Reducing Adverse Drug Events in Older Adults

Reducing Adverse Drug Events in Older Adults Gabrielle S. Buma With age comes the prospect of multiple health problems that may require treatment with several medications and multiple prescribers. The likelihood of morbidities and comorbidities such as, heart disease, arthritis, diabetes, and hypertension increases with age. Many older adults also take over the counter medications, vitamins, and other supplements along with their prescribed medications. The use of these multiple kinds of medications is called polypharmacy, and if done so correctly the use of multiple medications can have positive results in the treatment and maintenance of disease but if not used correctly the drugs could be less effective and result in expensive drug-related morbidity and mortality. The Agency for Healthcare Research and Quality claim that more than 770,000 people are injured or die each year from Adverse Drug Effects (ADEs) (Lynn, 2012). What makes this even more of a concern is that many experts believe that ADEs are significantly underreported. According to the Journal of the American Geriatrics Society, the annual cost associated with drug-related morbidity and mortality has been estimated to be at around $177 billion (Roth, Weinberger Campbell, 2009). Many factors play a role in the quality medication use in older adults; these factors can be considered overuse, underuse, and misuse. The misuse of medication that leads to adverse drug effects in older adults can be greatly reduced by improving health literacy and prescribing physician and patient communication. According to the Institute of Medicine, health literacy is considered an individual’s capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Martin, Kripalani, DuRapau, 2013). Currently in the United States, the older adults that are 65 years and older represent the largest group with the lowest general literacy and health literacy skills in the country (Bennett, Chen, Soroui White, 2009). This means that there is a large portion of the older adults over 65 that are making health decisions with the likelihood of not fully understanding them. Older adults over 65 years of age also have the highest rate of chronic illness of any other age group. The combination of low levels of literacy and high prevalence of multiple chronic conditions with multiple medications are major contributing factors to the high rate of ADEs in older adults. The article, Preventing Medication Errors, in the Institute of Medicine c ited that poor patient comprehension and unintentional misuse of prescription drugs as a significant cause for medication error and worse health outcomes (Martin, Kripalani, DuRapau, 2013). Many older adults are simply accidentally misusing prescribed medications due to a low level of health literacy. Low literacy in older adults and Medicare recipients affects their understanding of complex medication labels, instructions, and regimens (Martin, Kripalani, DuRapau, 2013). A way to improve older adult’s understanding of prescription drugs especially among those with limited literacy is greatly needed to prevent unintentional use that lead to AEDs, before the improvement can be made we need to first understand the factors associated with patients understanding of prescription drugs and their labeling. According to the National Assessment of Adult Literacy, adults who are socioeconomically disadvantaged that are a part of minority groups are more likely to be in poorer health (Davis, Wolf, Bass, Middlebrooks, Kennen, Baker, . . . . Parker, 2006 ). In the study, Low Literacy Impairs Comprehension of Prescription Drug Warning Labels, the authors measured a group of 251 adult’s ability to correctly interpret commonly used prescription medication labels. They measured the participant’s health literacy by having an expert panel evaluating the patient’s interpretation of the commonly used prescription medication labels. The results showed that one-third of patients were reading at or below a 6th grade level and that a patient’s comprehension of warning labels was associated with their level of literacy. The result that low literacy is associated with low comprehension and a difficulty understanding of warning labels on prescription medications is not a surpris e because the labels use terminology about a 6th grade reading level (Davis, Wolf, Bass, Middlebrooks, Kennen, Baker, . . . . Parker, 2006 ). The multistep instructions were found difficult for patients across all literacy levels. I found it surprising that the multistep instructions were difficult for all reading levels, but the study explains that the more steps a labels has the less concise and clear it tends to be to the patient. If the multistep instructions are a challenge for all literacy levels to understand then I would assume that it is quite challenging for a large population of the older adults who tend to have the lowest levels of literacy and so many different medications to keep track of with each having multistep directions. The study did offer recommendations that would help the understanding of medication labels for all literacy levels. These recommendations include; warning labels being developed with consumer participation, especially with lower literate populations, attempt to keep the steps short, clear and concise with familiar words and recognizable icons. After reading this study, I was surprised to learn that more prescription drug labels are not developed with