2. 2
INTRODUCTIONINTRODUCTIONINTRODUCTION
What is Polypharmacy?
It is the practice of administering or using multiple medications especially concurrently
(as in the treatment of a single disease or of several coexisting conditions)
(Polypharmacy, 2014)
Medications, when used correctly in older adults, can maintain or improve quality of life;
however it may lead to adverse drug reactions if used incorrectly (Hanlon, Schmader, & Sem-
la, 2013, p. 1365).
Many older adults struggled with substance abuse or dependence due to misdiagnosed or
overlooked (Briggs, et al., 2011).
Substance abuse affects millions of adults each year, of whom one in five are older adults
(Morgan, Brosi, & Brosi, 2011, P. 444).
The Wear and Tear Theory focuses on the idea that practicing harmful habits and behaviors
will disrupt our biological well-being, which can alter our body’s cells and tissues (Saxon, Et-
ten, & Elizabeth, 2010, P. 10)
Wear and Tear Theory is directly related to substance abuse/misuse and polypharmacy be-
cause some people who abuse their medications, tends to believe that through eating numer-
ous prescribed or over the counter medication, their chances of living a longer life would be
extended (Sergi, De Rui, Sarti, & Manzato, 2011, P. 509)
3. 3
FACTSFACTSFACTS
RISKS FACTORSRISKS FACTORSRISKS FACTORS
More than 19 million Americans experience substance
abuse and it is estimated that 20 percent of those affected
are older adults (as cited in Morgan, Brosi, & Brosi, 2011,
p. 445)
Drug side effects are responsible for at least 30,000 deaths
and 1.5 million admissions to hospitals each year, and elders are much more likely to
experience toxic effect from drugs than are younger people (Saxon, Etten, & Perkins., 2010,
p. 365)
Polypharmacy contributes to falls and hip fractures, which are associated with high morbidity and
mortality rates in the elderly (Sergi, De Rui, Sarti, & Manzato, 2011, p. 511)
Among older adults, 40% are unable to read prescription labels and 67% are unable to understand the
information given to them about their prescriptions (Benza, Calvert, & McQuown, 2010, p. 1009).
DRINK AND drug misuse among people with serious mental illness is an increasing challenge, af-
fecting up to one third of mental health service users (as cited in Sheret, Lewis, & Warr, 2013, p. 28).
Taking five or more drugs, which may result in increased risk for inappropriate drug
use and adverse drug reactions (Olsson, Runnamo, & Engfeldt, 2011, p. 6)
Stressors in late life, including loss and grief, decreased social support, social isolation,
and financial hardship (Namkee, & DiNitto, 2013, p. 439)
Older adults living alone and experiencing isolation, feeling of loneliness, and depression may be
more at risk for excessive substance use as a way to manage life stressors (Briggs, et al., 2011, p. 112)
Older adults who aren’t compliant with medication may be influenced by a variety of factors such as:
medication schedules, lack of doctor-patient discussion, memory impartment, inability to hear or see
well, loss of hand and finger dexterity, and not being given adequate information about drugs ( Saxon,
Etten, & Perkins, 2010, p. 366)
PRIMARY HOLISTIC NEEDS & INTERVENTIONSPRIMARY HOLISTIC NEEDS & INTERVENTIONSPRIMARY HOLISTIC NEEDS & INTERVENTIONS
Rationale: As people age, their body goes through changes such as skin wrinkle, loss of hair, slower heart
rate, decreased lung capacity, weaker gastrointestinal system, weaker endocrine system, and slower nervous system
(Saxon, Etten, & Perkin, 2010). According to the Wear and Tear Theory by Dr. August Weismann, our body will
eventually deteriorate due to being overworked or used (Saxon, Etten, & Perkins, 2010, P.10). To assist with cer-
tain chronic disease or diagnoses people sometimes take a variety of medication to assist with their health condition.
Older adults are at high risk of adverse reactions or substance abuse due to the amount of medications they intake.
The interventions we have seen to be most useful in regards to polypharmacy and substance abuse/misuse among
the eight Holistic Parameters are Physical, Psychological Well-being, Social Support, and Cultural Practices.
4. Client/Family Needs/Concerns
&Holistic Parameter
Interventions
Performance of Activities of Daily Living
(Physical)
Fall Risk Assessment
(http://consultgerirn.org/uploads/File/trythis/
try_this_8.pdf, 2013)
1) Physical activities also helps prepare the body to fight certain acute
and chronic diseases along the way. Some other benefits that aging
people may not realize are: being physically active will slightly im-
prove some cognitive functions and may prevent falls (Hutzler, 2011).
