Pharmacology and the Older

Adult
Geriatric Nursing
Topics
• Cultural Diversity & Medication Safety
• Pharmacokinetics: Alteration in the Older
Persons
• Polypharmacy
• Alteration and Complementary Medicine
• Promoting Adherence & Compliance
• Assessing Older Patients’ Appropriate Use of
Medication
• Medication Management
Cultural Diversity
• Patients whose culture is taken into
consideration have better outcomes than those
whose culture is not considered

• A key strategy for achieving cultural competence

is to learn about different cultural and religious
preferences, customs, and restrictions
Characteristics to Be Considered
• Heritage
• Ethnicity
• Nationality
• Religion
• Culture
Five Major Ethnic Groups
European Americans
• Christians
• Less likely to rely on spirituality (God) and turn to
science
• Turns to the government to take care of the elderly
• Does not have close family ties
• “doers” – does not want to be a “burden to others”
• Retirement – they lose their self-worth
• Follows the advice of health care providers than
other groups
Top 5 Health Concerns
1. Smoking by pregnant women
2. Drug-induced deaths
3. Deaths from poisoning
4. Deaths from melanoma
5. Deaths from chronic lower respiratory disease
before age 45
African Americans
• Most are Protestant, some are Muslim
• More spiritual especially in health and wellness
• Close family ties
• Does not trust authorities much
• Distrustful of Medical personnel
Top 5 Health Concerns
1. &
2. New cases of gonorrhea
3. Congenital syphillis
4. New cases of AIDS
5. Deaths due to HIV infection
Hispanic Americans
• Mostly Catholics
• Places a high value in family, religion, and
community
• Will seek homeopathic remedies with religious
artifacts before seeking health care
• Illnesses are also due to their “sins”
Top 5 Health Concerns
1. Congenital syphillis
2. New cases of tuberculosis
3. New cases of AIDS
4. Exposure to particulate matter
5. Cirrhosis deaths
Asian Americans
• Earliest settlers are from China
• Most are Buddhism, Confucianism, Taoism
• Basic concept: all things are composed of
opposing forces (yin-yang)
• Should be balanced, if not, diseases manifest
• Some elderly clients forgo life-sustaining
treatment because of Ren
Top 5 Health Concerns
1. New cases of tuberculosis
2. Congenital syphillis
3. No Pap test among females older than 18
4. Exposure to particulate matter other than 18
5. Carbon Monoxide exposure
Native American
• Mostly Indians/Alaskan Americans
• Naturalistic approach to health and illness
Top 5 Health Concerns
1. Fetal alcohol syndrome
2. Smoking by pregnant women
3. Alcohol-related motor vehicle deaths
4. Cirrhosis deaths
5. New cases of gonorrhes
Ethnicity and Obesity
• African American – 35%
• Hispanic – 33%
• European American – 22%
• Others – 30%

• African American & Hispanic : Poverty

• European American : Higher Income & Less
Education; or Excess in Living
Pharmacokinetics
• Time course by which the body absorbs,
distributes, metabolizes, and excretes drugs
• How drugs move through the body and how
quickly this occurs
Absorption
• Movement of a drug from the site of
administration, across the biological barriers,
into the plasma
• Least affected by age, although drug
movement decreases
Distribution
• Movement of a drug from the plasma into the cells
• As people age, water declines and fat stores
increase
▫ Affects distribution phase of water-soluble & fat
soluble drugs
• Hepatic & Renal mass, & hepatic & renal blood
flow decrease
▫ Hepatic metabolism of drugs is reduced
▫ Renal excretion is also decreased
Pharmacodynamics
• Time course a and effect of drugs on cellular and
organ function.
• Is what drugs do when they are inside the body

• Ex.
▫ Benzodiazepines – increased sedation
▫ Opiates – increased analgesia and respiratory
suppression
▫ Warfarin – increased anticoagulant effect
Polypharmacy

• Prescription, administration, or use of many

medications than are clinically indicated in a
given patient
Screening for Polypharmacy
• Is the medication necessary?
• Do the benefits outweigh the risks?
• Is this the safest drug available?
• Is the frequency of the medication prescribed
properly?
• Is the medication prescribed in the most
appropriate dose, route, and/or form?
Complementary & Alternative Medicine
(CAM)
• Is a group of diverse medical and health care
systems, practices, and products that are not
presently considered part of conventional
medicine
Classifications of CAM
1. Whole Medical Systems
2. Mind-body medicine
3. Biologically Based Practices
4. Manipulative and Body-based Practices
5. Energy Medicine
Whole Medical Systems
• Involves complete systems of theory and practice
that have evolved independently from parallel to
allopathic medicine
• Examples:
▫ Homeopathy
▫ Naturopathic Medicine
Homeopathy
• By German physician Dr. Samuel Hahnemann
• Natural law of “like cures like” or Principle of
Similars
• Homeopathic Theory: “when a person’s vital
force or self-healing process is out of balance,
health problems will develop”
• Goal: “Stimulate the body’s own healing
responses to prevent or treat illness”