the use of consumer participation, one would assume the in the developing of the instructions that it would be a priority to develop the instructions with consumer participation. It seems that more consumer participation with all health literacy levels would help create more user friendly labels that could result in a significant decrease in misuse of prescription drugs. The study, Improving Medication Management among At-risk Older Adults, evaluates health literacy but also medication self-efficacy and medication adherence. One reference in the study shows an alarming 54.3% of Medicare enrollees with limited health literacy were unable to understand what is considered simple medication instructions such as. â€Å"take on an empty stomach, † (Martin, Kripalani, DuRapau, 2013). The study describes a quality improvement pilot project where they provide at-risk older adults with illustrated medication instructions as an approach to improve medication understating use. In the quality improvement pilot project they evaluated the effect of their intervention on the older adult’s confidence in managing their medication and their self-reported adherence. This study, Improving Medication Management among At-risk Older Adults, took place at an adult day center were medication errors and misunderstanding medication instructions were identified as a problem. The authors and staff provided the adult day care center’s participants with illustrated depiction of their daily schedule PictureRxâ„ ¢ with the goal to improve the older adult’s understanding of medication instructions and improve medication safety. The illustrated aid shows the older adult’s medications pictorially, uses what they consider plain language for the instructions, and uses icons to aid patients in understanding the purpose and the dosing schedule (Martin, Kripalani, DuRapau, 2013). The PictureRx cards were used for six weeks and then the participants were surveyed along with reassessing their self-efficacy and adherence, as well as their perception on the PictureRx cards. The results showed that after the use of the PictureRx cards the participants reported much less forms of non-adherence and confidence significantly improved in areas of self-efficacy, such as correctly taking medications and following a routine. This article provides a valuable assessment of older adult’s health literacy and applies an intervention that resulted in an improved adherence and self-efficacy in older adults. When comparing the participant assessment before for the use of PictureRx and then the reassessment after shows a notably significant improvement. This pilot study shows an efficient way to improve older adult’s various health literacy levels and provides them with a way to better understand their overall medication regimens. I think something very similar to the PictureRx would be a great tool to implement for pharmacists when filling medications for older adults at the pharmacy and can provide a good reference for doctors when explaining medications to patients especially since doctors are so limited on the amount of time they can spend with a patient. Proper patient provider communication plays a huge role in a patient’s ability to understand their medications and ability to properly follow their medication regimes. Good communication about health history and medications with a provider and a patient could prevent the misuse of medication and an ADE. Before prescribing a new medication, the prescribing doctor is supposed to review the patient’s current medications, including over the counter medications, vitamins, supplements, and the patient’s health history. The article, Physician Communication When Prescribing New Medications from the Archives of Internal Medicine recommends that prescribing physicians should educate their patients about their medication’s purpose, how and when to take it, and the medications expected adverse effects. The patient and physician interaction is an opportunity for the physician to educate the patient on these topics which may reduce nonadherence that can be a result from poor understanding about medication use. The article also describes and assesses the quality of physician communication with patients about newly prescribed medications. The authors assess the provider’s communication through an observational study that combined patient and physician surveys and audiotaped 860 of the 909 participating patients while 270 new medications were prescribed (Tarn, Heritage, Hays Kravitz, 2006). During these visits the authors measured the quality of physician communication when prescribing new medications. The study by Tarn, Heritage, Hays, and Kravitz found that physicians stated full medication dosing directions for less than 60% of all of the medications that had been prescribed and informed the patients about the duration intake and ADEs for one third of the time. The study shares that ADEs were addressed for 35% of the medications and how long to take the medication was addressed at 34%. Although patients may be able to find information about their medications from different sources such as, a pharmacists and medication package inserts, information from their visits with the prescribing physician is inadequate to meet the patient’s needs. Conclusion The study found that the use of precise wording on prescription drug label instructions can improve patient understanding of how to take the medication patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language