Chapter 7: Medications and Older Adults

A central concern is polypharmacy, defined as the use of more medications than are clinically indicated, encompassing prescriptions, Over-The-Counter (OTC) drugs, and herbal supplements, which increases the likelihood of dangerous drug-to-drug interactions. The chapter thoroughly explains how the aging process alters pharmacokinetics—the body's handling of drugs through absorption, distribution, metabolism, and excretion. Age-related physiological changes—such as decreased liver perfusion, reduced muscle mass, increased body fat, and significantly impaired renal function—alter drug concentration levels, slow the elimination half-life of medications, and heighten the risk of toxicity, requiring careful assessment using tools like creatinine clearance. Changes in pharmacodynamics mean that older adults often respond unpredictably to medications, frequently exhibiting increased sensitivity to drugs, especially psychotropics. To promote safe prescribing, healthcare providers utilize specific guidelines like the Beers Criteria and the international STOPP/START criteria, the cornerstone of geropharmacology. Nursing care focuses on ensuring safe administration by adhering to the “Rights” of medication, meticulously assessing the patient for desired and adverse effects, and modifying techniques, such as using appropriate injection sites or alternative dosage forms, while strictly following guidelines like "start low and go slow." Essential nursing interventions also involve extensive patient education to counter knowledge deficits, address financial barriers, and improve medication adherence, covering topics like distinguishing similar containers, proper storage, and avoiding dangerous interactions with alcohol or OTC preparations.