The physiological changes that can occur with the aging process can impact absorption, metabolism, distribution, and excretion of drug as well as food. Compared to drug–drug interactions, the potential effects of food on the action of drugs may receive less attention but it requires the same level of awareness. There are a number of drug–food interactions that may occur, but the most significant interactions that affect older adults should be addressed to prevent potentially adverse or even deadly outcomes. This chapter discusses notable drug–food interactions that can occur in older adults and examines the severity of drug–food interactions and how this can be addressed. Drug–food interactions have the potential to pose serious health risks or even life-threatening outcomes in older adults; so careful monitoring and understanding of these potential effects is imperative to prevent or minimize negative outcomes.
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In order to fully understand the importance of drug dosing, it is important to understand the anatomy of the kidney, particularly as it relates to the geriatric population. Renal function often declines with aging, and this may worsen due to chronic diseases such as hypertension and diabetes. In older adults, chronic kidney disease with decreased renal function is an important factor for nurse practitioners to address medically and pharmacologically. This chapter provides an overview of prescribing considerations in renal disease. It discusses the anatomy of the renal system and reviews what constitutes renal impairment and adjustments that need to be made in older adults. The chapter then lists and analyzes drugs that require adjustment with renal impairment. It helps the reader to evaluate a patient case study and team management approach to renal impairment in an older adult.
The aging process is considered to be a complex process that can be associated with physical, biological, psychological, sociological, and behavioral changes. Older adults can typically present with multiple medical conditions, and the coexistence of these conditions can lead to challenges when it comes to diagnosis, treatment, and the natural progression of the individual health conditions in older adults. This chapter helps the reader to identify the commonly used medications for comorbidities and side effects, discuss the impact of chronic conditions on the decision to initiate medication and evaluate the most notable drug classes clinicians should be aware of in older adults. The determination of the appropriateness of drug therapy in an older adult can be paramount when it comes to achieving desired therapeutic outcomes. A thorough assessment should be performed prior to the initiation of therapy, and there should be ongoing monitoring of effect with the continuation of therapy.
For an advanced practice nurse (
APRN), the goals of care should always emphasize patient well-being and functionality. Geriatric care is a setting when these goals are brought into sharper focus due to functional decline, increased prevalence of illness, and the reality of end of life. This chapter delineates theories of aging, overall aging changes within the body, aging changes by organ system, and geriatric syndromes. There are numerous theories addressing aging, but they generally fall into two main categories–aging as a programmed state and aging resulting from an accumulation of damage. Recognizing the risks related to the aging process, the differences between disorders and aging, and acknowledging the challenges of geriatric syndromes is an essential part of the nurse practitioner role. Through recognizing and responding to aging issues appropriately, nurse practitioners can be key members of the geriatric healthcare team.
Mental health in the aging population is as much of a priority as in other age groups. Approximately 20% of individuals aged 55 and older experience some mental health issue such as anxiety or mood disorders. Mental health issues are risk factors for suicide. Mental health conditions such as depression can complicate other chronic diseases due to self-care activities such as sleep, stress management, medication adherence, diet, and physical activity that might be affected by depression. Mental health issues may be mistaken for frailty; so they should be adequately evaluated and treated. This chapter focuses on major depressive disorder, generalized anxiety disorder, screening for substance use disorders, screening and referral for psychosis, and sleep disorders. The primary care nurse practitioner will most often be treating depression, anxiety, and sleep disorders, but must be able to identify and refer patients for substance use disorders and psychosis.
This chapter provides an overview of aging changes in the endocrine system, and identifies endocrine diseases that frequently impact the aging population. It outlines pharmacologic considerations for endocrine disease treatment in geriatric patients, and describes pharmacologic and nonpharmacologic management of endocrine diseases in the geriatric population. Management of endocrine diseases in the geriatric population can often be complex due to comorbid conditions and polypharmacy. Nurse practitioners in primary care must balance managing symptoms, preventing worsening of illness or the incidence of other related illnesses, goals of care, and life expectancy. This chapter addresses the diagnoses of type 2 diabetes mellitus, thyroid disease, parathyroid disease, and osteoporosis. Primary care nurse practitioners are often the first stop for patients who may be experiencing symptoms related to endocrine disease. Nurse practitioners may also make ongoing treatment and referral decisions regarding type 2 diabetes, thyroid and parathyroid disease, and osteoporosis.
