McKenna's Drug Handbook for Nursing & Midwifery, 7e

Drug therapy in the older adult     15

with themedical regimen. However, in older adults, specific factors linked to ageing— such as diminished visual acuity, hearing loss, forgetfulness, the common need for multiple drug therapy and various socio- economic factors—can combine to make adherence a special problem. Approxi- mately one-third of older adults fail to comply with their prescribed drug therapy. They may fail to take prescribed doses or to follow the correct schedule, or they may take medications prescribed for previous disorders, discontinue medications prema- turely or use as-needed medications indis- criminately. Older adults who havemultiple prescriptions for the same medication may inadvertently take an overdose. Review each individual’s medication regimen with them. Make sure the person understands the amount of medication to take and the time and frequency of doses. Also explain how the person should take each medication—that is, with food or water or by itself. Give the person whatever help you can to avoid drug therapy problems. Suggest that they use drug calendars, pill ‘sort- ers’ or other aids to help in compliance, and refer the person to the prescriber or pharmacist if further information is needed.

residual drowsiness. Keep in mind that ingestion of alcohol may exaggerate such depressant effects, even if the sleeping aid was taken the previous evening. Nonprescription drug toxicity When aspirin, aspirin-containing analgesics and other nonprescription NSAIDs (ibu- profen, naproxen) are used in moderation, toxicity is minimal. However, prolonged ingestion may cause GI irritation—even ulcers—and gradual blood loss resulting in severe anaemia. Prescription NSAIDs may cause similar problems, especially with older adults. Although anaemia from chronic aspirin consumption can affect all age groups, older adults may be less able to compensate because of their already reduced iron stores. Laxatives may cause diarrhoea in older adults who are extremely sensitive to such drugs as bisacodyl. Chronic oral use of min- eral oil as a lubricating laxative may result in lipid pneumonia from aspiration of small residual oil droplets in the person’s mouth. Individual non-adherence Poor adherence can be a problemwith indi- viduals of any age. A significant number of hospitalisations result fromnon-adherence