1. Drug Therapy for Geriatric Clients Chapter 6

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 2 Drug Consumption Age ≥ 65 = increasing population growth  Elderly are estimated to consume approximately 1/3 of all prescription drugs  Estimate elderly use 3/4 of over-the-counter drugs

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 3 Absorption Diminishes with increased age GI concerns  Reduced stomach acid (HCl)  GI absorptive surface area is reduced  Prolonged gastric emptying rate  Blood flow to the intestines is reduced  Reduced muscle tone in the stomach and intestines

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 4 Distribution Water loss Muscle loss Fatty tissue increase Protein binding: decreased capacity

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 5 Metabolism General decline as age increases Causes are obscure; possibly due to:  Reduced blood flow to the liver

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 6 Excretion Measure creatinine function  Blood flow to the kidneys reduced  Renal function is reduced  Loss of intact nephrons

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 7 Drug Receptors Internal drug receptors may change  Results in diminished or greater responses  Close monitoring is required

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 8 Other Factors Memory loss Sensory loss Multiple health problems Multiple medications at multiple times Use of multiple pharmacies (continues)

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 9 Other Factors Economic factors Lack of education Communication problems Cultural considerations Diet therapy (continued)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 10 Implementation Oral medications  Position for administration: high Fowler’s  Speak clearly and slowly.  Offer the most important medication first.  Have plenty of liquid available.  Do not rush the elderly client.

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 11 Intramuscular Medications Use ventrogluteal site. Avoid deltoid muscle. Avoid vastus lateralis because of loss of muscle mass.

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 12 Storage Safe storage of medications  Keep out of the reach of grandchildren and other young children.

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 13 Evaluation Evaluate  Communication: Does client understand?  Drug action

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 6 - 14 Promoting Health Prevent infections. Improve nutrition. Encourage exercise and activity. Facilitate social interaction. Promote restful sleep.