Medication Management in Care of Older People (eBook)

Maggi Banning is a Senior Lecturer in Advanced Clinical Practice at Brunel University, West London, UK

Medication Management in Care of Older People 1
Contents 7
List of figures 13
List of tables 15
About the contributors 17
Preface 19
Introduction 21
1: Older people and their medicines: health objectives and health initiatives 27
Introduction 27
Development of the National Service Framework (NSF) for Older People 28
Management of medicines 29
The NHS Improvement Plan 30
Building a Safer NHS for Patients the role of medication safety
Prescribing drugs 31
Dispensing medicines 32
Access to medicines out of hours 33
The administration of drugs 33
Helping patients and carers to safely self-administer medicines at home or in care homes 35
Community matrons and the management of medicines 38
Patient case study 39
Conclusion 43
Implications for practice 43
2: The physiology of human ageing 45
Introduction 46
Homeostasis and ageing 46
Ageing and the cardiovascular system 48
Implications for practice 53
Hepatic ageing 54
Implications for practice 57
Renal ageing 58
Implications for practice 60
Ageing and the immune system 60
Ageing and the inflammatory response 62
Implications for practice 63
3: The application of applied pharmacology to the older person 65
Introduction 65
Drug absorption 66
Drug distribution 68
Drug metabolism 69
Drug excretion 71
Pharmacodynamics 74
Conclusion 81
Implications for practice 82
4: Medication management and the older person 83
Introduction 83
Medication review and the older person 85
Medication review structure 86
The single assessment process 88
Prescribing practice 93
Conclusion 95
Implications for practice 96
5: Medication errors and the older person 97
Introduction 97
The extent of the problem 98
The UK perspective 98
The potential dangers of medication errors 99
Definitions of medication error 100
Classification of medication errors 102
Causes of medication error 103
Forms of medication error 106
Medication errors that arise due to the supply and administration of medicines 106
Factors contributing to the development of medication errors 107
The nurse prescriber's role in the prevention of medication errors 108
Prescription writing education 110
Preventative measures involving prescriptions 111
Computerised prescribing systems 112
Conclusion 112
Implications for practice 113
6: Concordance with medication and older people 114
Introduction 114
Difficulties in establishing a rationale 115
Characteristics of the non-concordant individual 116
Psychological theory 117
Medication-related issues that underpin non-concordance 118
Promoting concordance with medication regimens 121
Patient self-medication schemes 122
The prescriber's role in the augmentation of concordance with medication for older people 123
The art of teaching 123
Barriers to teaching 125
Conclusion 127
Implications for practice 128
7: Neurophysiology, and neuropathology of ageing 129
Introduction 129
In search of the nerve cell 130
Neurochemicals and synaptic communication 131
Major neurotransmitters in the brain 131
The dynamic neurone, plasticity and memory 133
Changes in neuronal activity and communication in the ageing brain 137
What causes cellular damage with ageing? 138
Conclusion 143
Implications for practice 143
8: The management of the older person with a long-term condition 144
Introduction 144
Government policy and long-term conditions 145
The NHS Improvement Plan 147
The evolvement of the community matron 148
The education and training of the community matron 149
Case finding and case management 152
Interprofessional working 154
Lay carer's role 155
The future management of older people with long-term conditions 156
Conclusion 158
Implications for practice 159
9: The community pharmacist's role in the management of older people and their medicines 160
Introduction 160
Education and training 162
Community pharmacy contractual framework 163
Services to residential homes 170
Swallowing difficulties 173
Domiciliary visiting schemes 174
Compliance aids 175
Physical problems 175
Prescribing support 176
Multi-disciplinary working 177
Conclusion 177
Implications for practice 177
References 179
Index 197