Patients that have a limited literacy rate and those who are taking more medications are at a greater risk for misuse. Reference Page Davis, T. C., Federman, A. D., Wolf, M. S. (2009). Improving patient understanding of prescription drug label instructions. Journal of General Internal Medicine, 24(1), 57- Davis, T., Wolf, M., Bass, P., Middlebrooks, M., Kennen, E., Baker, D., . . . . Parker, R. (2006). Low literacy impairs comprehension of prescription drug warning labels. Journal of General Internal Medicine, 21(8), 847-851. Martin, D., Kripalani, S., DuRapau, J. (2012). Improving medication management among at-risk older adults. Journal of Gerontological Nursing, 38(6), 24-34. Roth, M., Weinberger, M., Campbell, W. (2009). Measuring the quality of medication use in older adults.Journal of the American Geriatrics Society,57(6), 1096-1102. Tarn, D. M., Heritage, J., Paterniti, D. A., Hays, R. D., Kravitz, R. L. (2006). Physician communication when prescribing new medications . Archive of Internal Medicine, 166(17), 1855-1862.

Women in Nation Building

Women’s participation in nation-building is an important ingredient in achieving an equitable, peaceful and more prosperous society. Gender equity and women’s inclusion play a central role both as a litmus test and as an active variable shaping a more democratic, stabilized and developed society. To enhance the results of nation-building, the study suggests that nations should place a greater emphasis on the broader concept of human security from the earliest phase of nation-building efforts. In addition, leaders should establish governance based on principles of equity and consistent rule of law, and should include women in the earliest economic reconstruction activities. Women play a special role in the overall development of the country. â€Å"There is no chance for the welfare of the world unless the condition of women is improved. It is not possible for a bird to fly on only one wing. † â€Å"woman is the builder and moulder of a nation’s destiny, though delicate and soft as lily, she has a heart, stronger and bolder than that of man, she is the supreme inspiration for man’s onward march. Today the educated women have come out of their inferiority complex and are shouldering all kinds of responsibilities, as Managers, officers, TV and radio news reader, pilots, Ministers, Anchors, Musicians, Clerks, Stenographers, and what not? state is a â€Å"union of families and villages†. Family is the basic unit of society, which is the foundation o f state itself. Happy families create a healthy society and healthy society is a pre-requisite of strong political order in democratic societies. A woman is an architect of society. She establishes the institution of family life, builds the home, brings up the children and makes them good citizens. Her strength in totality contributes in the making of an ideal family, ideal society and an ideal state. It has become essential for women to be politically empowered to achieve socio-economic justice. It has rightly been said who holds the purse holds the nation. As the women are better half of the nation, they deserve better share in political power. The male-dominated political parties and legislatures in the country do not bear with their equal number in epresentative institutions. What we lack is â€Å"political will† to understand the importance of women's role in nation building and all avenues open to them to get political power. MEN Should realize the power of women,And women should also realize their power too,what they can do for them,for their family,for their nation. They are the building blocks of nation building,In the words of Martin Luthar KIng ,†A mother's place is inside her home,But she should also make certain,she gets outside that home enough to help worth while crusades and actively mould the country her children will live in. She therefore holds a key position and her role in shaping the fate of the nation must be recognized and respected. This we see that a woman occupies a vital position in family,society and it is time we recognised and respected her ability. They should not search for the role models but try themselves to be role models in politics. It would be of no use giving equal share in parental property unless the social set-up is changed. That can be changed only by sincere implementation of laws made for women. A woman is shakti, the natural energy. The most ancient scriptures say that without the female power, it is not possible for humankind to survive. The female power has been the force behind all the great leaders of the world. Therefore, they must be politically empowered. The writing is on the wall – the hand that rocks the cradle is the hand that rules the world. OUR WOMEN have a great part to play in the progress of our country, as the mental and physical contact of women with life is much more lasting and comprehensive than that of men. For nothing was it said, â€Å"The hand that rocks the cradle rules the world†. In the apron string of women is hidden the revolutionary energy, which can establish paradise on this earth. Woman is the magnificent creation of god, a multi faceted personality with the power of benevolence, adjustability, integrity and tolerance. She is companion of man, gifted with equal mental faculty, a protector and provider, the embodiment of love and affection. The role given to women in a society is a measuring rod and true index of its civilisation and cultural attainment.

