Introduction
At an old age, multiple medical medicals are almost unavoidable. The wellness of the body reduces and several elements may contribute to the ill condition of the individual. The elderly need special care with proper medical interventions. Geriatrics is a specialty aiming at resolving medical issues for old people. It is significant in promoting prevention as well as treatment of diseases in older adults. The medical wellness for the elderly is affected by some factors. One of the most sensitive factors influencing the participation of older individuals in medication regimen is the irresponsiveness of the body to the drugs. The irresponsiveness may be following improper intake of drugs through the processes of absorption, distribution, metabolism as well as excretion. Also, the health for the elderly may be affected by the adverse drug reactions, which are influenced by factors such as social factors, patient-related factors, drug-related factors and disease-related factors. Depending on the sickness, the elderly may be prescribed some drugs based on their health problem.
SECTION 1
As an individual gets old, there are some physiologic changes that occur. The physiological changes usually cause various health complications. At an old age, the body is unable to execute various processes or activities that make the body function accordingly and which define good health for the person (Lonsdale & Baker, 2013). Such changes are known to affect the absorption, distribution, metabolism as well as excretion of drugs in the body.
Changes affecting Absorption of drugs in the body
The gastrointestinal (GI) tract gets into poor condition with age, which affects how certain drugs are absorbed in the body. As age advances, the GI motility and GI blood flow reduces. Also, the gastric acid secretion reduces in older people, which is likely to cause an increase in the gastric PH. High gastric PH and low gastric blood flow cause the reduction in drug absorption. Long exposure to use of medications may also affect the gastric PH thus reducing the absorption rate for medication (Al-Khadra et al, 2014). However, at some point, it would be difficult to predict the absorption rate of all the drugs in the body of an old person since the rate would depend highly on the nature of the drug being prescribed to the patient.
Changes affecting Distribution of medication in the body
The distribution of drugs in the body of a patient is usually affected by some factors at an old age. For oral drugs, the distribution begins after absorption as well as after first-pass metabolism (Son et al, 2014). The distribution of drugs in the body is influenced by factors such as PH, molecular size, as well as lipid solubility (Anyanwu, 2007). Certain changes in the body functions affect the distribution of drugs in the body can be influenced by some factors. As the muscle mass reduce, the absorption of body fat increases. Therefore, fat-soluble drugs are distributed quickly to the body of an elderly person. However, drugs to be distributed through the body muscle will be hard for elderly people following the incapacity of the muscles. Also, the aging process is linked to a theoretical reduction in body water, which affects the amount of distribution of water soluble drugs (Al-Khadra et al, 2014). Further, the bodies of the old people produce low albumin, which holds the drugs in an insoluble state.
Changes affecting Metabolism of drugs in the body
Elderly adults have low hepatic blood flow. The metabolism capacity of a person depends highly on the hepatic blood flow. With extremely low hepatic blood flow, the introduction of blood to the liver takes place at a slightly lower rate. As one age, the liver mass, as well as intrinsic metabolic activity including the CYP450 enzyme system, reduce. Since these factors are variable, it becomes difficult to measure the extent of hepatic function reduction and quantify the effect to ensure the doses are calculated by the function of the liver (Fialová & Onder, 2009).
Changes affecting excretion of drugs in the body
Excretion or elimination of drugs from the body mainly happens through renal excretion. The half-life of drugs increases with the reduction in renal function. As the body ages, the renal function reduces. The reduction is caused by low flow of blood to the kidney, decrease in kidney mass, as well as reduced size and functionality of nephrons (Son et al, 2014). Renal changes are usually predictive, and the adjustment of drug dose can be calculated or measured through laboratory measurements. The impact of the renal elimination of medications cannot be overstated since most of the drugs are completely or partially excreted by the kidneys. Reduced glomerular filtration is usually as a result of old age (Al-Khadra et al, 2014).
SECTION 2
Predisposing Factors to Adverse Drug Reactions (ADRs)
The risks of developing ADRs are as a result of some factors. The factors are related to drugs, patient, disease as well as social elements.
