Side effects are well-known and even expected with most prescription and over-the-counter medications. However, many don’t realize that these consequences have a more profound effect in the elderly body. As caretakers in the assisted living industry, it is important to know your clientele and note any physical changes, changes in disposition or behavior that may be a result of medications they are taking.
Assisted Living Education covers some common concerns for elderly residents and their medications in a two-part blog series.
Pharmacodynamics & Pharmacokinetics
Elderly residents are particularly susceptible to the effects of pharmacodynamics and pharmacokinetics for several reasons. Pharmacodynamics refers to how the drug interacts with the body and body systems once it’s ingested. This includes the chain of bodily responses, from the effectiveness of the body’s drug receptors, to the body’s own homeostasis, or even the functionality of the body’s organs. Pharmacokinetics refers to the movement of the drug through the body, e.g., how it’s metabolized, absorbed, and ultimately eliminated from the body.
The older the body gets, the more these particular effects become a concern when taking medication. Because the aging body is declining in various aspects, any part of these pharmacokinetic or pharmacodynamic processes could be less effective. Thus, certain medications could become either less effective or potentially riskier, especially when taken with other medications.
Many elderly residents respond with anticholinergic effects. This means that particular drugs block the neurotransmitter acetylcholine from absorbing in the central nervous system (CNS) and peripheral nervous system (PNS). Because of their effects on such critical body systems, there is evidence that links these types of drugs to poorer cognitive function, including executive functions of the brain, loss of memory, and increased risk of dementia, or worsening of dementia symptoms.
Higher Risk of Contraindications
Most elderly residents are on multiple prescriptions due to varying health issues, age-related or otherwise. Because of this, doctors and even caretakers need to be vigilant about ensuring these residents are well-monitored and don’t ingest any other medications or even foods that could combine negatively with one of their existing prescriptions.
As a CNA, nurse, or other assisted living facility staff member, we cannot emphasize enough how important it is to get to know your residents as well as thoroughly noting any observations of behavior/disposition change, physical changes, or anything else that might seem out of the ordinary for a particular resident. These little red flags can be a sign of something more serious, but more importantly, potentially preventable.
This open communication among caretakers, the resident’s attending doctor, plus any other specialists is crucial for several reasons. Keeping everyone in the loop helps better resolve any issues that might occur, and to help distinguish between any new symptoms due to a new health development, or if it might actually be a side effect from one of their current medications.
Merck Manual warns against a prescribing cascade in which a side effect of a drug is incorrectly identified as a sign or symptom of a new disorder, and thus a new drug is prescribed to remedy it. For example, some antipsychotic medications can cause symptoms that present similarly to Parkinson’s Disease, and an uninformed physician may prescribe a medication to reduce effects commonly seen in Parkinson’s patients.
Adverse Drug Effects
Common adverse drug effects seen in elderly residents are oversedation, confusion, hallucinations, dizziness/falls, and bleeding. According to Merck Manual, 17% of elderly individuals are hospitalized due to adverse reactions, as opposed to only 4% of younger individuals. 90% of these hospitalizations are preventable just by opening the lines of communication between residents, their caretakers, and other healthcare providers.
Because elderly individuals have a higher risk of complications, some physicians are more hesitant to prescribe stronger doses of medication. As such, medications may then seem ineffective.
Additionally, if elderly individuals are left to self-administer their medications, adherence and consistency may be poor for a couple of reasons. They may forget a dosage because their memory isn’t as sharp, or they may avoid medications because the cost is too high for their budget or fixed income. Some individuals may not like to take their medications, either because of the side effects, or because they’re just stubborn. It’s possible their behavioral resistance is due to frustration, or even effects of dementia or Alzheimer’s. In these cases, medications may have to be mixed into food to make it more palatable or tolerable to the individual.
In an assisted living facility, this is another reason why communication among staff members is crucial. If a resident is beginning a new medication, communicating their tolerance or intolerance is essential for deciding whether to continue the medication or not. Additionally, facilities can help the individual or individual’s family in making choices when it comes to medication if it is unaffordable. Communicating whether a resident refused their medication is absolutely noteworthy as well.
Assisted Living Education
Assisted Living Education is committed to the highest level of education and services for people in the assisted living community. We offer RCFE Certification, Staff Training, online coursework, including continuing education, and so much more. Our instructors have years of professional, industry experience and teach their courses with engaging, hands-on material and a real-world perspective. Visit our contact page for any inquiries, or give us a call at 1-800-200-0188 for immediate assistance.