Assignment 2 40%
Assessment Due Date
Week 8 Friday (11 Sep. 2020) 5:00 pm AEST
Word Limit: 1800 words
Referencing Style: American Psychological Association (APA 6th or 7th Edition)
Learning Outcomes Assessed
• Discuss the relationship between metabolic, biophysical and cognitive changes in the older person and their likelihood of safety risks including that related to polypharmacy
• Evaluate the safety risks of an older person in relation to medications, falls and infection and generate a risk assessment
• Formulate interventions to minimise an older person’s identified safety risks
Case Study:
Patient Details
• 68 year old woman
Current Medical History
• Type 2 diabetes (diagnosed 5 years ago) • Chronic obstructive pulmonary disease (COPD)
• Coronary heart disease (non-ST elevation • Chronic back pain myocardial infarction 1 year ago)
• Depression (2 episodes) • Hypertension
• Hypothyroidism • Atrial fibrillation
Results
• HbA1C 86 mmol/mol (10%) • Spirometry shows mild airway obstruction
• BP 150/85 mmHg • No urinary protein detected
• Body mass index 35 kg/m2 • eGFR 55 ml/min
Lifestyle
• Smokes 10–15 cigarettes per day • alcohol: 20 units per week
Current medication (stable since admission)
• Aspirin 75 mg once daily • Lisinopril 30 mg once daily
• Metformin 1 g three times daily • Amlodipine 10 mg once daily
• Gliclazide 80 mg twice daily • Atenolol 50 mg once daily
• Pioglitazone 30 mg once daily • Furosemide 40 mg once daily
• Salbutamol inhaler as required • Gabapentin 400 mg three times daily
• Beclomethasone inhaler 100 micrograms • Codeine/paracetamol 8/500 mg 2 tablets twice daily up to four times daily
• Levothyroxine liquid 100 micrograms once daily • Diclofenac 50 mg up to three times daily
• Citalopram 20 mg once daily • Omeprazole 40 mg once daily
• Bendroflumethiazide 2.5 mg once daily
Current function
Works as a receptionist in local garage works 3 half days per week. She lives with her husband (out of work long-term) and provides support to her elderly mother who lives alone and has early dementia. Two previous acute admissions to hospital. Flu-like illness led to exacerbation of COPD two years ago. Chest pain 12 months ago, found to be in atrial fibrillation on admission and had positive troponin levels. Angiogram showed widespread coronary artery disease but not severe enough to warrant revascularisation. Echocardiography showed normal left ventricular systolic function. On dual aspirin and clopidogrel for 1 year, recently moved to aspirin monotherapy.
Most Recent Consultations
Ongoing problems with ankle swelling. Back pain difficult to manage and resistant to several strategies. Occasional heart palpitations and persistent indigestion with heartburn. Long-term financial worries and increasing caregiver strain. “I had a heart attack about a year ago and really worried about that happening again. I don’t know what my mother and husband would do if I got too ill to work or look after her”
Task:
Case study analysis
o Read the case study and summarise the key concepts
o Prioritise 3 interventions you will use to improve polypharmacy
o Develop the 7 steps to appropriate polypharmacy
Checks Medication related risks/problems identified
1. What matters to the patient? Priorities may include:
Possible therapeutic targets:
2. Need
? Identify essential medications (ones that are not to be stopped without expert advice)
3. (Continued) need for medications
? Identify and review the (continued) need for medications
4. Effectiveness
? Identify the need for adding/intensifying medication therapy in order to achieve therapeutic objectives
5. Safety
? Identify patient safety risks
? Identify adverse medication effects
6. Costs
? Identify unnecessary costly medication therapy
7. Patient centeredness
? Does the patient understand the outcomes of the review?
? Ensure medication therapy changes are tailored to patient preferences
? Agree and communicate plan