Drugs related factors
Drug-related factors may be expounded in many ways. The first element is the drug dose and frequency. The dose, the administration rate, as well as the time of the day when the drug is taken affect the occurrence of ADR. Giving an under dose, an overdose of medication, raising or reducing the administration frequency, changing the appropriate time to administer medication may lead to extensive drug effects (Anyanwu, 2007).Poly-pharmacy could be the other factor in defining the ADR effects of a drug. It concerns the prescription of extremely many medications at the same time to one patient than the clinical requirements (Valença, 2010). One patient may consult different prescribers for the different health conditions which may cause poly-pharmacy. Poly-pharmacy may lead to the ADRs following the addictive drug effect, discontinuation of treatment, duplication, synergism, as well as physiological antagonism (Lonsdale & Baker, 2013).
Patient-related factors
Several factors related to the patient may have extensive effects on the development of ADRs among elderly people. Age is the first factor with exhaustive effect on pediatric and geriatric patients. Geriatric patients who may have multiple disease conditions, reduced drug elimination, as well a previous allergy history are prone to ADRs. Pediatric patients have poor metabolism for drugs hence higher risks for ADRs (Anyanwu, 2007). Gender may also be major factors influencing the development of ADRs in a patient. The GIT motility differs between men and women (Valença, 2010). Men have more body weight, larger internal organ size as well as glomerular filtration with lesser body fat. The factors are highly influential to the drug pharmacokinetics as well as pharmacodynamics (Son et al, 2014). Female elderly patients have higher levels of active cytochrome P3A4, which is an indication of the differences in metabolism rate for drugs between men and women (Anyanwu, 2007).
Renal function is the other factor influencing the Adverse Drug Reactions (ADRs) in a patient. Kidney controls the rate of drug clearance as well as metabolism causing drug toxicity and reduced therapeutic effect which can be detected by the level of creatinine clearance. The low rate of drug clearance in a patient with the complication of the kidney is following the changes that happen in the drug transport system as well as metabolic enzymes (Al-Khadra et al, 2014). Drugs allergy can cause the T-cell and antibodies to get into the elicitation phase. The changes in the body as a result of the allergic reactions may make the intake for some drugs difficult leading to complications in the body of the elderly patient. The allergic complications may make it difficult to treat certain conditions since the intake of the drugs becomes hard (Fialová & Onder, 2009).
Disease-related factors
At an old age, the strength of the body functions is likely to have reduced significantly. The body parts may not be performing as they are supposed. Therefore, the body becomes weak since the immune system cannot fight the disease at the specific time. Exposure to many diseases at the same time puts the patient into risk of drug-disease interaction which may cause ADRs. A useful drug in the treatment of one condition may be harmful to the other (Fialová & Onder, 2009). Therefore, complications are likely to come up making it difficult to treat an elderly person.
Social factors
Some social factors may influence the development of ADRs. Race and ethnicity are likely to be some of the most sensitive social factors to influence the development of ADRs. The ethnic background of an individual is governed by genetic factors which control the genetic polymorphism as well as individual differences in the ability of enzymes to metabolize drugs. The existence of ADRs is different from one group of patients to another following the genetic differences (Son et al, 2014). Alcohol and smoking habits may be the other factors that influence the existence of ADRs amongst the elderly people. Alcohol leads to the development of hepatitis and liver cirrhosis, which are highly influential to the rate of drug metabolism. When certain drugs mix with alcohol, lead to various ADRs such as nausea, vomiting, headache, as well as hypotension. Smoking has been identified as a leading cause of diseases like peptic ulcer, cancer and various cardiovascular diseases (Al-Khadra et al, 2014). Therefore, it is a major factor that would influence the wellbeing of the elderly after engaging in the practice for a long time.
SECTION 3
Classes of medications
Analgesics
They are commonly known as painkillers. They are any member of the group of drugs useful in achieving analgesia or relief from pain (Golar, 2011). They act in different ways on the peripheral as well as the central nervous systems. There are different classes of painkillers; some are prescriptive while others are non-prescriptive.
