Medication « The Professional Geriatric Care Manager’s Blog

Shingles

January 27, 2012 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Aging, Eldercare, Health, Life, Medication, Prevention, Tips

It can start out with burning or shooting pain, tingling, or itching on one side of the body or face. The pain can be mild or severe. Blisters then form and can last one to 14 days. It’s shingles, a disease caused by the varicella-zoster virus, the same virus that causes chickenpox. Once one has had chickenpox, the virus stays in your body, and can cause shingles many years later. Other symptoms of shingles include fever, headache, chills and upset stomach. Sometimes a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation or death. The pain of shingles may last for weeks, months or even years after the blisters have healed.

You cannot catch shingles from another person with shingles. A person who has never had chickenpox, though, can get chickenpox from someone with shingles. Shingles is far more common in people 50 years of age and older. It is also more common in people whose immune systems are weakened because of a disease such as cancer, or drugs, such as steroids, or chemotherapy. There is no cure for shingles. Early treatment with antiviral drugs, such as Zovirax or Valtrex, that fight the virus may help. Medication may also help prevent any lingering pain. Taking a cool bath or using cool, wet compresses on your blisters may relieve the itching and pain.

Two vaccines may help prevent shingles. The chicken pox vaccine has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who have never had chickenpox. In 2006, a vaccine was approved for the treatment of shingles. It is recommended for adults 60 years and older. It does not guarantee you will not get shingles, but will reduce the course and severity of the disease if you do. A person should not get the shingles vaccine who has had a life threatening allergic reaction to gelatin, the antibiotic neomycin or any component of the shingles vaccine, a weakened immune system, or is pregnant. Minor problems associated with the shingles vaccine have included redness, soreness, swelling and itching at the site of the injection and headache. At least one million people a year in the United States get shingles. The shingle vaccine is used only as a prevention strategy. It cannot be used to treat people who currently have the disease. Speak to your doctor or other healthcare provider to learn more and if the shingles vaccine is for you.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care.

Please contact us in our Ramsey or Ridgewood Office to schedule a consultation.

201-587-5283.

145 N. Franklin Turnpike, Suite 311, Ramsey, NJ 07446

45 N. Broad St., Suite 503, Ridgewood, NJ 07450

Drug Reactions in the Elderly

January 6, 2012 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Aging, Education, Health, Medication, Prevention, Safety, Tips

There are four medications used alone or together that are felt to be responsible for drug reactions resulting in the most emergency room visits in the elderly. They are Coumadin (Warfarin); aspirin, Plavix (Clopidogrel), or other antiplatelet drugs; Insulin; and oral diabetes drugs. All of these medications or medication groups are commonly prescribed to older adults. In addition, they are difficult to use correctly. Some of them require regular blood testing and dose changes, and the correct therapeutic index is a narrow one.

Every year in the United States, approximately 100,000 individuals 65 years and over are taken to the hospital for adverse reactions to medications. These visits may be a result of an accidental overdose or because the amount of medication prescribed for them was too much and resulted in an adverse reaction. Common factors among the drugs responsible for these visits are they are difficult to use, require blood testing to adjust their doses, and a small dose can have a powerful effect.

Coumadin or Warfarin, a blood thinner, tops the list. It is one of the drugs which requires regular blood monitoring and dose adjustment. Its therapeutic range is narrow and it can interact with many other drugs and foods. Insulin injections are next on the list. Blood sugars are difficult to control in people with diabetes. A diabetic who takes a slightly larger dose of insulin than needed can send themselves into shock. Antiplatelet drugs, such as aspirin and Plavix are next on the list, followed by oral hypoglycemic drugs used to control diabetes. These medications are critical for many older adults, yet none of these drugs are typically listed as “high risk.” The medications usually listed as high risk are the over the counter drug Benadryl and powerful narcotic painkillers such as Demerol. These drugs, though, account for fewer emergency room visits.

When individuals show up at the emergency room as a result of drug misuse or abuse, it provides an opportunity to reach out with counseling or exploring other options that could help prevent it from being repeated or further consequences. Often times this opportunity is missed. Data suggests focusing on safety initiatives on a few medicines that commonly cause serious harm can improve care for many older adults. Individuals need to work with their physicians and their nurses, pharmacies, or a geriatric care manager to make sure they are receiving appropriate testing and taking the correct dose of their medications.

145 N. Franklin Turnpike, Suite 311, Ramsey, NJ 07446

45 N. Broad St., Suite 503, Ridgewood, NJ 07450

Melatonin Nightmares?

