Medication issues in older patients in the Emergency Department are among the most challenging and important areas of their management. In this era of chronic disease management, most older people come to the ED already taking five or more medications. Many ED visits are actually generated by an adverse effect of some medication, and most visits involve the administration or the addition of at least one more new drug. The potential for unwanted effects from interactions between the various drugs or interactions between the drugs and the patient’s diseases is almost unlimited – particularly in a physiologic system that is changing with age.
Throughout this module we will review the physiologic changes that occur with aging and demonstrate the effect they can have on how the aging body both processes and responds to medications. You will examine case studies, all of which could appear in your ED, that illustrate points about polypharmacy, communication, and strategies to manage especially high-risk medication classes.
At the end of this module you should be able to:
- Describe the physiologic changes associated with healthy aging that affect medication use;
- Explain physiologic changes that affect prescribing in the older patient;
- Select appropriate drugs and dosages considering the patient’s acute and chronic diagnoses, other medications, and functional status;
- Recognize high-risk medication classes and how they can be safely used or avoided;
- Demonstrate an approach to polypharmacy including an awareness of drug-drug and drug-disease interactions;
- Demonstrate strategies for effective communication about medications.