Medication « The Professional Geriatric Care Manager’s Blog

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

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.

Alzheimer’s Medications

March 25, 2009 at 7:58 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Alzheimer's Disease, GCM, Medication, Support

There are currently four medications that are FDA approved for the treatment of Alzheimer’s Disease. These drugs are:

Aricept, Exelon, Namenda, and Razadyne.

The first question that may come to mind when considering the use of one of these medications is, “Which works best?” The American College of Physicians advises that there is little evidence that one of these drugs works better than the others. They point out that the real differences between these medications include cost, possible adverse reactions, and how easy it is for the medication to be taken. If the drug needs to be taken several times a day it may be to complicated or difficult to manage; particulary if the person with the disease has a difficult time taking medications.

So instead of asking, “Which works best”, the care managers at Distinctive Care recommend that the following questions be asked when discussing a medication regime with the physician:

Which medication will be the safest when taken with the other medications my loved one is taking?
Which medication has the lowest risks of side effects based on my loved one’s medical status?
What adverse reactions should I look for at home, what should I notify you about and when should I notify you?
What form does the medication come in (pill, liquid or skin patch)? How often shoulf the medication be taken? When should the medication be taken? Are there any special instructions I will need to remember, for example should it be taken with food or on an empty stomach?
How long will it take to know if the medication is working? If the medication does work might there be a time when it will stop working and it will become necessary to stop taking the medication?
How much do these medications cost? Will it be covered by our insurance? And do not be afraid to ask for samples to see if the medication is effective for your loved one before spending the money to have the prescription filled!

After reviewing these questions with your loved one’s physician you will be better prepared to make a collaborative decision with the physician that is in the best interest of your loved one.

If you would like to find out more about what to ask at a doctor appointment contact us in our Ridgewood, NJ office at 201-587-5283.

The Dreaded Diagnosis

February 27, 2009 at 8:30 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Alzheimer's Disease, Care Plan, Cognitive Ability, GCM, Help, Medication, Tips

If you or your loved one is diagnosed with Alzheimer’s Disease, you are not alone. There are currently over 5 million people diagnosed with Alzheimer’s Disease and a new diagnosis is made every 72 seconds. It is a progressive disease that affects the nerve cells in the brain and can result in loss of memory, loss of ability to think and speak clearly, loss of ability to perform activities of daily living and changes in behavior.

The disease progresses at different rates and continues for the remainder of a person’s life. Although there is no cure for Alzheimer’s Disease, there are some treatment options available that can slow the progression of symptoms. Early diagnosis and treatment may help to increase the person’s chance for longer term independence. Once you have the diagnosis you can start doing all the things possible to make a difference. Early diagnosis and treatment can make a difference because, despite the fact that there is no cure, there are prescription medications that can help slow the progression of symptoms, improve the ability to perform everyday task and to maintain independence for as long as possible.

Alzheimer’s Disease drug therapy is working if there is an improvement in symptoms, if symptoms do not change, or if the symptoms of the disease worsen more slowly. There are currently four medications available for the treatment of Alzheimer’s Disease. They include Aricept, Exelon, Razadyne and Namenda. You should talk to your doctor to see what treatment is best for you or your loved one.

The Care Managers at Distinctive Care always include non-medical interventions to their Client’s care plans. These include:

Making dietary changes to include lots of rich, dark vegetables, and fruits, which may help protect brain cells. Ensuring adequate nutrition is also important. You can encourage your loved one to eat well by offering healthy snacks, reminding him/her to eat full meals and providing finger foods for those who have difficulty sitting still through a meal.

Staying physically active is important because the more active your loved one stays, the better his/her health may be, with maintenance of strength, balance, flexibility, and endurance.

Remaining socially involved can help reduce stress which may help to maintain healthy connections between brain cells.

And mentally stimulating activities such as reading or working on puzzles may help to strengthen brain cells.

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