults, examines its negative physiological and economic effects, and outlines strategies to promote safe and appropriate medication prescribing.
[…]

2020-01-27T09:45:06-05:00January 27th, 2020|Nursing|0 Comments
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As Another Coronavirus Begins to Spread, Follow Reasonable Precautions and Avoid Fear-Mongering

(Editor’s note: Published January 24. The situation has considerably changed in the intervening weeks, during which the virus has rapidly spread across the globe. We obviously now know a great deal more about the dangers it presents.)

Emerging infections are part of our world—more evident these days because we have the tools and global communication networks to quickly identify them. This month, we’ve begun another crash course in the initial management of a new pathogen.

Short timeline from first cases to screening test availability.

Rumors of a concerning cluster of undiagnosed pneumonia in Wuhan, China, surfaced on social media on December 31. The patients weren’t responding to antibiotic therapy, but tests were negative for the usual viral suspects. World Health Organization staff quickly connected with Chinese health officials and testing and epidemiological investigations kicked into high gear.

Many of the infected patients had worked at a fish and live animal market in Wuhan, suggesting that the illnesses might be zoonotic (passing from animals to human) in origin. On January 7, the pathogen was identified as a new coronavirus, related (though not closely) to the coronaviruses that cause SARS and MERS. The viral genome was quickly sequenced, and on January 12, China shared the genetic sequence with the global scientific community. By […]

2020-03-19T17:12:45-04:00January 24th, 2020|infection control, infectious diseases, Nursing, Public health|1 Comment
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Putting Down Her Burden: A Patient’s Final Choice

‘goodbye, inhaler!’

Chronic illness as a Sisyphean bargain.

Sisyphus was a legendary king of ancient Greece who was condemned by the gods to eternally roll a rock up a hill, only to have it roll down again each time as it neared the top.

Many people with chronic illness today may be able to relate. Chronic illness can mean years or even decades of worsening symptoms and ever more complex medication and treatment regimens, side effects of treatments, treatments for side effects, monetary pressures, activity limitations, a sense of separateness from the legions of the merely ‘walking worried’ around us, and the subtle pervasive tension and vigilance of never quite knowing what might come next.

The ironies of advanced medicine.

The assumption, of course, is that all the effort is worth it. And it is: many of us benefit from, or know people who benefit from, drugs that keep them alive when 50 or 100 years ago they would have died long ago, or keep them able to walk, or breathe without a struggle, or sleep without excruciating nerve pain or the itching of terrible skin sores, and so on. Life has always been about compromise; these are simply new refinements of a universal equation.

2020-01-23T10:03:01-05:00January 23rd, 2020|Nursing, nursing stories, patient experience|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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