Essay about Book Review on “Where We Stand Class Matters”

Akiba-zemi (GSP490 F12-S13) Book Review 1 Yukimi Ouchi January 7, 2013 Book Review on â€Å"Where We Stand: Class Matters† In her book Where We Stand: Class Matters, Bell Hooks address the issues of classism interlocking with racism, white supremacist ideology and sexism in contemporary American culture. Her arguments in this book are greatly tied to her personal experience that she moved up from working class to the upper class as she succeeds in academic life and writing many books. Through this book, the most important point she puts emphasis on is the acknowledgment of the complex interlocking of classism, racism and sexism. Bell Hooks is not a poor working-class any more,†¦show more content†¦As far as she describes, she just enjoyed living with grandparents and she says that the lure of life was everywhere and in everything, but no one in the crowded house had a regular job or social security number, and no one talked about class even if they were open about money. Hooks personal memories tell me that poor people ar e afraid to talk about class because to be poor in the U.S. was to be an object of shame and ridicule, and because they were afraid to face the reality that makes them feel miserable, unpleasant, and unsecured. And the most importantly, most of them are not really conscious about how classism affects and exploits them. On the other hand, according to Hooks privileged (mostly white) people do not want to talk about class because they do not really want to change. Hooks says Citizens in the middle who live comfortable lives, luxurious lives in relation to the rest of the world, often fear that challenging classism will be their downfall, that simply by expressing concern for the poor they will end up like them, lacking the necessities of life. We can see the widening gap between rich and poor and more and more class-segregated society in the U.S. today, but this appears rather favorable circumstance for the privileged people with class power. I came to realize that whites of all class backgrounds seek to keep underprivileged non-white people in subordination to maintain their own class status. Hooks interprets it the victimsShow MoreRelatedAnalysis Of Christopher Doob s The First Edition Of Social Inequality And Social Stratification 1119 Words   |  5 PagesThe author structures this book in the direction towards a theoretical concept that attracts the reality of social inequality and stratification as a whole. Doob dissects this books into eleven chapters given that each chapter examines the inequality of stratification. Also during the readings of this book Doob used plenty of data to show the socioeconomic strata revolved around the history of America. 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homosexuality a mental disorder - 4366 Words

HOMOSEXUALITY: A MENTAL DISORDER? A Term Paper Presented to Trexie O. Alawi College of Arts and Sciences SURIGAO DEL SUR STATE UNIVERSITY Tandag City, Surigao del Sur In Partial Fulfilment Of the Requirements of the Course English 102 (Writing in the Discipline): TTH 7:30 – 9:00 a.m. 2nd Semester, AY 2013-2014 By Bruce Franklyn G. Aliguay February 2014 Homosexuality: a mental disorder? Thesis Statement: People should know that, homosexuality is a normal aspect of human sexuality and should not be considered a mental disorder. OUTLINE I. What is homosexuality? II. Origin and nature of homosexuality A. Glandular disturbance B. Genetic causes C.†¦show more content†¦The term gay is used predominantly to refer to self-identified homosexuals of either sex. Lesbian is a gender-specific term that is only used for self-identified homosexual females. Dr. Vincent Berger added that, Gay in modern usage usually refers to homosexual men or women. 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