December 28, 2011 at 10:30 am | Posted in Joanne Jordan, Office Manager | Leave a comment
Tags: Caregiver, Eldercare, Health, Life, Medication

Melatonin has received a lot of press coverage in the last few years, as a supplement which may help improve sleep. It is a natural hormone secreted by the pineal gland in the brain, which regulates other hormones and maintains the body’s circadian rhythm, or “body clock.”

Several of our clients use melatonin supplements (with their doctors’ supervision, of course) to combat insomnia. Recently, the caregiver for one of them reported that our client has been having increasingly frequent vivid nightmares or hallucinations, including the very scary belief that a stranger has entered her home in the middle of the night.

In our weekly case review meeting, our care management team brainstormed possible explanations for this change in her behavior. Is the client struggling with increased anxiety which manifests itself in her dreams? Is this behavior evidence of a new or worsening physical condition such as an infection, or a different form of dementia? Could she be experiencing a drug interaction from the many prescriptions she is on? Could it be simply a side effect of one or more medications she takes? Melatonin is known to produce nightmares in some patients at higher doses.

All of these, and more, are plausible explanations for our client’s change in behavior. These will be explored by her Distinctive Care Geriatric Care Manager, who works closely with her physicians to monitor her care.

If it turns out to be melatonin at fault, discontinuing it or adjusting the dosage should provide prompt relief from the nightmares. And this case illustrates the importance of discussing all supplements with your physician, whether or not they are “all natural” or sold over the counter.

Signs of Sepsis

November 18, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Health, Help, Life, Medication, Safety

Sepsis is a condition in which the body is fighting a severe infection that has spread through the body via the bloodstream. The individual will have low blood pressure which will lead to poor circulation and shock. In severe cases one or more organs may fail, such as the lungs, kidneys and liver. The elderly population, especially those with weak immune systems, are at increased risk. Others at risk include the very young, those taking an immunosuppressant and steroids, individuals being treated with chemotherapy, and individuals with long-standing diabetes and AIDS. Many different microbes can cause sepsis. Infections such as pneumonia, urinary tract infections, cellulitis and appendicitis can lead to sepsis.

If an individual is septic, they will probably have a fever. In addition, they may have chills, decreased urination, increased heart rate, rapid breathing, confusion, agitation, dizziness, a possible rash and pain in their joints. One should call a doctor if they have any signs or symptoms of sepsis, particularly if they are being treated with chemotherapy, have had an organ transplant, or have diabetes or AIDS. Sepsis may be diagnosed with blood work, and samples of sputum, urine, spinal fluid or drainage from a wound. If an individual is diagnosed with sepsis, they will be admitted to the hospital and treated with intravenous antibiotics and fluids. Oxygen is also given to maintain normal blood oxygen.

The individual’s prognosis relies on age, health history, health status, how quickly diagnosis was made and the specific type of organism causing the sepsis. The earlier that treatment is started for sepsis, the better the outcome.

Laughter is the Best Medicine

October 7, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Health, Life, Medication, Personal, Study

What if you could laugh your way to good health. Studies have shown laughter is a great natural cure for many medical conditions. When laughter is shared, it binds people together and increases happiness and intimacy. Laughter triggers healthy physical changes in your body. Humor and laughter strengthens your immune system, boosts your energy, diminishes pain and protects you from the damaging effects of stress. Best of all, it is fun, free and easy to use.

Laughter is a powerful antidote to stress, pain and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humor lightens your burdens, inspires hope, connects you to others and keeps you focused and alert. Laughter relaxes your whole body. It can relieve physical tension and stress. Laughter has been proven to boost your immune system. It decreases stress hormones and increases immune cells and infection fighting antibodies, improving your resistance to disease. Laughter can trigger endorphins, which are the body’s natural feel good chemicals. Endorphins can promote an overall sense of well-being. Laughter protects the heart. It improves the function of blood vessels and increases blood flow which can help protect you against a heart attack or other cardiovascular problems. Overall, a sense of humor appears to keep you healthy and improve longevity.

Studies have shown laughter may also be a good medicine with no side effects for elderly dementia patients. Humor therapy has been successful in improving mood, decreasing agitation and behavioral disturbances and increasing social engagement in those individuals with dementia.

Think how good you feel after a good laugh. So grab a good comedy video, tell a joke, or just laugh at something funny. It may benefit your health and it certainly is the most fun medicine you can take!

Resistant Germs

August 12, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Education, Health, Life, Medication, News, Prevention, Research, Tips

Imagine a world where bacteria no longer responds to antibiotics. The widespread use of antibiotics in humans, animals and agriculture is creating an increase in resistant bacteria. Inappropriate prescribing of antibiotics has played a significant role in the emergence of resistant bacteria. Patients insist on antibiotics and physicians prescribe them. One third of people believe that antibiotics will cure the common cold. In addition, many individuals do not complete the course of antibiotics prescribed, stopping them once they feel better. Antibiotics are often used in animal feed and this use can lead to the creation of resistant strains of bacteria. Poor hand hygiene by hospital staff has also been associated with resistant organisms.

