The Nurse's Role in the Prevention of Elderly Drug Abuse

Older Americans spend $15 billion a year on prescription medications, four times more than younger people. Most of those drugs are designed for disorders of the cardiovascular, central nervous, and musculoskeletal systems. While many drug regimens are effective in managing the signs and symptoms of chronic disease, there is good evidence that many elderly patients simply have too many medications in their medicine cabinets.

Types

• An elderly adult often has access to a wide variety of drugs, including current and expired prescriptions for himself or other members of the household, over-the-counter medicines, herbal remedies, vitamin and mineral supplements, alcohol, and illegal substances. All of these products can be abused in some way. A nurse can get a better picture of her patient's drug intake by compiling a list of current drugs with their correct doses and frequencies. This process, known as medication reconciliation, is a good starting point for abuse prevention. (See Reference 1)

Drug Action

• According to the National Institute of Drug Abuse, there is a noticeable difference in the way a person responds to drugs as he ages. A medication may work at a much lower dose than originally prescribed, it may cause side effects he's never noticed before, or it may fail to work at all. During the medication reconciliation process, the nurse will ask about these effects and side effects to get a clear picture of what's going on.

Interactions

• As the number of drugs taken each day increases, the elderly adult has a higher risk of drug-drug or drug-food interactions. According to University of Chicago researchers, these interactions might cause a prescribed medication to be less effective, make another drug more potent in the person's body, or cause side effects when the drug interacts with other products. These unpredictable responses can cause serious problems, including confusion, coma and death. A nurse can share the patient's updated medication list with his pharmacist and doctor to detect potential interactions.

Scheduling

• Faced with the need to take large numbers of pills each day, an older adult may choose to swallow several at each meal, or save them until bedtime. If he has a memory loss, he may forget to take pills for an entire day and then decide to make the loss up with double doses the following day. All of these practices can limit the drugs' effectiveness and create dangerous side effects. A nurse can work with the patient to develop a visual schedule of medications or pre-fill a box labeled with slots for various days and hours to ensure drugs are taken on time. (See Reference 2)

Psychosocial Factors

• According to the CDC, elderly people are at significant risk for depression and substance abuse after loved ones die and psychosocial networks evaporate. A nurse providing care in the home, at a doctor's office, or in the hospital can assess for these issues and make appropriate referrals for diagnosis and treatment. (See Reference 3)

Warning

• When evaluating an older adult for substance abuse, a nurse can never assume prescribed medications are safe. In fact, opiates (including codeine and hydrocodone) are the most frequently abused drugs in elderly people. (See Reference 1)