Week 3

Question 1

Unlike their White counterparts,_____________ older adults experience significant health disparities, including lower life expectancies and an increased risk of chronic health conditions such as hypertension, diabetes, dementia, stroke, and cancer

Answer 1

African American

Question 2

Research indicates thatbAfrican Americans—young and old—experience subtle and overt forms of ___________________

Answer 2

racial discrimination.

Question 3

African American older adults have experienced cumulative race-related stressors that negatively impact their _______________________

Answer 3

physical and mental health

Question 4

service providers in the aging and health-care fields need greater awareness, education, and training to competently address race-related stress in _____________ older adults

Answer 4

African American

Question 5

For African American older adults, encounters are accumulated over the lifespan, stored in memory, and __________ with each new racist and discriminatory experience

Answer 5

relived

Question 6

Limited access to community resources (e.g., grocery stores, pharmacies, culturally competent health and aging service providers, transportation, housing, etc.) significantly contributes to the experience of _______________ stress and creates barriers to achieving healthy and productive aging.

Answer 6

race-related

Question 7

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Create ______ spaces. Provide opportunities for dialogue around race, culture, gender, sexuality, and socioeconomic issues.

Answer 7

Create safe spaces. Provide opportunities for dialogue around race, culture, gender, sexuality, and socioeconomic issues.

Question 8

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Support, strengthen, and enhance ___________ .

Answer 8

resilience

Question 9

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Be mindful of __________ . Pay attention to the impact of stressful events and incidents continuously showcased in the media (e.g., television, radio, or newspaper). When possible, limit exposure.

Answer 9

triggers

Question 9

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Understand the impact of _________ . For African Americans, the effects of racism are felt daily. Racism also intersects with other forms of discrimination, including ageism, classism, sexism, ableism, and heterosexism.

Answer 9

racism

Question 10

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

› Refer to ____________ services and support. Most African American older adults have developed effective coping skills (e.g., spirituality, kinship networks) to manage experiences of racism. However, when needed, culturally competent mental and behavioral health services should be made available.

Answer 10

mental health

Question 10

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Celebrate _________ . Organize and encourage activities that celebrate African American life, history, culture, customs, and norms

Answer 10

culture

Question 11

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

Listen with __________. Recognize and acknowledge past and present experiences. Provide support for the thoughts, feelings, and experiences shared

Answer 11

empathy

Question 11

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

› Be _______. Consider your own cultural background and its influence on your values, beliefs, assumptions, and biases. Seek out training opportunities on culturally competent geriatric care, with special attention to race- related stress.

Answer 11

aware

Question 12

CORE PRINCIPLES OF PAIN TREATMENT

Base the treatment plan on the older adult’s _______. Encourage older adults to set functional goals (e.g., performing certain daily activities, including socializing and hobbies). Older adults should determine treatment goals for themselves with input from health providers.

Answer 12

goals

Question 12

WHAT AGING AND HEALTH-CARE PROVIDERS CAN DO

› ___________. Support and promote local and national efforts to increase access to community and national resources for African Americans across the lifespan

Answer 12

Advocate

Question 13

CORE PRINCIPLES OF PAIN TREATMENT

Every older adult deserves ____________ pain management. Certain populations, including racial minorities, people with limited ability to communicate, older adults, and people with past or current substance abuse, are at higher risk for inadequate pain management.

Answer 13

adequate

Question 14

CORE PRINCIPLES OF PAIN TREATMENT

Use both drug and ___________ therapies. To achieve overall effectiveness of treatment, allow for reduction of drug dosages, and minimize adverse drug effects, always incorporate non-drug therapies into the pain management plan.

