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Adverse drug effects are especially problematic in the elderly because they have slowed metabolism and excretion of medications. Often such adverse reactions are caused by the use of unnecessary medications, or the use of medications in excessive doses. Adverse drug effects are a widespread problem and can lead to significant injury and even death in the elderly. Physicians, nurses, and pharmacists are all responsible for the medication regimen in the nursing home setting.
The statistics regarding adverse drug effects are shocking. In the November 2006 issue of Clinical Geriatrics, a publication of the American Geriatric Society, the following was noted:
30% more money is spent in the United States on treating adverse drug effects than on all pharmaceuticals combined.
31% of older adults use more than one pharmacy, creating challenges for a comprehensive drug review.
50% of older adults receive prescriptions from more than one prescribing clinician.
One in 12 physician visits for the elderly result in a prescription of medication that is not recommended for them.
6,900,000 elderly persons are currently taking medications not recommended for the elderly.
10.3% of all prescriptions in the United States generate an electronic safety alert to the dispensing pharmacists. Of these alerts, 88% are overridden by the dispensing pharmacist. When interviewed, some pharmacists stated they did not believe the alert was important, was not real, or that they already knew about it.
The Centers for Medicare and Medicaid Services (CMS) have taken note of the high risk of injury related to adverse drug effects. In December 2006, CMS clarified federal mandates to state surveyors regarding the appropriate use of medications in the nursing home setting under F329 of the OBRA regulations. The rules are not new, but facilities are receiving clarification as to what medications should be reduced or eliminated from residents’ medication regimens. The clarification makes facilities responsible for the medication regimen, more so than the physician, nurse practitioner, or physician’s assistant who ordered the medication. State surveyors evaluate compliance with such rulings, and will, in essence, question the facility when rules are not followed. This clarification by CMS should be referred to when questioning whether therapy is recommended for the elderly population.
The following are questions you should ask the nursing home staff or medical provider of your loved one if you suspect medications are unnecessary or causing adverse effects:
Is this medication necessary?
Is the drug contraindicated in the elderly population?
Is the resident taking the lowest effective dose of the drug?
Are medications being used to treat the side effects of other medications? For example, medications for constipation are often given to treat the side effects of certain pain medications.
Can the drug regimen be simplified?
What are the potential drug interactions of the medications currently prescribed?
American Medical Director’s Association
Centers for Medicare and Medicaid Services
Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. Cancer can start almost anywhere in the human body, which is made up of trillions of cells
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Common Cancer Treatment Options
Marrow Stem Cell Transplantation
A bone marrow transplant is a procedure that implants healthy blood-making stem cells into the body to replace damaged or diseased bone marrow. In cases where the bone marrow is not functioning or cannot produce enough healthy blood cells, a bone marrow transplant is required. Bone marrow transplants are of two types, autologous and allogeneic. Transplants in which cells from the human body are used are called autologous, and transplants from a donor or donor are called allogeneic transplants.
Chemotherapy is a drug-based therapies. Chemotherapy is a special form of drug therapy that aims to stop or destroy the growth and proliferation of cancer cells that cause uncontrolled growth in the human body and damage healthy tissues.
Immunotherapy is a new dimension of drug therapy in cancer. Millions of cancer cells are born in our bodies every day. There are cells in the human immune system to defeat cancer cells. When the immune (immune) system recognizes cancer cells, it immediately takes action and destroys the cell. T cells (T lymphocytes) in the immune system fight these cancer cells and try to destroy them.
Interventional Radiology is a field of radiology that includes techniques applied for diagnosis and treatment in many areas of medicine. The patient is usually administered local anesthesia; Interventional radiology, which includes the diagnosis and treatment methods performed by entering the body with very small means (in the size of a pinhole), enables diseases to be treated with much simpler interventions than before, without the need for open operations and diagnostic surgical applications, and to obtain clearer information about the disease.
Radiotherapy, that is, beam therapy, aims to destroy cancer cells to a large extent by emitting radiation beams on cancer cells and to treat cancer with this process. Radiotherapy procedures are in the field of specialization in the medical science called radiation oncology.
Diabetes is a metabolic disease that develops when the secretory gland called the pancreas does not produce enough insulin hormone in your body or the insulin hormone it produces cannot be used effectively.
Our digestive system breaks down the eating into nutrients. Carbohydrates or various sugars are broken down into glucose for use by the body and absorbed. Glucose is an important fuel source for many organs in our body. However, in order to use glucose as a fuel, the glucose molecule must enter the cell. For this reason, we need a special hormone. Beta cells in the pancreas produce a hormone called insulin.
Insulin is the chemical messenger necessary for the entry of glucose into the cell to regulate blood sugar levels that rise after a meal. Insulin is released into the bloodstream to trigger blood glucose to enter cells. Insulin lowers your blood sugar level, allowing glucose to enter the cell.
Not only insulin but also glucagon which has an effect on blood sugar levels. If your blood sugar levels are too low or you haven’t eaten for too long, glucagon inform the liver to release stored sugar.
The other active hormone in diabetes is GLP-1 which helps the pancreas for production of the right amount of insulin to move sugar from the blood into the cells. When blood sugar gets too high, GLP-1 stimulates beta cells to increase insulin production and also helps lower the amount of sugar converted by the liver. When blood sugar gets too high, insulin production increases. Metabolic disorders in these systems lead to diabetes.
These days, autumn makes itself felt, unpredictable weather causes an increase in flu cases. It is possible to protect against influenza, which can be seen more frequently in crowded environments, by vaccination.
Influenza is an infectious disease which is disease that enters the body through the respiratory tract with viruses called “influenza”. Influenza can cause epidemics, especially in late autumn, winter, and early spring.
Healthy individuals injected with flu viruses usually heal spontaneously in one week. However, it can cause serious and fatal complications especially in the elderly, children, and people with chronic diseases
Influenza, which is a contagious virus infection, is a much more severe disease than the common cold. The flu virus, which can survive for weeks, especially in the winter, is very easy to transmit. One of the most important ways to protect against the flu is the flu vaccine.
The flu vaccine is inactive and is prepared each year according to the World Health Organization’s recommendations. After the flu vaccine is administered, the protective antibody level is formed on average, 10-15 days. It can prevent 70-90% of flu symptoms in healthy young adults.
Who can have the flu vaccine?
Flu vaccines are suitable for most people with rare exceptions
- people 50 years and older
- People with chronic diseases in a nursing home
- People with chronic diseases such as chronic obstructive pulmonary disease (asthma, chronic bronchitis, etc.), heart patients, diabetics, chronic liver and kidney patients,
- Those with immunologic diseases.
- Those with immune-suppressed diseases suppressed immune system (HIV/AIDS patients, cancer patients, organ and bone marrow transplant recipients, chemotherapy, radiotherapy patients, steroids)
- Between 6 months and 18 months and taking long-term aspirin therapy (to reduce the risk of developing Reye’s syndrome),
- Pregnant women (within the knowledge of the patient’s physician),
- Babies older than six months (trivalent inactivated flu vaccine), older than thirty-six months (3 years old) (trivalent or quadrivalent flu vaccine can be administered),
- Health workers,
- All healthy individuals who want to be protected by vaccination can get vaccinated.