What all nurses need to know.
Psychotropic medications are commonly administered to elderly patients to help manage behavior and psychiatric symptoms. These drugs are known to have potentially serious side effects, to which older adults are more vulnerable. Nurses care for older adults in many different practice settings but have varying degrees of knowledge about these kinds of medications. The purpose of this article is to provide information to geriatric nurses in all settings about how the most commonly prescribed psychotropic medications (i.e., anxiolytic, antidepressant, and antipsychotic drugs) differentially affect older adults, and examine recent concerns about the use of psychotropic medications with older adults.
Although much of the literature regarding the use of psychotropic medications among older adults is focused on their use in nursing home settings and in residents with dementia, psychotropic medication use is quite common among older adults with or without dementia in all settings (community, assisted living, acute care medical and psychiatric units, and nursing homes). Psychotropic medications are more prevalent among community-dwelling older adults than other age groups. For example, community-dwelling older adults are 7 to 18 times more likely to use psychotropic drugs than are middle-aged adults. Smith, Buckwalter, Hyunwook, Ellingrod, and Schultz (2008) noted research findings suggesting that between 35% and 53% of assisted living residents receive one or more psychotropic medications, and Voyer and Martin (2003) found that more than half of community-dwelling older adults who are admitted to nursing homes receive psychotropic medications within 2 weeks of their admission. In a study of older adults with dementia in nursing homes and acute care geriatric units, Pitkala, Laurila, Strandberg, and Tilvis (2004) found that 87% of patients were taking one psychotropic medication, 66% were taking two, 36% were taking three, and 11% were taking four or more.
It is well documented that older adults are highly vulnerable to the adverse effects of psychotropic medications. Those older than age 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions associated with psychotropic medications. The risk for adverse reactions increases dramatically with the number of medications used and with increasing age (Brooks & Hoblyn, 2007). Thus, it is imperative that nurses caring for older adults, regardless of the setting, are knowledgeable about these medications and are able to recognize and appropriately respond to side effects and adverse effects. The purposes of this article are to (a) provide geriatric nurses working in all settings with information about how psychotropic medications differentially affect older adults; (b) examine recent concerns about the use of psychotropic medications with older adults; and (c) discuss nursing implications related to potential side effects and adverse effects of these medications.
Because of severe adverse side effects and inappropriate prescribing practices, the use of psychotropic medications first came under scrutiny with nursing home residents. As a result, the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), federal legislation mandating minimum health and care requirements for nursing homes, placed limitations on the use of psychotropic medications with nursing home residents.
Adverse Effects of Psychotropic Medications in Older Adults
Psychotropic medication is a broad term referring to medications that affect mental function, behavior, and experience. Psychotropic medications are typically administered to older adults to manage symptoms of anxiety, depression, psychological distress, and/or insomnia.
Administration of psychotropic medications is potentially hazardous and can result in serious and sometimes fatal consequences for patients of all ages. This is even more evident for high-risk populations such as older adults. Nurses in all practice settings caring for elderly patients should be familiar with this group of medications, their side effects, and the impact of age-related changes on their pharmacodynamics and pharmacokinetics. Careful assessment, close monitoring of potentially serious side effects, and use of nonpharmacological interventions when possible will help prevent potential deleterious or fatal effects on this highly vulnerable group. Read more at: http://www.ncbi.nlm.nih.gov
PGx Medical’s Metabolic Validation Testing helps healthcare professionals administer the Right Drug, Right Dose, Right Patient. And can be your tool for reducing unnecessary medications. This easy buccal swab is a once in a lifetime test that will help you provide your residents with a better quality of life and eliminate the trial and error process.
For more information on the PGx Medical Metabolic Validation Test, contact:
PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112
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Resource: (Usher, Lindsay, Holmes, & Luck, 2003), (NSW Department of Health, 1997), (Bulat, Castle, Rutledge, & Quigley, 2008; Carr, 2005; Grasso, Bates, & Shore, 2007; Mott, Poole, & Kenrick, 2005),(Brooks & Hoblyn, 2007),