Medication Administration & Safety: Geriatric

Reflect and Respond to the four questions below.

Identify how age- related changes impact the patient’s ability to take medication and explore ways to help ensure they take
them.
Age effects the body as a whole. Aging changes how medication is absorbed, distributed, metabolized and exerted. There is often
multiple comorbidities which effect medication; this could often result in polypharmacy. Non-adherence might occur due to the
geriatric population not believing the benefit of the medication, concern over taking multiple medication, unwanted side effects or due
to cost (Lonsdale & Baker, 2013). Cognitive impairment can also result in non-adherence (Lonsdale & Baker, 2013). If swallowing is
effected- might need to consider other forms of taking medication such as crushed, or just splitting meds in half. Ideally the patient
should adhere to medication regimen and take the same medication at the same time everyday. A few ways to ensure medication is
taken:
 Provide education regarding the need of the medication, side effects and importance of adherence.
 Ensure appropriate follow ups with physician regarding medication use and any side effects.
 Consider possible ways to help with any side effects that may arise to ensure ongoing safety and adherence
 Consider pharmacy providing medication blister packs.
 Set up reminders to take medication (using watch or phone alarms).
 Consider need for PSW/ nurse referral to assist medication administration.
 Social work referrals may be needed if financial cost is an issue – or speak to provider to see if there are any alternatives
Patient with dementia might struggle more with medication adherence. With cognitive impairment, patients might believe they do
not need the medication and they are perfectly healthy. Patients may believe the pills are “poison”. Might also forget to take
medication. It is harder to assess the effects of the medication if the impairment effects speech. Patients might forget to the healthcare
provider about the side effects or may not be able to tell them. This may often result in increased responsive behaviours- at times
perceived as worsening condition and thus more medication which further contributes to the polypharmacy. A different approach
might need to be taken with patients with dementia. Multiple approaches with medication might be needed if resistance is faced. At
times a different nurse or having family members administer medication is more accepted.
Consider your obligations of safe medication administration when a patient/ individual is living with dementia
Patients with dementia might not be able to let the nurse know of their full name and date of birth. Depending on the healthcare
setting, patients might have an arm band to confirm this information. Continue to follow the seven rights of medication preparation
for patients with dementia.
 During the COVID-19 pandemic, the medical has reported that the aging population does not always receive proper nursing
care and critical healthcare resource they deserve.
How might ‘age biases or ageism’ impact or effect your professional attitude and ability to provide culturally and physically
safe holistic care to elderly patients when healthcare resources are insufficient.
Ageism shouldn’t affect how patients are treated. Everyone should have access to healthcare and be treated with dignity and
respect. The pandemic showed us the flaws we have in our system and how they can severely effect the geriatric population. Ageism
can impact our attitude and ability to provide holistic care to elderly patients when healthcare resources are insufficient. It can be
challenging to care for patients with dementia. During the pandemic, I worked in long term care, it was difficult having to navigate the
care of 32 residents with the help of 3 PSW’s. Having to adhere to COVID-19 precautions, asking residents to stay in there rooms
when unwell and caring for sick residents was challenging. The residents did not understand why their family members- especially
those whom often visited daily- no longer visited. The social isolation effects many residents and the residents with dementia had
increased responsive behaviour due to the lack of socialization. I found that at times sitting with one resident and taking them off the
unit for a quick stroll made a great difference in their behaviours throughout the shift. However, this was challenging due to the lack
of staffing and time constraints. Despite the insufficient resources, I attempted to continue to provide safe holistic care to the residents
I was caring for. With ageism, this can be brushed off as just another behaviour that needs to be medicated instead of looking at the
situation. Often when burnt out, nurses look at the situation with limited insight and that a patient/resident is just being “difficult
. However, it is often more than that. A patient yelling out or screaming can sometimes be labelled as “just confused” and sometimes
ignored, however it is not normal or part of aging. The root of the behaviours should be addressed and appropriate activities should be
provided to keep the patient stimulated and engaged.

References

Lonsdale, D. O., & Baker, E. H. (2013). Understanding and managing medication in elderly people. Best Practice & Research Clinical Obstetrics &
Gynaecology, 27(5), 767-788. https://doi.org/10.1016/j.bpobgyn.2013.06.002