Medication management is a cornerstone of care in post-acute and long-term care (PALTC) settings, especially given the complex medication regimens older adults often require. This multifaceted process involves prescribing, dispensing, administering, and monitoring medication to optimize therapeutic outcomes while minimizing adverse events. In older adults, where polypharmacy and age-associated physiological changes are prevalent, effective medication management becomes both a clinical and operational imperative.
Core Principles of Medication Management
- Comprehensive Medication Review (CMR): This involves a regular, thorough evaluation of all prescribed, over-the-counter, and complementary medications. A CMR can identify potential drug-drug or drug-disease interactions, redundancies, or therapeutic gaps.
- Deprescribing: As important as prescribing, deprescribing involves the systematic discontinuation of medications that may no longer be beneficial or might be potentially harmful. This is particularly relevant for drugs with a narrow therapeutic index or those considered potentially inappropriate in older adults.
- Dosing and Route Adjustments: Aging can bring about changes in drug metabolism and excretion. Thus, "start low and go slow" is a foundational principle, ensuring appropriate dose adjustments, especially in the presence of renal or hepatic impairment.
Implementing Safe Medication Practices
- Medication Reconciliation: This should be a regular activity, especially during transitions of care, such as hospital to PALTC facility transfers. It aids in ensuring medication accuracy and continuity.
- Adherence Monitoring: Non-adherence can be intentional or non-intentional. Identifying barriers to adherence, such as complex regimens, cost issues, or cognitive impairment, and implementing strategies like pill organizers or medication synchronization can enhance compliance.
- Education and Communication: Both patients and their caregivers should understand the indications, dosing, potential side effects, and monitoring parameters for each medication. Open channels of communication between prescribers, pharmacists, nurses, and families facilitate this understanding.
- Adverse Drug Reaction Monitoring: Prompt identification and management of adverse drug reactions, along with reporting to medication safety databases, are crucial.