How does this happen? Everytime an individual takes an antibiotic to fight an infection, the antibiotic destroys most of the bacteria. However, a few tough germs may survive either by mutating or by obtaining resistant genes from other bacteria. These survivors can reproduce quickly, creating new drug resistant bacteria. The presence of these resistant bacteria strains usually means that the next infection will not be cured by the first choice antibiotic. As a result, more infectious diseases are harder to treat than they were a few decades ago.

Some of the bacteria that have resistance to antibiotics are:

Staphylococcus bacteria, which causes the majority of infections in patients in hospitals in this country;
Streptococcus pneumonia, which causes pneumonia, meningitis and ear infections;
Enterococcus, the bacterium which can cause everything from urinary tract infections to heart valve infections.

To help prevent drug resistance, a patient and healthcare provider need to discuss the appropriate medication for an illness and avoid overusing or misusing antibiotics. Diagnostic tests are needed to determine which antibiotic would best treat an infection. These tests sometime take days to give results. In the meantime, many physicians prescribe broad-spectrum antibiotics when a more specific treatment would be better. The common practice of prescribing unknown infections with broad-spectrum antibiotics is another reason for the emergence of antimicrobial resistance. Follow prescription medication directions and never share or take medications prescribed for someone else. Do not save your antibiotics for the next time you get sick, take all the medication as prescribed. To further control drug resistance among disease-causing microorganisms, we need ongoing programs to decrease the use of antibiotics, both in the medical setting and agriculture; increase use of vaccines to prevent infection; and the development of new classes of antibiotics to fight emerging resistant bacteria.

Antimicrobial resistance is the result of overuse and misuse of antibiotics in people and animals, lack of diagnostic tests to rapidly identify infectious agents, and poor hygiene and infection control in the healthcare and community setting. All together these factors have contributed to the growing problem of resistant infections that are increasingly difficult and costly to treat.

Did You Take Your Medicine Today?

July 15, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Caregiver, Health, Life, Medication, Personal, Tips

Nearly three in four Americans do not follow doctor’s orders for taking prescription medications. Medication non-compliance, the failure to take drugs on time in dosages prescribed, is as dangerous and costly as many illnesses. It is a problem that is associated with 125,000 patient deaths each year, 23% of nursing home admissions and 10% of hospital admissions. One in three never fill their prescription. Some forget to pick up their prescription from the pharmacy. Others skip doses, or do not take the correct amount of the drug. Some who begin taking the medication correctly, end up eventually stopping the medication due to side effects, forgetfulness, desire to save money, or disbelief the medication is necessary or working.

A drug can not work if you are not taking it! Among the elderly, the reasons they fail to take their medications can range from cognitive issues, to depression and physical problems. Staying on medications takes a lot of work and commitment. Individuals are sometimes overwhelmed by the number of different medications they are prescribed. Those that live alone or are unmarried are more likely to miss medications.

Non-compliance is a battle that caregivers, healthcare providers and patients have to fight together. Many studies have shown that compliance increases when individuals are reminded to take their medication at doctor’s visits or with follow-up calls and visits from nurses. Some pharmacies now have reminder services, where they either call the client or alert the doctor when their patient fails to refill a prescription after a certain amount of time. Special pill boxes, such as the ones divided into sections, can be found at most drugstores and are helpful in reminding people to take their medications. As a nurse and a geriatric care manager, I fill pill boxes at weekly visits and maintain an updated medication list in the home of my clients to promote compliance. We all must work to improve compliance, as it has been shown that decreased compliance leads to worsening symptoms, decline in health, increased hospitalizations and in some cases death.

Caution with Medications

July 7, 2011 at 10:30 am | Posted in Amy Shein, GCM | Leave a comment
Tags: Advocacy, Eldercare, GCM, Health, Medication

As a registered nurse I am always concerned about my client’s needs and usage of prescription and over the counter medications. Older adults have multiple diseases and because of this, they tend to take many medicines. As they continue to age, the ability to breakdown and metabolize drugs generally declines with age. We see diminished kidney and liver function as we age. The kidneys and liver are where drugs are mainly metabolized. If a client’s kidneys or liver are not functioning properly, this can cause blood concentrations of drugs to reach higher level and take longer to eliminate them from the body. It can be very challenging to diagnosis properly the problem of over-medication; symptoms are not always clear-cut. Please see from the list below, the most common signs and symptoms of over medication can resemble many other conditions:

Fatigue
Motor problems such as walking and standing
Skin flushing and rashes
Weight loss or gain
Falling and problems with balance
Mood swings
Memory problems
Withdrawal
Confusion
Abdominal pain

It is important to remember to look at the elderly adult and really look and listen for all recent changes in their behavior, appearance and speech. Any noticeable change needs to be brought to the doctor’s attention. To improve communication with the physician, keep a log of the behavior or symptom. Write down when it happens, how long it lasts, and describe it in detail. We all need to be considered part of the medical team. When meeting with the doctor, go over the log in detail. Ask him dosage level, interaction effects and alternatives.