Answer 14

non-drug

Question 15

CORE PRINCIPLES OF PAIN TREATMENT

Prevent and/or manage medication ___________ . Bothersome side effects are a major reason for treatment failure and non-adherence, and should be prevented when possible or managed aggressively

Answer 15

side effects

Question 16

CORE PRINCIPLES OF PAIN TREATMENT

Evaluate the _____________ of all therapies to ensure that they are meeting the resident’s goals. Achievement of an effective treatment plan requires therapy to be individualized for each older adult, often requiring adjustments in drug, dosage, or route. Consistent reassessment is critical to good outcomes

Answer 16

effectiveness

Question 17

CORE PRINCIPLES OF PAIN TREATMENT

Address pain using an inter-__________ approach. The multi-dimensional nature of the pain experience often requires the involvement of many disciplines. These can include psychology, physical and occupational therapy, pharmacy services, spiritual care, and multiple medical specialties, as well as complementary therapy practitioners, such as massage therapists, acupuncturists, and art therapists

Answer 17

disciplinary

Question 18

A critical issue in aging research is whether aging is affected by ___________________ of underlying processes. If there are hundreds of different biological pathways that affect aging, then odds are slim that science could ever hope to devise a way of even understand why aging happens at all

Answer 18

one, several, or a multitude

Question 18

Theories of aging can be divided into two categories:

those that answer the question “____ do we age?”
and those that address the question “_____ do we age?”

Answer 18

those that answer the question “Why do we age?”
and those that address the question “How do we age?”

Question 19

The cross-linking hypothesis

Although many scientists agree that cross-linking of proteins, and perhaps the cross-linking of _______________ as well, is a component of aging, it is likely only one of several mechanisms that contributes to aging.

Answer 19

DNA molecules

Question 19

THE EVOLUTIONARY SENESCENCE THEORY OF AGING Natural selection, because it operates via reproduction, can have little effect on later life. In the wild, predation and accidents guarantee that there are always more younger individuals reproducing than older ones. Genes and mutations that have harmful effects but appear only after reproduction is over do not affect reproductive success and therefore can be passed on to future generations.

Answer 19

Natural selection, because it operates via reproduction, can have little effect on later life. In the wild, predation and accidents guarantee that there are always more younger individuals reproducing than older ones. Genes and mutations that have harmful effects but appear only after reproduction is over do not affect reproductive success and therefore can be passed on to future generations.

Question 20

THE EVOLUTIONARY SENESCENCE THEORY OF AGING cont. Because the gene’s harmful effects do not appear until after reproduction is over, they cannot be eliminated through_______________

Answer 20

natural selection.

Question 21

THE GENOME MAINTENANCE HYPOTHESIS OF AGING Mitochondria create damaging _________________ as a by-product of normal energy production. Somatic mutations in the DNA of the mitochondria accumulate with age, increasing free radical production, and are associated with an age-related decline in the functioning of mitochondria. Many scientists believe that mitochondrial aging is an important contributor to aging in general.

Answer 21

free radicals

Question 22

THE GENOME MAINTENANCE HYPOTHESIS OF AGING In fact, many scientists believe that humans have long lifespans because we are much better at _____________________ than short-lived animals like mice.

Answer 22

repairing our genome

Question 23

THE REPLICATIVE SENESCENCE HYPOTHESIS OF AGING Most scientists today believe that what determines the Hayflick Limit for dividing human cells is the length of a cell’s ____________. Telomeres can be pictured as protective caps on the ends of chromosomes. Each time a cell divides, it must first double its chromosomes, so that each daughter cell receives a full complement of genetic material. But each time a chromosome reproduces itself, it loses a small bit of its telomeres. Oxidative damage can also shorten telomeres. When a cell’s telomeres have reached a critically short length, after 40 to 60 population doublings in young human cells, Certain skin cells produce collagen during their younger, reproductive years. When they reach senescence and can no longer divide, they produce collagenase, an enzyme that breaks down collagen. Some researchers suggest that this process may be responsible for the thinning and wrinkling of skin as we age. the cell can no longer replicate its chromosomes and thus will stop ____________. These cells with shortened telomeres become “senescent” in the sense that although they do not die, they can no longer divide

Answer 23

Most scientists today believe that what determines the Hayflick Limit for dividing human cells is the length of a cell’s telomeres. Telomeres can be pictured as protective caps on the ends of chromosomes. Each time a cell divides, it must first double its chromosomes, so that each daughter cell receives a full complement of genetic material. But each time a chromosome reproduces itself, it loses a small bit of its telomeres. Oxidative damage can also shorten telomeres. When a cell’s telomeres have reached a critically short length, after 40 to 60 population doublings in young human cells, Certain skin cells produce collagen during their younger, reproductive years. When they reach senescence and can no longer divide, they produce collagenase, an enzyme that breaks down collagen. Some researchers suggest that this process may be responsible for the thinning and wrinkling of skin as we age. the cell can no longer replicate its chromosomes and thus will stop dividing. These cells with shortened telomeres become “senescent” in the sense that although they do not die, they can no longer divide

Question 24

Polypharmacy is a common clinical issue in older adults; approximately 30% of senior citizens take at least ____ or more medications.

