Geriatric drug therapy interventions

Abstract

Geriatric drug therapy interventions involve the encouragement of appropriate therapy and prevention of problems with medications. Exponentially rising health care costs of the elderly have brought radical suggestions for rationing of health care. The place of drug therapy in holistic care of the older patient should be in the context of an increased awareness of the self-care concepts of 'wellness.' Drug-related problems of non-compliance and adverse drug reaction and interactions may influence the need for admission of up to one-third of hospitalizations and one-half of nursing home placements of older adults. Additionally, drug-related problems occur across all levels of progressive patient care. In the nursing facility, two-thirds of patients have been shown to have a drug-related problem up to every other month during their length of stay. Underrecognition of patient problems as well as misdiagnosis studies have pointed out areas where drug therapy outcomes could be improved, especially in the areas of malnutrition, depression, osteoporosis and dementia. The Food and Drug Administration has proposed new guidelines for all drugs to include a pharmacokinetic screen to assure that geriatric patients call have safe levels of newer agents. Insidious adverse drug effects of increased falls and fractures as well as pressure ulcers due to psychoactive drugs, NSAID-associated gastritis and gastrointestinal bleeding, drug-induced delirium and incontinence and constipation are being detected. Managed care may offer less than optimal care when compared with fee-for-service plans for health care of the elderly. Interventions in geriatric drug therapy can improve drug adherence and reduce adverse drug reactions as well as contribute to improved disease state management in the geriatric patient.