The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
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This chapter addresses the treatment of the obese pediatric patient. Treatment can include medical therapy, pharmacotherapy, or even surgical therapy. Medical treatment is slightly different for a growing child in comparison to an adult, especially if the child is overweight or even mildly obese. If no other health concerns exist, the goal may not be weight loss, but rather weight maintenance. Pediatric patients should be screened for depression as well as sleep apnea, and referrals initiated for further counseling or testing, as needed. Prescription weight-loss medications are not often recommended for children or adolescents, as long-term side effects of many prescription medications are unknown. Patients and families should be reminded that medications do not replace healthy eating or physical activity; these should be encouraged in addition to prescription medication. Surgery is also not recommended for those who have an untreated psychiatric disorder, including an eating disorder.
Polycystic ovarian syndrome (PCOS) is an endocrine disorder and one of the most commonly occurring endocrine disorders in women. PCOS is the most common cause of female subfertility. This chapter describes Rotterdam criteria for classification of PCOS. It then provides clinical screening for PCOS. The screening process includes physical examination such as hair distribution; breast examination; peripheral exam; laboratory analysis such as free testosterone; estradiol; serum prolactin; clinical intervention such as patient education; pharmacotherapy and pregnancy-related risks. The chapter describes the goals for management of PCOS. The goals are to lower insulin levels; restore/preserve fertility; treat hirsutism and/or acne; regulate menstruation; prevent endometrial hyperplasia and hence prevent development of endometrial cancer. The decision is driven by whether the woman is younger or older, as well as her desire for future conception.
Gastrointestinal complaints, especially constipation, are frequent issues in the elderly population. This chapter provides an overview regarding management of constipation, diarrhea, diverticulosis/diverticulitis, and irritable bowel syndrome. Inflammatory bowel conditions, chronic pancreatitis, and gallbladder issues are also important for nurse practitioners to identify, but management generally occurs in specialty care settings. Bowel conditions are common and result in pain and functional limitations in older adults. Primary care nurse practitioners must be aware of the presenting symptoms, diagnostic workup, and pharmacologic treatment of these conditions. Of particular note in older adults is the management of chronic constipation, which can improve quality of life. The chapter describes the major gastrointestinal complaints in the geriatric population that may be encountered in primary care, identifies pharmacologic considerations for gastrointestinal disease that are unique to the geriatric population, and outlines pharmacologic and nonpharmacologic treatments for gastrointestinal complaints in older adults.
Adverse events related to pharmacotherapy increase in the presence of polypharmacy. There are no concrete definitions of polypharmacy, although it is considered a major medical issue in the elderly. This is due to higher rates of comorbid health conditions in the elderly, a complex medical system, and treatment guidelines that recommend multiple medications to manage chronic conditions such as diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and cardiovascular disease. These same issues, along with healthcare access and prescription costs, may also contribute to issues with medication adherence in the elderly. Patient education and deprescribing are two essential approaches for nurse practitioners to address polypharmacy and medication adherence in all patients, including geriatric patients. This chapter defines and describes polypharmacy and its implications in older adults; identifies the factors contributing to medication adherence in older adults; and outlines the process for deprescribing in the geriatric patient.
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.
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.
The presence of upper respiratory tract infections in older adults is not considered to be more common when compared to their younger counterparts, but the associated complications are more prevalent in this population. Upper respiratory infections can include an aspect of the upper airway and are most commonly attributed to viruses. This chapter discusses acute and chronic respiratory conditions that can be identified in older adults. It evaluates the preventive and treatment approaches for managing specific respiratory conditions or disorders in older adults. The chapter then reviews pharmacological and nonpharmacological interventions that can be used to manage or treat respiratory conditions in older adults. The acute respiratory conditions include: acute sinusitis, acute bronchitis, bacterial pneumonia, and influenza. The chronic respiratory conditions include: allergic rhinitis, chronic obstructive pulmonary disease, and asthma. Either nonpharmacological or pharmacological interventions have been found to be effective in the management of upper respiratory infections.
In the geriatric population, a myriad of medications can be utilized to manage or treat a variety of disease states or existing conditions. The ability to effectively optimize drug therapy is an essential component of caring for an older adult. This chapter evaluates the currently available drug therapies that are prescribed in geriatric patients and assesses the potential therapeutic effect and adverse effects that can arise from the specific drug classes. It discusses what to evaluate when determining appropriateness of initiating medications in geriatric patients. Drug-related problems can occur in older adults, and consideration must be given for potential drug-drug interactions as well as drug–food interactions. Ultimately, the decision to initiate any given drug in a geriatric individual can entail a number of factors, but striving to achieve optimal therapeutic outcomes while minimizing the potential for adverse effects is a key component to treating this unique patient population.
Pain management in the elderly remains a very complex and challenging issue to tackle. Much research is still required to assess the applicability and effectiveness of each of these described pain management modalities in our geriatric population. The advances in pharmacotherapy and drug delivery systems, while definitely promising, unfortunately do not bypass the uncertainty of drug pharmacokinetics and pharmacodynamics in the older population. This chapter briefly discusses the technological applications for pharmaceuticals and devices for pain management. It also describes the technological advancements in nonpharmacological management of pain, both acute and chronic. Nonpharmacological approaches include behavioral (cognitive behavioral therapy, biofeedback, and psychotherapy); physical or biomechanical (physical therapy, massage, chiropractic or osteopathic manipulations, exercise, thermal applications, such as heat and cold); interventional (e.g., surgery, acupuncture, injections such as botulin, nerve ablation, nerve blocks, epidural steroid injections); and finally neuromodulation approaches including the physical application of various electrical, ultrasound, and magnetic devices.