Answer 24

5

Question 25

The normal changes of aging and physical changes associated with disease predispose older adults to an increased ______________ to prescription and over-the-counter medications.

Answer 25

sensitivity

Question 26

Nurses should refer to the _______ Criteria and screening tool of older people’s prescriptions (STOPP) criteria when questioning the appropriateness of an elderly patient’s medications.

Answer 26

Beers

Question 27

In lieu of pharmacologic measures, nurses should use patient-centered, evidence-based ______________ strategies to treat common symptoms.

Answer 27

nonpharmacologic

Question 28

Polypharmacy in older adults is a _________ problem that has recently worsened. Approximately 30% of adults age 65 and older in developed countries take 5 or more medications. Although older adults make up approximately 14.5% of the US population, elderly individuals purchase 33% of all prescrption drugs, and this proportion is expected to increase to 50% by the year 2040.

Answer 28

global

Question 29

It not only includes prescribed medications but also over-the-counter and herbal preparations. Polypharmacy is most commonly defined in the health care literature as taking 5 or more medications. ________________ has been described as taking 10 or more medications

Answer 29

Hyperpolypharmacy

Question 30

Polypharmacy is associated with the development and worsening of _________________, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. 7 Polypharmacy in older adults also increases the risk of adverse drug events (ADEs) and avoidable hospitalizations. Polypharmacy also has financial conse- quences, as it results in increased health care costs for the patient and for the health care system. Treatment for medication errors and ADEs in the older adult population is estimated to cost more than 880 million dollars per year. 8 In 2012, inappropriate polypharmacy cost 1.3 billion dollars in avoidable health care costs

Answer 30

geriatric syndromes,

Question 31

A prescribing ___________ begins when a side effect or adverse drug reaction of a medication is misinterpreted as a new health condition, thus resulting in the prescription of a new medication

Answer 31

cascade

Question 32

Medications should be started at _____ doses, and the nurse should monitor patients for adverse reactions

Answer 32

low

Question 33

Half of all people age 65 and older have at least ____ medical diagnoses, and one-fifth have 5 or more medical conditions. 16 It is not uncommon for older adults with multiple medical problems to be treated by different medical specialist

Answer 33

3

Question 34

older adults are more sensitive to many medications and are also more sensitive to medication ___________ . The bedside nurse should anticipate that older adult patients have the potential to respond differently to medications than other age groups

Answer 34

changes

Question 35

Metabolism The most common site of drug metabolism is the liver. Given the normal aging changes of decreased hepatic blood flow and decreased hepatic size and mass, the older adult’s hepatic metabolism of medications is _________ . This reduction may lead to elevated concentrations of medications in the body and, thus, ADEs. For example, in older adults, there is an approximately 60% reduction in the metabolism of NSAIDS and anticoagulant agents. 19 Given the potential for an increased concentration and duration of these medications, an elderly patient taking this medication combination has an elevated risk of gastrointestinal bleeding.

Answer 35

reduced

Question 36

Elimination Most medications are eliminated through the kidneys. Kidney function starts to decline in the fourth decade of life. Many older adults have some degree of renal compromise; thus, medications may take __________ to be cleared from the body, and there is a higher risk of toxicity. A patient’s estimated glomerular filtration rate should be taken into account when prescribing medications that are renally eliminated. Renally eliminated medication dosages and frequencies should be adjusted in the presence of kidney disease

Answer 36

longer

Question 37

The aging body’s loss of cell function influences pharmacodynamics of medications, typically causing older adults to be more __________ to medications.