Pharmacological Considerations in Gerontology:A Patient-Centered Guide for Advanced Practice Registered Nurses and Related Health Professions
This book is an effort to combine the presentation of chronic health conditions experienced by aging patients with pharmacologic considerations that are unique to this population. Nurse practitioners are increasingly responsible for delivering care to elderly patients in primary care who present with complex conditions, medication regimens, and numerous specialty providers. This reference will provide a “big picture” look at how to approach pharmacotherapy and present principles to guide decision-making so that adverse drug events may be prevented. An evidence-based, quick-access reference for adult gerontology nurse practitioners and related health care providers, this book describes a holistic, patient-centered approach to prescribing drugs to older adults. Comprehensive yet concise writing distills timely guidance on the complexities of safely prescribing to this unique population. The book opens with physiologic changes and assessment considerations for older adults, followed by a discussion of pharmacokinetics and pharmacodynamics, then a final section on guidelines for drug selection, drug interactions, and multimorbidities. Each chapter presents information in a consistent, easy-to-read template. Patient Care Pearls alert readers to crucial information and relevant case studies with examples of inappropriate medical prescribing provide context for drug delivery. Key points and chapter summaries help reinforce information. Additional features include the provision of guidelines for psychotropic medications in long-term care facilities, special considerations for frail older adults, and the role of pharmacists as a resource for other practitioners.
Pharmacokinetics focuses on how the body is able to process a specific drug once it has been administered. The aging process can involve a progressive decline of the functionality of multiple organs. For any given geriatric patient, there can be a variety of disease states, and with these diseases there can be coexisting medication therapies. This chapter evaluates the aging process and its impact on pharmacokinetics. It discusses specific effects of drugs associated with age-related changes and the formation of a pharmacotherapeutic plan and its effect on therapeutic outcomes in older adults. The administration of a medication to a younger individual may differ when compared to an older adult due to age-related effects. The aging process can bring about a reduction in physiological effects in older adults or reduced functioning of organs or processes and with this, modifications must be made with drugs that are given to this population.
The growth of the aging population in the United States is expanding, but our knowledge of sexuality among older adults is not keeping pace, allowing the ongoing perpetuation of myths about sexuality and aging. Aging couples may benefit when they understand that they may not be able to restore the sexual health they remember from their teens, 20s, or 30s but can expect to determine realistic, attainable goals that may include a variety of changes in routine, expansion of their sexual repertoire, and the incorporation of medications. This chapter briefs on the social context of aging, myths about sexuality in older adults, and challenges to sexual activity as people age. It then describes biological, psychological, and relationship changes and aging; and sexual behavior in residential healthcare. Older adults need to be counseled about practicing safer sex as 12% to 22% of all new
AIDSdiagnoses occur in this population.
The ability to reduce the burden of illness among older adults is necessary as individuals are living longer and experiencing lower rates of disability. Advanced practice nurses are skilled to relieve the burden of illness among older adults through specialized training and providing treatment in a variety of clinical settings. While geriatric-focused content exists, advanced practice nurses can benefit from clinical pearls specific for the advanced practice nurse providing holistic mental health care. This handbook offers advanced practice nurses, nurse educators, and graduate nursing students a reference that is intended to be supplemental to uniquely providing care for older adults which includes an overview of the aging process as well as assessing and developing treatment plans for older adults with mental health disorders. As older adults often work collaboratively with family, friends, caregivers, and health care providers, approaches to such relationships are explored and intended to serve as a resource for providing mental health care that can contribute to the overall success of treatment. The text provides an interprofessional box that encourages and assists the advanced practice nurse navigating through interdisciplinary collaborative practice. Such interprofessional partnerships can enhance care—particularly in cases of complexity. Advanced practice nurses can utilize the provided case studies to identify and modify service delivery that promotes evidence based practice.