BScN, RN, GNC(C) President,
Eldercare Home Health Inc.

For those of you who are not familiar with Eldercare Home Health, we always follow up a request for senior care with a face to face Registered Nurse assessment. It’s not that we don’t believe the person on the phone who is giving us details about a Client’s need for care, it’s just that our perspective as the Visiting Nurse, may reveal some additional important safety issues.

We will always want to see a current list of medications. These include prescriptions as well as over the counter medications that a Client may be taking. A Client’s doctor or pharmacist may not have been aware of some of these nonprescription medications when they either prescribed or delivered medications.

It always amazes me how many prescriptions some of our Client’s do have. Ten medications with three or four differing administration times is not unusual. I don’t know about you, but I find it difficult just to remember to take one multi-vitamin each day. These older adults, some of whom have memory deficits, are being asked to organize a personal pharmacy!!

We always recommend either a medication dossette – a “pill box” with multiple compartments that clearly show when medications are due, or asking the pharmacy to provide blister packs – a pill “card” where the times and dates are clearly labelled for each day and the Client can punch out the medications when they are due.

There are so many variables to be aware of when taking medications. Some medications must be taken with food. Some must be taken on an empty stomach. Some medications interact with one another. Others must be taken at specific intervals to be effective. Some medications are best taken in the evening and some in the morning. Lifestyle factors must be taken into consideration for some medications, like a diuretic or “water pill” where a Client will need to be close to the bathroom for a period of time when the medication will cause a strong urge to void.

There are some medications which are not well tolerated by seniors. Codeine is an example of a medication where the side effects make it a less than perfect choice for many seniors. Codeine can be found in Tylenol 1,2 and 3. The numbers represent how much codeine is in each tablet. One of the unfortunate side effects of codeine is constipation. Another is to make the Client seem “loopy” (not a medical term) or confused.

Despite these well documented side effects, many seniors still receive prescriptions for codeine when they present to hospital with complaints of pain, for example, after a fall.

In addition to these known side effects, interactions and timing issues, there are also issues relating to absorption, allergies and individuals differing responses to medications.

Taking the right medications, in the right dosages, by the right route, at the right time is a complicated matter. Sorting it all out will mean that the Client is receiving the optimal effect from the medication.

Clients must be sure that all prescribing physicians and the pharmacist filling the prescriptions are aware of all of their medications, even the over the counter ones or “natural remedies”. And of course, having the expertise of a Registered Nurse,specialized in the care needs of the elderly, to assist with monitoring medication efficacy will go a long way to minimizing potential side effects and negative outcomes of medication administration.

When it comes to starting with new medications or determining the right medications for Clients there’s the old adage that I always practice by: Start Low….Go Slow.

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