Please Reply to the following 2 Discussion posts:
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PleaseReplytothefollowing2Discussionposts.docx
Please Reply to the following 2 Discussion posts:
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DISCUSSION POST # 1 Reply to Nozomi
Most of my nursing career has involved caring for adults and the older population. My first job after nursing school was at a nursing home, and I moved on to work at a geriatric psychiatric unit. After that, I worked in urgent care and telemetry, where the vast majority of my patients were adults as well.
Contrary to the majority of the adult population, older adults frequently present with frailty and numerous comorbidities, which require a multi-disciplinary approach to healthcare (Ellis & Sevdalis, 2019). Ellis & Sevdalis (2019) suggest that one way to provide high-quality care to the older population is through the provision of a comprehensive geriatric assessment (CGA). This is a team-based process in which providers, nurses, social workers, and allied health professionals approach the care of a geriatric patient in order to achieve a holistic approach to healthcare and continuity of care (Ellis & Sevdalis, 2019). Personally, I have encountered this type of interaction during my employment at a geriatric psychiatric hospital. As a charge nurse, I regularly held meetings with the doctors, case managers, social workers, and family members to formulate individualized plans for the patients. This was a valuable experience, since the patient’s medications, socioeconomic situations, financial elements, health status, and other aspects were reviewed from various angles. As I progress through this course, I am hoping to partake in this interdisciplinary work from the provider perspective.
Another element of geriatric patient care I would like to learn about is polypharmacy and ways to decrease the burden on the patients by conducting a thorough review of the necessity of their medications. According to Roh et al. (2022), despite the fact that only 14% of the U.S. population is aged 65 years and older, this group comprises 33% of all prescription drug purchases, and this number is expected to increase to 50% by the year 2050 (Roh et al., 2022). Polypharmacy is defined as taking five or more medications, and is a prevalent issue in the older population (Cheng et al., 2022). Polypharmacy causes many negative consequences, such as adverse drug reactions, poor adherence, increased cognitive decline, and higher risk for falls (Roh et al., 2022). As a primary care provider, it is extremely important to correctly reconcile the patient’s medications through the process of verifying, clarifying, and reconciliation (Roh et al., 2022). This is especially true when patients are transferred between various levels of care or different facilities (Roh et al., 2022). As the number of older patients increases in the coming years, I believe that medication safety is of utmost concern for all providers who care for this special population.
DISCUSSION POST # 2 Reply to Astrid
Having worked as a staff nurse in an acute care hospital for over 13 years, including the last two clinical terms in internal medicine as a student nurse practitioner, I have cared for and treated many older patients. The geriatric population often faces the challenges of chronic diseases, comorbidities, and other limitations associated with old age. Over 80% of elderly Americans are affected by at least one or more chronic illnesses (Fong, 2019). Major chronic diseases include cardiovascular disease, type II diabetes mellitus (DM), chronic lung disease, and cancer (Fong, 2019). Geriatric patients have significant morbidity and require care and assistance. Fong (2019) states that functional impairment develops dynamically and progressively. As people age, their health problems worsen, and they lose the capacity to perform activities of daily living, such as eating, dressing, bathing, and toileting. In addition, I have also had challenging nursing experiences with older adults suffering from cognitive impairment from a variety of possible causes, such as delirium, dementia, or medication side effects. A combination of cognitive and physical decline places older patients at greater risk for falls and injuries. Therefore, safety precaution is vital in the geriatric population.
Furthermore, although I will not be caring for any geriatric patients during this clinical term, significant anticipated learning opportunities I hope to gain from this course, the current didactic course, and throughout the program include the roles of a provider in caring for geriatric patients with chronic illnesses, treating and managing chronic illnesses, managing polypharmacy, deprescribing, and utilizing tools to assist in choosing appropriate medications for older patients. Multiple medications, also known as polypharmacy, are used among geriatric patients due to their chronic conditions requiring one or more medication management. For example, a few weeks ago in clinical, a 68-year-old female patient presented to the clinic for a wellness exam. Her medical conditions included type II DM, hypertension, hyperlipidemia, osteoporosis, and a history of transient cerebral ischemic attack. Her medication list consisted of 13 medications. However, she reported stopping all of her medications, except for her insulin, for a couple of months because a friend told her she did not need any medications. Unfortunately, she presented with elevated blood pressure, lipid profile, fasting glucose, and glycated hemoglobin levels. Rather than resuming all 13 medications, she was prescribed to continue her Humalog and Lantus insulin injections, two of her five antihypertensives, aspirin, and atorvastatin. She was advised to follow-up to evaluate her progress. She was also advised to discontinue the rest of her medications until further recommendations. This is called deprescribing, the process of tapering or discontinuing medications to manage polypharmacy (Halli-Tierney et al., 2019). Halli-Tierney et al. (2019) recommend that providers perform medication review and reconciliation at each visit with a deprescribing plan put into place. It is also important to consider underlying causes to treat first, alternative nonpharmacologic treatments, and benefits versus risks of treatment (Halli-Tierney et al., 2019).
Additionally, learning about tools to improve polypharmacy-related patient outcomes will be helpful when caring for and treating geriatric patients. The Beers criteria, screening tool of older people’s prescriptions (STOPP), and screening tool to alert to right treatment (START) are tools that can provide clear criteria to facilitate efficient decision-making processes (Halli-Tierney et al., 2019). These tools allow a patient’s list of medications to be compared to a list of potentially inappropriate medications and check for interactions between medications and diseases, duplicate medications, and medication changes needed for particular disease states, such as renal impairment (Halli-Tierney et al., 2019). For instance, the Beers criteria, which were recently updated, have a list of inappropriate drugs by drug class and disease state (Halli-Tierney et al., 2019). The STOPP and START criteria are used to detect inappropriate medications (STOPP) and alternative medications that can be safely prescribed to treat a particular disease (START).