(Client)
2) The Physical Therapist or family will be able to understand if they
need to purchase certain walking aids for their loved one’s safety
(Quadagno, 2011). (Physical Therapist, Family)
3) A physical therapist will perform the test to evaluate the patients
walking ability and balance (Lee, Yoon, Lee, Yoon, & Chang, 2012).
(Physical Therapist)
Cognitive Impairment & Sleep Disturbance
(Psychological)
Mini Cognitive Assessment (http://
consultgerirn.org/uploads/File/trythis/
try_this_3_2.pdf, 2012)
Sleep Disorder Screening Questionnaire
(http://www.emoryhealthcare.org/saint-josephs
-hospital-atlanta/downloads/Sleep%
20Disorder%20Screening%20Questionnaire.pdf,
2014)
1) A nurse will assess if the patient has the ability to take their own
medications the correct time, route, and dosage (Sheret, Lewis, &
Warr, 2013). (Psychiatric Nurse)
2) The mini cognitive assessment should be performed to evaluate
how cognitive the older adult is (Namkee & DiNitto, 2013).
(Psychiatric Nurse)
3) A specialist will assess the older adult’s sleep disorder and find out
what’s causing the sleep disturbance (Sheret, Lewis, & Warr, 2013).
Patient will be able to rule out any possible outcome of a certain sleep
disorder: Sleep Apnea, Insomnia, Narcolepsy, Periodic Limb Move-
ment or Misuse of Drugs. (Stress Management, Family)
Lack of social network supports and miscommu-
nication between providers and patients can lead
to substance abuse of drugs, polypharmacy, and
misuse of medication causing the body to deteri-
orate (Carlson, 1994, p. 8).
(Social & Psychological)
1) Evaluate the patient’s social behavior and use instrumental screen-
ings to determine whether the patient is suffering from a substance
abuse disorder (Benshoff et al., 2003, p. 46). (gerontologist, nurse,
caregiver, social worker)
2) Monitor the individual when using medications, examine the medi-
cations use, and impose medication management for the older adult to
diminish harms to the body (Carlson, 1994, p. 28). (nurse, gerontolo-
gist, caregiver)
3) Refer patient to behavioral therapy, self-report, and urine drug
screens to meet treatment needs of the patient (McHugh et al., 2014).
(nurse, physical therapist, social worker, gerontologist, counselor)
Sociocultural beliefs, values, and languages often
shape the approach and behaviors of substance
abuse of drugs, medication misuse, and
polypharmacy amongst older adults of different
cultural backgrounds. Excessive use of drugs
and substances intake may be a cultural norm in
treating chronic illnesses or in relation to tradi-
tional culture (Abbott & Chase, 2008).
(Culture)
1) Provide cultural assessments and screening for effective diagnosis
and care of older adults with a different cultural background (Abbott
& Chase, 2008). (gerontologist, nurse, care Manager, social worker)
2) Offer cultural competent in providing substance abuse treatment
services to patients with a different cultural background or bilingual
older adults (Steinhagen & Friedman, 2008). (gerontologist, social
worker, nurse)
3) Refer patient to drug counseling and collaborate with similar cultural
groups in the recovery process of substance abuse and inform the risk
factors of harmful substances that can affect the body (McHugh et al.,
2014). (counselors, gerontologist, case manager, social worker)
5. FIND LOCAL HELP AND SUPPORTFIND LOCAL HELP AND SUPPORTFIND LOCAL HELP AND SUPPORT
Outpatient Treatment
Treatment Associates Inc.
Sacramento Treatment Clinic
Address: 7225 East Southgate Drive
Telephone: (916)-394-1000
www.crchealth.com
Provides community outpatient treatment clinics for people in need of recovery
Operates several programs in behavioral health to assist individual in attaining quality of
life.
Provides resources to help individual in the achievement of a lasting recovery.
Offers a contact number at 1-877-637-6237 to speak with a specialist in finding a facility
for individual in need of substance abuse treatment services and other behavioral health care
services (CRC Health, 2011).
Substance Abuse Treatment Options
National Council on Alcohol and Drug Dependence
1446 Ethan Way
Sacramento, CA 95825
Telephone: (916) 924-4818
http://ncaddsac.org/
Provide services to families, friends and individual seeking
for help in substance abuse of residential treatment, intensive outpatient treatments, transi-
tional living, and case management services.
