This week’s entry involves my thoughts and aspect of working with older adult clients that I have found to be incredibly important to gaining a comprehensive picture and providing the best possible treatment for each individual. As I’ve gained more experience working with older adults, I’ve also gained a wealth of knowledge into the world of pharmacology. As a counselor it is imperative to have some background into the numerous psychotropics that are used so widely in today’s world; however, as a counselor working with older adults, I have also become familiar with medications that target just about every human function. It is important to note that my growing familiarity still leaves me far from an expert in pharmacology, rather my familiarity has driven my curiosity and in addition led to some concerning questions regarding the use of certain medications in older adults. I do believe the prescription of various medications to older adults is out of a desire to best maintain or improve their health and well being; however, in hearing stories from the families of some of my older adult clients and reading literature on such medications, I find myself feeling as though the relationship between the use of pharmaceuticals and older adults needs some large modifications and improvements.
There have been many improvements with the FDA’s regulation of medications and older adults. In 1999, it became a regulatory requirement within the FDA to include studies that analyze the effects of medications on individuals 65 and older. However, after working with some older adult clients who have been on over a dozen medications at one time, I wondered about the interaction of these medications. In researching medications and older adults, there seem to be few studies that specifically look at the interactions of the numerous medications older adults are commonly prescribed. In addition, it seems as though older adults will be prescribed more medication without any reevaluation of their current medications. The possible side effects of such interactions could be hindering the older adult’s health and quality of life instead of actually improving his or her functioning. I have had numerous experiences in which a simple adjustment to dosages or the elimination of at least one unnecessary medication has done wonders to the individual’s ability to function and maintenance of personhood.
I had one client who was prescribe a common anxiety medication in attempt to help this individual relax as they worked to adjust to their new setting in the nursing home. However this client was also taking a great deal of medication to help maintain his blood pressure, cholesterol, diabetes, and dementia diagnosis. The client was always incredibly restless and agitated, leading the physician to increase his dosage of this anxiety medication. This client’s wife was dismayed by how incredibly different her husband’s personality seemed to be. After some consideration, I suggested another medication reevaluation. This time the client’s wife made an appointment with a geriatric specialist. The specialist assessed the use and need for each prescription and ultimately concluded that the medications were interacting in a way that was leaving the client constantly upset, irritable, and agitated. After discontinuing the client’s use of the anxiety medication, as well as making adjustments to the dosage of the other prescriptions, the client’s wife was amazed at how much better he seemed to be after a week of the new doctor’s orders.
Medications also can be a large burden in terms of cost for the older adult clients themselves, along with the healthcare system as a whole. The issue of medications and older adults is a huge topic that requires a great deal of work and research; however with the collaboration of disciplines it is possible to create a model of care that best tailors each older adult’s treatment plan using a quality of life focused mindset. As always, I’d love to talk more about any of your ideas or experiences. My email is firstname.lastname@example.org. Thanks for reading!
Lee Kehoe is a licensed counselor working with the older adult population. It is her passion to serve the older adult population through counseling, research, and advocacy efforts, with the hope of raising awareness to the growing needs of older adults and their families.