Drugs interact with one another, sometimes multiplying or magnifying the effects and causing additional symptoms. OTC (over the counter) medicines and dietary supplements can also have interaction effects. This is why it is critical that good communication with the doctor and tell her or him about all the medications in the medicine cabinet and or bring them to their doctor’s appointment. Periodically do an in-depth review of all medications with the primary physician.

As a Geriatric Care Manager, I oversee the client’s medications and always keep an updated medication list at the client’s home/facility and also in my possession. Their medication list is always provided to the physician at the time of their visit.

Last week I spoke to a physician of the recent decline in one of my client’s behaviors and weight loss. Medications where reviewed and changes had been made to two medications. A big positive outcome had occurred in just one week’s time. I am always so happy that I am a big advocate for my clients.

Medications and the Elderly.. in the day in the week of Geriatric Care Manager in Bergen County

January 28, 2010 at 9:23 pm | Posted in Lori Habersaat, GCM | Leave a comment
Tags: Aging, Medication

I recently worked with a Geriatrician who also held a pharmacological degree and shared some vital information that I am grateful for. The information was based around the topic of discussion about a client of mine that I had brought to him for a medical evaluation. His very brief but profound statement regarding the use of medications and the elderly was the following- “Less medication is better”. I for one agree with this statement based on numerous published literature and my own nursing experiences both in patients in an ICU setting as well as working with Elderly at home.
Numerous issues contribute to this conclusion including the aging organs (kidneys and liver) ability to metabolize the medication and rid the body of it as well as the individual’s hydration and mobility status to name a few. How frequently have we as nurses and Care Managers seen the adverse outcome of medication changes unknowingly?
As a Geriatric Care Manager this is a vital component to our Client’s Care Management along with evaluating drug interactions and remembering that even with adverse effects identified as infrequent they may and can occur more frequently with some specific medications and the elderly. More on this topic is to come.

Pseudo-dementia

November 11, 2009 at 7:01 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Dementia, Depression, Drug Interaction, Medication

As most of you know I have frequently talked about how adverse medication reactions can cause lots of problem in older adults. This is particularly true because often times the older adult’s kidneys and liver do not work as well as when they were younger and the drugs are not metabolized as quickly.

I have an interesting experience I’d like to share with you about my favorite Client, my dad. Many of you are aware of the fact that my mother died in March of this year. My parents were married for over 60 years and my father has taken her death extremely hard. Most recently he had been complaining to me that he has been feeling “fuzzy” around the edges. As someone who suffers from depression, I can tell you with certainty that fuzziness is a symptom of depression. I hate depression and even though it’s to be expected during the grieving process I was concerned enough about my father to consult with his geriatrician and get him started on an antidepressant.

My father suffers from dual dementia, he has both Alzheimer’s disease and vascular dementia. He is relatively high functioning and is taking Aricept and Namenda to slow the progression of these diseases. He takes other medication for his blood pressure and cholesterol as well.

Well, I picked up the new medication and filled his mediminders. Day one of the new medication was uneventful. Day two, my father seemed increasingly confused. He could not subtract 20 dollars from his checking account balance. (I handle most of his finances, but he has always been able to handle small checks for even amounts.) He did not answer the phone when I called him…after checking on him he indicated that he heard the phone, but didn’t know what to do with the phone.

Oh-oh! What happened to Dad??? Luckily as a nurse the first thing I suspected was a drug interaction! I called the doctor and let him know that I was discontinuing the medication. On top of the two dementias he really has, he was experiencing a pseudo-dementia. It took two days but he is back to his baseline now…still not perfect, but he can subtract even amounts and knows what to do with the phone again!

One of the things we do at Distinctive Care Geriatric Care Management as part of our initial assessment process is a complete medication review to determine if there are any drug interactions the family should be aware of that could potentially be exhibiting as signs of dementia and should be investigated. We also do medication management for our Clients, monitoring for adverse side effects, especially when starting on a new medication.

Distinctive Care Geriatric Care Management serves Bergen and surrounding counties. If you are interested in finding out more about the medications your loved one is taking contact us for a medication review at any of our 3 locations, in Ridgewood, Tenafly and Dumont by calling our main office at 201-587-5283.