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The Use of Drugs in the Elderly
June 2011-- The Geriatric and Long Term Care Review Commitee has made the following recommendations to Ontario's chief coroner in its 20th annual report.
• Health care professionals should be reminded of the limited indications for the use of Loperamide Hydrochloride in the clinical setting. The first step in managing diarrheal illness, especially in the elderly, should include a comprehensive and thorough clinical assessment following which the clinical diagnosis(es) can be formulated. Fecal impaction with overflow incontinence/diarrhea should always be included in the differential diagnosis. Health care professionals should also be reminded that Loperamide Hydrochloride is absolutely contraindicated in the management of Clostridium difficile associated disease.
• Health care professionals should be reminded that elderly seniors who are on antiplatelet medications are at increased risk to develop serious vascular intracranialsequelae as a result of minor trauma. In addition, the development of confirmatory diagnostic symptoms and signs may not be readily apparent. Ongoing monitoring for the symptoms and signs of intracranial complications is highly desireable.
• Health care professionals should be reminded that the use of more than one antiplatelet agent may increase the risk for hemorrhagic complications, especially following a minimal traumatic event.
• Health care professionals should be reminded of the importance of monitoring medications prescribed in the elderly. Even when medications such as analgesics are required in the elderly, toxic side effects may still occur.
• Health care professionals should be reminded that Codeine is not a reliable and effective analgesic for end of life care. Morphine Sulfate or Hydromorphone are more effective analgesics. While the initial dosage should be low in most instances, doses may be titrated upwards to ensure adequate pain relief.
• Health care professionals should be reminded of the importance of adjusting the dosages of medications to obtain an effective, therapeutic outcome (i.e. don't treat by dose, treat by outcome). |
