Discussion w13 650
Q-1

In the older population, there are many health concerns that affect them and their day to day life. Each body system plays an important role in life in general, but a body system we can not physically measure is the psychiatric system. In the elderly population, one of the more serious health concerns that are associated with comorbidity, impaired functioning, isolation, use of healthcare resources, and increased overall mortality is a depressive disorder (Sekhon, Patel, Sapra, 2020). Defining depression in the geriatric and elderly population is actually pretty simple as if a patient’s age is greater than or equal to 65 years old with no previous history of depression which is characterized as late-life depression (Sekhon, Patel, Sapra, 2020).

The major incidences that can trigger late-life depression include loss of a loved one, failing to achieve goals or disappointment in love relationships, and a provider can use the DSM-5 to assess the patient and see their degree of depression (Sekhon, Patel, Sapra, 2020). These triggers or contributors usually first drive these individuals to find something to alleviate their negative feelings, usually towards addiction (Szanto et al.,2020). Addiction comes in many shapes and forms, some turn to alcohol or drugs, while others turn to different types of addiction with animal care or hoarding (Szanto et al.,2020). Unfortunately, some see no way out and turn to suicide as their only option, so a study by Szanto et al., proposed an in-depth screening of cognitive impairment in patients who have had positive DSM-5 results for depression as a way to stratify their risk for imminent suicidal attempts or ideations (2020).

There are many treatment options available for depression in general, but the options are limited in the elderly for concerns of drug-drug interactions, pharmacokinetics, and pharmacotherapeutics (Sekhon, Patel, Sapra, 2020). As late-life depression can impair cognitive function, it can also impair their ability to make informed consent, so testing for decisional capacity is important before treatment options can be discussed (Sekhon, Patel, Sapra, 2020). Some pharmacological therapies that have been approved for use in the elderly are Atypical antidepressants, tricyclic antidepressants, monamine oxidase inhibitors (Sekhon, Patel, Sapra, 2020). Non-pharmacological interventions include individual therapy, group therapy, and a controversial but data supported therapy of electroconvulsive therapy (Sekhon, Patel, Sapra, 2020).

The most important takeaway from this is that we as providers should keep in mind late-life depression in every patient over 65, and screen them as we see them, or if any red-flags show up from their responses or anything from family members (Sekhon, Patel, Sapra, 2020).

References:

Sekhon. S., Patel, J., Sapra, A. (2020). Late-Onset Depression. StatPearls Treasure Island StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK551507/

Szanto, K., Galfalvy, H., Kenneally, L., Almasi, R., & Dombrovski, A. Y. (2020). Predictors of serious suicidal behavior in late-life depression. European Neuropsychopharmacology, 40, 85–98. https://doi-org.lopes.idm.oclc.org/10.1016/j.euroneuro.2020.06.005

Q-2

The use of multiple drugs, often termed polypharmacy is commonly defined as using from 5 to 10 prescription drugs. This polypharmacy is sometimes necessary, but may be associated with an increased risk of adverse outcomes. The U.S. Center for Medicare and Medicaid Services estimated the annual costs of polypharmacy at over 50 billion dollars. Polypharmacy is especially common in elderly patients. Although elderly patients comprise <13% of the U.S. population, they almost 33% of prescription medications annually (Golchin et al., 2017). Because individuals are living longer with chronic diseases, elderly patients also tend to have more complicated chronic conditions, may respond differently to medication therapy or experience more severe adverse reactions due to differences in pharmacokinetic and pharmacodynamic characteristics, compared with younger patients. They may also visit multiple prescribers and use multiple pharmacies that will lead to increased risk of medication-related problems through poorly coordinated or duplicated care. Medication adherence and drug safety continue to be important problems, especially for seniors. Polypharmacy was associated with duplicate prescribed drugs and contraindicated prescribed drug combinations. This can potentially increase the risk of adverse drug reactions. The use of multiple medications, and their associated risks, might be medically indicated for patients with numerous and/or complex co-morbid conditions; this will be increasingly prevalent with the expected demographic trend toward a progressively elderly U.S. population (Golchin et al., 2017). Nurses and pharmacists in hospitals and nursing homes can be pivotal in helping older patients manage their medications and prevent polypharmacy. For instance, knowing that a patient has end-stage renal disease allows the pharmacist to determine that the prescribed metformin is not appropriate for that particular patient. Linking each prescribed medication to a disease state or diagnosis will make that medication potentially necessary. There are three major keys to reducing polypharmacy risks: 1. It is important to talk with patients about keeping an accurate list of all medications, including the prescribed dosage, the dosing frequency, and the reason it was prescribed. Discuss with the patient any dietary restrictions necessitated by a specific medication. Inform the patient about potential side effects, and provide information about look-alike and sound-alike medications. These face-to-face meetings are invaluable and facilitate strong relationships with patients. 2. Instruction and good communication are vital. Primary care providers and specialists must maintain good communication with each other and with patients in order to minimize problems and maximize adherence. 3. Organization can improve compliance. Patients should be advised not to share their medications or save them for future use. Medications should be stored in a secured place. Color-coded pillboxes or blister packs can help elderly patients adhere to their regimen. One useful reminder method for patients with cognitive deficits involves basic techniques like linking dosing schedules to routine daily activities, such as brushing the teeth, eating breakfast, or performing other memory-trigger activities (Saljoughian, 2019). As medical care becomes increasingly complex in our aging population, it is particularly important to improve cooperation, coordination, and communication between patients, providers, and pharmacists. These efforts can complement current national endeavors toward a more patient-centered approach to health care and promoting the concept of the medical home. References Golchin, N., Frank, S. H., Vince, A., Isham, L., & Meropol, S. B. (2017). Polypharmacy in the elderly. Journal of research in pharmacy practice, 4(2), 85–88. https://doi.org/10.4103/2279-042X.155755 Saljoughian, M. (2019). Polypharmacy and Drug Adherence in Elderly Patients. Retrieved from https://www.uspharmacist.com/article/polypharmacy-and-drug-adherence-in-elderly-patients Q-3 Anxiety is a common symptom seen in the geriatric population including worry/distress disorder, fears, and OCD. As we age there are normal parts of anxiety in aging such as fears and concerns, disorders that mimic anxiety, and comorbidities. An assessment should include interviewing the geriatric patient and any involved caregivers that can identify if they normalize certain behaviors that show anxiety (Subramanyam, 2018). Substance abuse/addiction can lead to anxiety so that should be included in the interview to assess for alcohol, prescription, or illegal substances because they can mask or exacerbate the symptoms. The current treatments include medications, therapy, coping skill, social support, and stress management based on the capabilities of the patient. If any medications are started it needs to include safety profiles with all the other medications, monitor for side effects, and what to look for. Cognitive behavior therapy has been proven to help and be a safe way to help treat the geriatric population (Pary, et al., 2019). Psychosocial implications from anxiety include social anxiety, depression, seclusion, etc. Encouraging the patients to be involved in social activities, seek help, and have open communication with their providers and family. Many people choose to self-medicate with alcohol because it calms their nerves or helps them sleep but it can interfere with rest causing more issues with anxiety, emotions, and mood. Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines for Geriatric Anxiety Disorders. Indian journal of psychiatry, 60(Suppl 3), S371–S382. https://doi.org/10.4103/0019-5545.224476 Pary R, Sarai SK, Sumner R, Lippmann S. Anxiety in geriatrics. Postgrad Med. 2019; 131(5): 330? 332. https://doi.org/10.1080/00325481.2019.1624583