The purpose of this review was to identify evidence-based interventions related to medication management and the community-dwelling older adult. The focus of this review was interventions that fall within the scope of practice of the registered nurse. The guidelines do not address the specific intervention of medication prescribing. However, the interventions are applicable to professional nurse providers whether they are prescribing or not. This chapter discusses risk factors for problems in medication management followed by evidence-based interventions in areas of medication reconciliation, medication procurement, medication knowledge, physical ability, cognitive capacity, intentional nonadherence, and ongoing monitoring.

Non-pharmacological therapies for common chronic medical conditions in older patients are underused in clinical practice. We propose a protocol for the assessment of the evidence of non-pharmacological interventions to prevent or treat relevant outcomes in several prevalent geriatric conditions in order to provide recommendations.

This is a comprehensive outline detailing pain management in older people containing information on common challenges, assessment treatment and medication to use. 

This chapter of the Introduction to Behavioural and Psychological Symptoms of Dementia (BPSD): A Handbook for Family Physicians outlines the general approaches to the use of psychotropic medications in the management of behavioural and psychological symptoms in dementia.   22 pages.

Focused Research

The Research Institute for Aging (RIA) has been conducting projects based around a variety of themes- one of which is “optimizing medications for seniors.”

Emerging Priorities in Aging

Conferences & Workshops - Aging Research & Innovation Forum • October 26, 2012 • Kingston, ON

On October 26, 2012, as part of our series of Aging, Research & Innovation Forums, over 100 educators, clinicians, students, caregivers and researchers from across Ontario attended the Emerging Priorities in Aging conference at Portsmouth Olympic Harbour Restaurant in Kingston to discuss ideas, projects and research about the care and welfare of older adults.

Medications work with your body and/or other medications to cure, treat or prevent health conditions (1). Older adults are likely to experience health problems that require them to take medications – about 40% of those aged 85 and above use at least ten medications (2). The use of five or more medicines, including prescription and nonprescription products, is known as “polypharmacy” and can be a problem for older individuals (2).

Sometimes medications can cause side effects or react with other medications (medication interactions) (1). For example, a medicine may cause headaches or constipation, or make another medicine stronger or weaker (1). How much taken (dose), age, weight, sex or health status can affect the chances of side effects or medication interactions (1).

Prescription drugs can also interact with tobacco, alcohol, herbal supplements, certain food items and over-the-counter medications (1). To get the most out of medications and avoid medication interactions or serious side effects, take medicines as directed by the health care provider – i.e. how much, when and how (with food, drink, etc.) (1).

Try to fill prescriptions at the same drugstore or pharmacy. This way, the pharmacist has a history of which medicines used and can lookout for any potential drug interactions (1).

It is also important to keep a complete list of all medications (including non-prescription products) vitamins and supplements (including herbal products) used (3). Take this list of current medications along with the actual medications in their original containers to every medical appointment and pharmacy visit.

If you think the person you are caring for is experiencing side effects or having a drug interaction, talk to a doctor or pharmacist right away. They can review the medicines used and make sure the right treatment is given.

References

(1)  HealthLink BC. (2016). Dealing with medicine side effects and interactions. Retrieved from https://www.healthlinkbc.ca/health-topics/ug5135#ug5138

(2)  Institute for Safe Medication Practices Canada (ISMP Canada). (2018). Deprescribing: Managing medications to reduce polypharmacy. https://www.ismp-canada.org/download/safetyBulletins/2018/ISMPCSB2018-03-Deprescribing.pdf

(3)  Institute for Safe Medication Practices Canada (ISMP Canada). (2016). 5 questions to ask about your medications when you see your doctor, nurse, or pharmacist. Retrieved from https://www.ismp-canada.org/download/MedRec/MedSafety_5_questions_to_ask_poster.pdf

Polypharmacy is defined as the use of five or more prescription medications.   Polypharmacy is common among seniors and can lead to reduced adherence with medication regimens and problems with drug interactions. (4) Medication-related problems are common, costly, and often preventable in older adults and lead to poor outcomes. 

Why is this Important?

  • 27% of seniors reported taking five or more medications on a regular basis. (4)
  • 12% of seniors taking five or more medications experienced a side effect that required medical attention compared with 5% of seniors taking only one or two medications(4)
  • 27% of adverse drug events (ADEs) in primary care were preventable, with most problems occurring at the ordering and monitoring stages of care (1)
  • The number of prescription medications was associated with the rate of emergency department use. (4)
  • Less than 50% of all seniors reported receiving a prescription medication review from their physician identifying  potential side effects. (4)
  • The number of medications being taken increases the risk of adverse drug reactions (ADRs), which can increase the likelihood of hospital visits.

Key Considerations

  • When conducting a medication review ask for all prescribed medications, OTC and herbal preparations
  • Monitor compliance of medication adherence, ask about common side effects and adverse occurrences especially when new medications have been ordered
  • As patients become more frail, the potential harm from medications must be weighed against the potential benefits (1)
  • Follow the Beers criteria when prescribing and evaluating: 
    i)    medications to avoid in older adults regardless of disease or conditions
    ii)   medications considered inappropriate when used in older adults with certain conditions or syndromes
    iii)  medications to consider for use in certain individuals recognizing the potential for misuse and harm is substantial (5)

References

1.       Campanelli, C. (2012).  American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate
          Medication Use in Older Adult. 
Published online Feb 29, 2012.  Retrieved Feb.27, 2014 from:  
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571677/

 2.      Frank, C.  (2010) Multiple medications in geriatric care.  OSMT Volume 17/Issue 2, Summer 2010. 
          Retrieved Feb. 2014 from:     
          http://www.osmt.org/uploads/Multiple%20medications%20in%20geriatric%20care.pdf

 3.      Institute for Safe Medication Practices Canada.  (2014). Safe Medication Use in Older Persons Information
          Page
. Retrieved Feb. 2014 from:    
          https://www.ismp-canada.org/beers_list/

 4.      Reason, B.  et al.  (2011) The impact of polypharmacy on the health of Canadian seniors. Oxford Journals.
          Medicine, Family Practice.  Volume 29, Issue 4Pp. 427- 432.  Retrieved Feb. 27, 2014 from:
          http://fampra.oxfordjournals.org/content/29/4/427.long  

5.       The American Geriatrics Society. (2012).American Geriatrics Society Updated Beers Criteria for
          Potentially Inappropriate Medication Use in Older Adults, Beers Criteria Update Expert panel, 
         
Journal of American Geriatrics Society (2012), 1-16, Retrieved May 2014 from:
        
 http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines

This presentation describes an approach to safe prescribing for older patients. It explores the significance and causes of polypharmacy and identifies contributory factors to medication related problems and ways to avoid them.
72 Slides.

FASTlinks is a serices of custom google-maps that display links for elder care services in South East Ontario organized into 10 common elder care domains:Driving & Transportation,  Hearing & Vision, Cognition, Mood Disorders & Depression, Acitivities of Daily Living (ADL),Instrumental Activities of Daily Living (IADL), Mobility & Falls, Medications, Pain & Social Services.

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