Organization also operates several services to individual in the early stage of substance
abuse and treatment options for recovery.
Provides information on substance abuse and description of programs services within the
organization.
Offers a 24/7 hope line at (916) 922-5122 for individual in need of help in substance abuse
and for families seeking help for someone whom they are concern about (NCADD Sacra-
mento, 2014).
Counseling
Effort Counseling Center
1820 J Street
Sacramento, CA 95811
Telephone: (916) 313-8400
www.theeffort.org
Effort Counseling Center is a non-profit agency that strives to help patient with Medi-Cal
and Medicare to received access to health services.
Offers inpatient and outpatient, addiction treatment, and mental health counseling for
person in need of help.
Appointments can be arrange at 916-737-5555 for health care services
Operates a 24 hour suicide crisis line at 916-368-3111 and 1-800-273-8255 (WellSpace
Health, 2014)
6. 6
WEBSITES:WEBSITES:WEBSITES:
SUBSTANCE ABUSE SERVICES AND TREATMENT OPTIONSSUBSTANCE ABUSE SERVICES AND TREATMENT OPTIONSSUBSTANCE ABUSE SERVICES AND TREATMENT OPTIONS
Substance Abuse Treatment Services Locator
Substance Abuse and Mental Health Services Administration (SAMHSA) provides a
treatment services locator to individuals seeking out for services within the community
of one’s choice. https://findtreatment.samhsa.gov/
Provides a 24/7 Treatment Referral Line
to individuals in need of help and services
at 1-800-662-HELP (4357)
Includes several information regarding
self-care group programs, treatment ser-
vices, agencies, and other informational
websites on substance abuse of drugs, misuse of medications, and polypharmacy
(SAMHSA, 2014).
Non-Profit Referral and Placement Services
Drug-rehab.org provides assistance to individuals affected
by drug addiction to seek out for help.
http://www.drug-rehab.org/
Provides services and assessments to individuals in need of
help.
Refers individuals to rehab facilities and programs within the
community that meet the needs of the person.
Offers a contact number to individuals seeking for help and services at 1-888-233-9731
(Drug-Rehab, 2014).
Information and Services
Recovery Connection provides treatment services and materials on Substance Abuse
and Addiction of drugs to help individuals in need of assistance.
http://www.recoveryconnection.org/substance-abuse/
Recovery Connection includes interventions, information, treatment programs, links to
other sources, and a 24/7 contact number for individuals seeking out for treat services at
1-800-993-3869.
Offers a live chat line 24/7 to answer any questions or concerns regarding treatments,
addiction, or problems of substance abuse (Recovery Connection, 2014).
7. 7
COSTSCOSTSCOSTS
Approximate Cost of Substance Treatment Services
Treatment services in smaller programs are more expensive and hold a longer stay.
The average cost of substance abuse treatments services is between $3,754 and is 75%
effective in the treatment provided.
A 28-day treatment is range between $860 (Barnett, 1997, p 615).
Average cost of treatment for outpatient facilities is estimate between $1, 433.
Cost for residential treatment of alcohol or substance abuse is $3,840 per admission
Non-hospital residential treatment is range between $76.13 per day (SAMHSA, 2007)
Payment/Insurance Accepted for Substance Abuse Services
Private health Insurance
Medicaid/Medicare
Self-payment /Cash
Sliding fee scale (payment is determined based on income for certain clinics)
Military Insurance (SAMHSA, 2014)
CONCLUSIONCONCLUSIONCONCLUSION
Polypharmacy, or multiple drug use, is a major quality of-care concern for older adults,
as a recent issue of clinics of geriatric medicine devoted to the topic evidences (Hanlon,
Schmader, & Semla, 2013, p. 1367).
The Wear and Tear Theory is based on the assumption that continued use of the body
leads to worn out or defective parts of the body (Saxon, Etten, & Perkins, 2010, p.10).
Many factors associated with substance abuse and misuse of drugs or medications can
lead to health factors of polypharmacy, effects of drugs, adverse reactions, and further
health complications (Hanlon, Schmader, & Semla, 2013,
p. 1365).
Early interventions such as counseling will allow individuals
to adapt to a safer and healthier life by avoiding health prob-
lems from misusing drugs or abusing medications (Carlson,
1994).
8. 8
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