DE SAGUN, LEILA CAMILLE A.

BSN3Y1-1B

NCMB314-LEC CU4

Study Questions:

1. What is Omnibus Budget Reconciliation Act (OBRA) 1987?

 The Omnibus Reconciliation Act of 1987 set forth new provisions for Medicare and Medicaid sections
related to new standards for care in the nursing home setting. One major provision was for nurse aide
training. Within that provision there are four specified requirements: (1) nurse aide training for 75
hours, (2) competency evaluation of newly trained nurse aides, (3) competency evaluation of nurse
aides already providing care, and (4) a registry for nurse aides. The primary implications of these
requirements center on the responsibility of the individual nurse or nurse community in ensuring
appropriate implementation of the new requirement. Without appropriate implementation, some of the
provisions increase the liability of the nurse and the risk to the public. The reality of OBRA 1987 and
its intent of bringing a measure of quality assurance to the nursing home industry should only serve as
an impetus for the nursing community to better translate the nurse role and its contribution in the
nursing home setting to policy makers at local, state, and federal levels.
 Omnibus Budget Reconciliation Act (OBRA) 19871.
Legislated the appropriate use of medications in institutionalized older persons
Use of chemical restraint
Use of unnecessary drugs
Antipsychotic drugs should not be used unless necessary to treat a specific condition that is
diagnosed and documented in the clinical.
Beers Criteria
Commonly used consensus criteria related to inappropriate medications.
Developed in 1997, and adopted in 1999 by the centers of Medicare and medical services for
the regulation of medications in nursing homes
Inappropriate medications administered to older persons include:
Prescriptions for long-acting benzodiazepines, persantine, propoxypheneo
Long-term use of drugs that are to be used for short-term use only. (e.g., histamine blockers,
short-acting benzodiazepines, oral antibiotics)
High doses of drugs prescribed above dosage limitations (iron supplements, histamine blockers,
antipsychotic agents)

2. List down age-related changes of the body that affects taking of medication.

 Decrease in body water (as much as 15%) and an increase in body fat.
 Increased concentration of water-soluble drugs (e.g. Alcohol) More prolonged effects of fat-soluble
drugs.
 Decreased hepatic blood flow.
 Changes in pharmacodynamics in the older person may be caused by decreases in the number of
receptors and receptor binding.
3. What are the commonly use medication by the elderly? What will be the effects of this medication to the
body?

 1. Anxiolytics and Hypnotics

o Anxiety can be a significant problem in older persons and is often associated with depression
& dementia.
2. Antidepressants
o tricyclic antidepressants should be avoided in the older patient because of their
anticholinergic and sedative side effects profile
3. Antipsychotics
Conditions inappropriate Antipsychotic drug use:
 Wandering
 Poor self-care
 Restlessness
 Impaired memory
 Anxiety
 Depression
 Insomnia
 Unsociability
 Indifference to surroundings
 Fidgeting
 Nervousness
 Uncooperativeness
 Agitated behavior when not a danger to self or others.
4. Cardiovascular Medications
o The main concerns with the use of cardiovascular medications in older adults are an increased
risk of orthostatic hypotension and dehydration, especially with volume-depleting agents and
vasodilators.
4. Cardiovascular Medications
o The main concerns with the use of cardiovascular medications in older adults are an increased
risk of orthostatic hypotension and dehydration, especially with volume-depleting agents and
vasodilators.
5. Antimicrobials
o Dosing of antibiotics may need to be altered in older clients because of reduced renal
elimination.
6. Nonprescription Agents
o A record of established safety data for the prescription product is necessary
 The drug's expected use should be appropriate for OTC treatment
 The drug should lack undesirable properties and not require special precautions when used
without physician oversight
NONADHERENCE(non-compliance)
o RISK FACTORS
 Living alone without social support.
 Visual or auditory impairments.
 Increasing use of alcohol.
 Socioeconomic factors.
 Unpalatable bulk powders or large tablets.