Commonly prescribed Analgesics
Paracetamol and NSAIDs
The mechanism action of paracetamol is not confirmed, but it seems to work mainly on the brain than peripherally in nerve endings. Paracetamol works on the reduction of pain as well as inflammation. The drug is considered to have minimal side-effects, and it is usually safe to low as well as infrequent doses as prescribed by the doctor. If the precautions are not considered, the drug can lead to life-threatening situations such as liver damage and kidney damage (Golar, 2011).
Opioid drugs
The drugs are usually typified by morphine, and they have the potential for mood changes, physical dependence, tolerance, as well as a hedonic effect which may result in the compulsive use of drugs. The opioid drugs work on both the central and peripheral nervous systems. In the central nervous system, opioids have effects in some areas, which include the spinal cord. In the peripheral nervous system, the actions of opioids have effects on the myenteris plexus and submucous plexus in the gut’s walls which are the main causes of the extensive constipating effects of opioids (Golar, 2011). Also, there is an argument that opioids produce effects on neurons through action on receptors, which are located on neuronal cell membranes.
Flupirtine
It is an aminopyridine which works mainly by acting as a non-opioid analgesic. It is usually used as an analgesis for acute as well as chronic pain in moderate and severe cases. It has a muscle relaxant property, which makes it popular for patients with back pain and it is significant for other orthopedic uses (Golar, 2011). It is also used for migraines, ocology, postoperative care, as well as gynecology purposes.The mechanism of action of the drug is usually through the NMDA receptor antagonist and GABA receptor.
Nonprescriptive Analgesics
Aspirin
Aspirin causes various effects in the body mainly reduction of inflammation and relief of pain. It works together with the oxidative phosphorylation in cartilaginous mitochondria through diffusion from the inner membrane space as a proton carrier into the mitochondrial matrix where it gets to ionize further to excrete protons. Aspirin energizes and moves the protons by behaving as a competitor to ATP synthase. Aspirin can also encourage the formation of no-radicals in the body so as to help in the development of an independent mechanism that would be significant in the reduction of inflammation (Golar, 2011).
Acetaminophen
The primary mechanism of action of acetaminophen is the inhibition of cyclooxygenase (COS) with a prime effect on COX-2. Inhibition of COX enzymes prevents the metabolism of arachidonic acid to prostaglandin H2 (Golar, 2011).
NSAIDs
The pain relieving action of nonsteroidal anti-inflammatory drugs (NSAIDs) is usually defined by the inhibition of the enzymes that help in the synthesis of prostaglandins. The NSAIDs exert their analgesic effect not only through peripheral inhibition of prostaglandin synthesis but also employs some peripherals as well as central mechanisms. The other basis of analgesic mechanisms is unrelated to inhibition of prostaglandin synthesis (Golar, 2011).
Therapies for pain relief
Massage therapy is one of the strategies useful in dealing with pain. It helps in relaxing tight muscles as well reduce pain in the body. It is usually recommended by doctors and can be offered by a qualified masseuse. The second one is therapy where the patient is required to exercise regularly. It helps in the improvement of movement and strength as well as reduction of pain. It helps in relaxing the body and more energetic to avoid or minimize pain. The third therapy is the transcutaneous electrical nerve stimulation (TENS). It is a battery-powered device that is attached to one’s skin and placed over the paining point. It employs safe electrical signals to help in the reduction of pain (Son et al, 2014).
Antidepressants
These are drugs mostly useful in the treatment of major depressive disorders as well as other disorders like anxiety and obsession.
Prescribed antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
They are the most common types of antidepressants. They reduce the amount of serotonin that is reabsorbed by the presynaptic neuron. In return, more of the neurotransmitter remains in the synaptic gap for more time leading to compensation for the minimal levels of serotonin in some depressed individuals (Valença, 2010).
Serotonin-noradrenaline reuptake inhibitors (SNRIs)
It was developed to be a better antidepressant than SSRIs. It works on the same principle of reducing the level of serotonin that the presynaptic neuron reabsorbs. It causes the neurotransmitter to remain in the synaptic gap for longer causing compensation for the minimal levels of serotonin in the patient (Lonsdale & Baker, 2013).
