Pharmacology for the Older Adult: A Primer for the Fine Print
The World Health Organization and the Centers for Disease Control and Prevention have reported that the leading causes of death globally and in the United States are noncommunicable diseases.1,2 Noncommunicable diseases are nontransmissible and noninfective that may result from behavioral or genetic factors, have a slow progression, and are of long duration. Half of the top 10 causes of death in the United States include heart disease, cancer, chronic lower respiratory disease, cerebrovascular accidents, and diabetes.3,4 The management of these diseases include the use of medications, nutrition, and physical activity that rehabilitation professionals should be aware of.
This thematic issue of Topics in Geriatric Rehabilitation on pharmacology and nutrition is intended to fill the knowledge gap many clinicians report having regarding medications and nutrition. Integrating a medication review into a rehabilitation professional's examination provides for greater opportunity to capture medication errors, determine whether the medications are working as intended, and allow for clinicians to determine the effects of medications on physical functioning and movement.
Understanding the medical management of heart failure is a crucial part of care planning and clinical decision-making for rehabilitation professionals. Amy Walters and Germaine Ferreira provide a clear explanation of the drugs and their intended side effects. Nicole Stout and Susan Wagner share their expertise regarding polypharmacy and the side effects in cancer management. The management of diabetes is continually evolving, and Susan Wenker and Denise Walbrandt Pigarelli provide a review of the essentials of diabetes mellitus medical management. Annie Burke-Doe reviews medication-induced myopathy for rehabilitation professionals who have opportunities for early identification that is key to improving patient care, as many myopathies are potentially reversible at early stages.
The article by Kevin Warren et al on multimodal pain management shares information on symptom management of acute pain intended to reduce unnecessary opioid use as there is a narcotic use disorder issue in the United States.5,6 Kevin Neville explores the dangers of anticoagulants that are considered high-risk medications, with drugs reaching the market including a new class of drug called direct oral anticoagulants (DOACs). This review article explains how deep venous thrombosis prevention medications work, what DOACs are, and how they work differently than Coumadin (warfarin), aspirin, and heparin do.7,8
Finally, Rich Severin et al explain the role nutrition has in health, especially when we see the sequelae of poor eating in the older adult population with frailty, sarcopenia, and malnutrition.9 The purpose for providing the information here is to make effective change to practice by translating this pharmacology and nutrition knowledge into an effective medication review. Having an effective medication review will improve patient safety, patient care, and outcomes.
—Kenneth L. Miller, PT, DPT, GCS, CEEAA
4. National Center for Health Statistics. Health United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: National Center for Health Statistics; 2016. Report No. 2016-1232. http://www.ncbi.nlm.nih.gov/pubmed/27308685
. Accessed December 22, 2018.
5. Bernhofer EI, Sorrell JM. Chronic pain in older adults. J Psychosoc Nurs. 2012;50(1):19–23. doi:10.3928/02793695-20111213-03.
6. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464.
8. Maddula S, Ansell J. Target specific oral anticoagulants in the management of thromboembolic disease in the elderly. J Thromb Thrombolysis. 2013;36(2):203–211. doi:10.1007/s11239-013-0926-8.
9. Gardner CD, Hauser ME. Food Revolution. Am J Lifestyle Med. 2017;11(5):387–396. doi:10.1177/1559827617696289.