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Related Issues:
Medication adherence, polypharmacy, medication misuse, medication reconciliation, ADEs (adverse drug events), PIMs (potentially inappropriate medications)
Why Review of Medication is Important:
Normal Age-Related Changes:
Pharmacokinetics (absorption, distribution, metabolism, excretion)
GI Absorption:
IM Absorption:
Transdermal Absorption:
Distribution:
Metabolism:
Pharmacodynamics
Older adults are at increased risk if they have any of the following:
Conditions
Medication-Related Risk Factors
Behavioral Risk Factors
Chemotherapy-related Risk Factors
Surgery
Assessment:
1. Screening Questions
2. Observations
3. Screening Tests and Measurements
4. Standard Physical Evaluation
Nursing Intervention:
American Geriatrics Society 2012 Beers Criteria Update Expert Panel. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc, 60(4), 616-631.
Boparai, M.K. & Korc-Grodzicki, B. (2011). Prescribing for older adults. Mt Sinai J Med, 78(4), 613-626.
Edelberg, H.K., Shallenberger, E., & Wei, J.Y. (1999). Medication management capacity in highly functioning community-living older adults: detection of early deficits. Journal of the American Geriatrics Society, 47(5), 592-6.
Fick, D.M., Cooper,J.W., Wade, W.E., Waller, J.L., Maclean, J.R., & Beers, M.H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med,163(22), 2716-24.
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J., & O'Mahony, D. (2008). STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther, 46(2), 72-83.
Korc-Grodzicki, B., Boparai, M. & Lichtman, S. (2014). Prescribing for older patients with cancer. Clinical Advances in Hematology and Oncology, 12(5), 309-318.
Lacasse, C. (2011). Polypharmacy and Symptom Management in Older Adults. Clinical Journal of Oncology Nursing, 15(1), 27-30.
Lees, J. & Chan, A. (2011). Polypharmacy in elderly patients with cancer: clinical implications and management. Lancet Oncol, 12(13), 1249-1257.
Maggiore, R.J., Gross, C.P., Hurria, A. Polypharmacy in older adults with cancer. (2010). Oncologist, 15(5), 507-522.
Nathan, A.,Goodyer, L., Lovejoy, A., & Rashid, A. (1999). 'Brown bag' medication reviews as a means of optimizing patients' use of medication and of identifying potential clinical problems. Fam Pract.,16(3), 278-82.
National Comprehensive Cancer Network. US National Comprehensive Cancer Network Guidelines for Senior Adult Oncology 2015. Version 2.2015.
Prithviraj, G.K., Koroukian, S., Margevicius, S., Berger, N.A., Bagai, R., & Owusu, C.(2012). Patient Characteristics Associated with Polypharmacy and Inappropriate Prescribing of Medications among Older Adults with Cancer. J Geriatr Oncol, 3(3), 228-237.
Puts, M.T., Monette, J., Girre, V., et al. (2010). Potential medication problems in older newly diagnosed cancer patients in Canada during cancer treatment: a prospective pilot cohort study. Drugs Aging, 27(7), 559-572.
Qato, D.M., Alexander, G.C., Conti, R.M., Johnson, M., Schumm, P., & Lindau, S.T. (2008). Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United States. JAMA, 300(24), 2867-2878.
Zwicker, D., & Fulmer, T., (2012). Reducing Adverse Drug Events. In M. Boltz, E. Capezuti,T. Fulmer, & D. Zwicker (Eds.), Evidence-Based Geriatric Nursing Protocols for Best Practice. (324-362). New York: Springer.