Noradrenaline and specific serotonergic antidepressants (NASSAs)
The drug is usually effective in the brain. It helps in relieving the brain of exhaustive processes, which may cause it to stretch beyond its capacity. It helps in relaxing the mind to the most comfortable size that would accommodate normal activities (Lonsdale & Baker, 2013).
Non-prescribed antidepressants
Folate
The brain needs high levels of folate, which is a soluble B vitamin for proper functions. Folate helps in the production of certain neurotransmitters that affect the mood as well as the motivation of an individual.
Fish Oil
It is available in form of pills. It contains the omega-3 fatty acids, which are major substances in the formation of the brain. The oil is also significant in boosting the effectiveness of the conventional antidepressant medications (Valença, 2010).
S-adenosyl-L-methionine (SAMe)
It is available in a dietary supplement. It is a naturally occurring chemical in the human body and helps in dealing with mild and moderate depression. It helps in raising the brains supply with dopamine, which is involved with mood and motivation (Lonsdale & Baker, 2013).
Therapeutic actions of depression
Talking out
The mind gets relieved when it releases the entire problem that it had held at a particular time. Talking helps in going around the problem and defining the challenges surrounding it as well as strategies to resolve the problem in it (Lonsdale & Baker, 2013).
Exercise
It is a form of therapy that engages the mind in the physical activities thus making the patient to forget about his poor health status at the specific time (Golar, 2011). The mind easily forgets of the problem and concentrates on the exercising efforts.
Engaging in social activities
When one is in a group, he gets carried away by the activities of the group thus focusing less on the personal problems. The mind gets time off the excessive thoughts of the problem of the individual (Golar, 2011).
SECTION 4
Drug interactions that NP may get concerned about
Intake for antidepressants and painkillers would be a point of concern. In specific, paracetamol, which is a painkiller and Noradrenaline and specific serotonergic antidepressants (NASSAs), which is an antidepressant would be a point of concern for the nurse practitioner. The two drugs work in the mind of the patient. The reaction of one of the drugs would be the cause for the condition that the other drug wishes to treat. Therefore, there is a need to consider the sensitivity that would occur after them mind engages in a tag of war between the two drugs (Valença, 2010). As a result, complications are likely to continue causing the patient more trouble.
Conclusion
Treatment for elderly people may be challenging. They deserve special care, and they need to be offered the most outstanding form of treatment since at old age they may suffer different diseases. The statuses of their body systems affect the absorption, distribution, metabolism as well as excretion of drugs. The treatment of the old people may result in the risks of developing ADRs which may be caused by some factors. Such factors are connected to drugs, patient, disease as well as social elements. Different drugs have different dissemination methods as well as the mechanisms of action. Proper prescription of medicine is needed to ensure the drugs do not create further problems.
References
Al-Khadra, S., Meisinger, C., Amann, U., Holle, R., Kuch, B., Seidl, H., & Kirchberger, I. (2014). Secondary Prevention Medication After Myocardial Infarction: Persistence in Elderly People over the Course of 1 Year. Drugs Aging, 31(7), 513-525.
Anyanwu, E. (2007). Neurochemical Changes in the Aging Process: Implications in Medication in the Elderly. The Scientific World JOURNAL, 7, 1603-1610.
Fialová, D., & Onder, G. (2009). Medication errors in elderly people: contributing factors and future perspectives. British Journal Of Clinical Pharmacology, 67(6), 641-645.
Golar, S. (2011). Use and understanding of analgesics (painkillers) by Aston university students.Bioscience Horizons, 4(1), 71-78.
Lonsdale, D., & Baker, E. (2013). Understanding and managing medication in elderly people. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(5), 767-788.
Son, K., Park, S., Lee, J., & Kim, C. (2014). Difference in adherence to and influencing factors of a healthy lifestyle between middle-aged and elderly people in Korea: A multilevel analysis.Geriatrics & Gerontology International, 15(6), 778-788.
Valença, C., Germano, R., & Menezes, R. (2010). The self-medication in elderly people and the role of health professionals and nursing. Rev Enferm UFPE On Line, 4(3esp), 1254-1260.