Answer 37

sensitive

Question 38

Consequences of Polypharmacy Adverse drug event An ADE is an _________ that results from use of a medication

Answer 38

injury

Question 39

Risk factors of adverse drug events in the elderly Age >85 y Frailty Low body weight or body mass index Six or more chronic health conditions Memory problems Estimated CrCl <50 mL/min 9 1 medications (prescribed and over the counter) 12 1 doses of medications/d Prior ADE Multiple prescribers Multiple pharmacies No regular reviews of patient’s medication list Poor communication among providers Prescription of complex medical regimens

Answer 39

Age >85 y Frailty Low body weight or body mass index Six or more chronic health conditions Memory problems Estimated CrCl <50 mL/min 9 1 medications (prescribed and over the counter) 12 1 doses of medications/d Prior ADE Multiple prescribers Multiple pharmacies No regular reviews of patient’s medication list Poor communication among providers Prescription of complex medical regimens

Question 40

Approximately __.3 million health care visits were attributed to ADEs in 2005. Up to 35% of community-dwelling older adults have experienced an ADE that was discovered during an outpatient visit, and 40% of hospitalized older adults have experienced an ADE as well.

Answer 40

4

Question 41

Costs ______ can cause unnecessary emergency department visits and hospitalizations. which contributes to increased health care costs for the patient and the health care system.

Answer 41

ADEs

Question 42

________ Criteria - a rigorous clinical practice guideline published by a panel of experts who have conducted a comprehensive evidence review to identify medications that may confer additional risk to older adults.

Answer 42

Beers

Question 43

_____________- a patient-centered deprescribing framework has been proposed as a novel method for considering an older adult’s comprehensive health and medication list with specific attention to reducing PIMs.

Answer 43

Deprescribing

Question 44

Using evidence-based strategies to reduce PIMs should be considered during care transitions (eg, from hospital to home, from home to nursing facility), as care transitions are known to be a common juncture for medication errors. Hospitalization may be another appropriate time to reduce ______ and to consider whether any of the patients’ medications could have contributed to their hospital admission

Answer 44

PIMs

Question 45

Conversations about medications should begin by listening to patients’ ___________, preferences, and goals of care

Answer 45

concerns

Question 46

Registered nurses have many opportunities to facilitate __________ to reduce polypharmacy in older adults.

Answer 46

deprescribing

Question 47

nurses may have the opportunity to identify ADEs. By elevating concerns about potential ADEs, nurses may prompt conversations about ______________ . Bringing knowledge of polypharmacy, its associated adverse outcomes, and specific frameworks for deprescribing (eg, Beers criteria, STOPP/ START criteria) may enhance the effectiveness of communication with prescribers.

Answer 47

deprescribing

Question 48

_________ have the opportunity to lead initiatives aiming to educate interdisciplinary team members and patients on improved medication management practices.

Answer 48

nurses

Question 49

Nurses can encourage the use of in-home systems to promote accurate medication ________, and they can also facilitate in-person methods of reconciling and educating patients about their medications

Answer 49

taking

Question 50

brown bag review begins by asking a patient to bring ______________________, including over-the-counter and herbal agents, to their health care visit.

Answer 50

all of their current medications

Question 51

_____________ is a growing problem in the United States and demands the attention of the registered nurse. Nurses in all health care settings have opportunities to reduce and prevent polypharmacy through implementation of evidence-based practices and delivery of person-centered care.

Answer 51

Polypharmacy

Question 52

there are more than __.7 million LGBT adults ages 50 or older living in communities across the country.

Answer 52

2

Question 53

it is estimated that there are approximately 2.7 million LGBT adults aged 50 and older in the United States, ___ million of whom are 65 and older.Broadly, these LGBT adults comprise the community referred to as “LGBT elders” in this report.

Answer 53

1.1

Question 54

Key challenges for LGBT older adults Discrimination lack of legal/social _________ reliance on chosen family lack of competent inclusive __________

Answer 54

Discrimination lack of legal/social recognition reliance on chosen family lack of competent inclusive healthcare

Question 55

APPROXIMATELY ONE IN FIVE (20%) LGBT OLDER ADULTS ARE PEOPLE OF __________

Answer 55

COLOR

Question 56

________ OF LGBT OLDER ADULTS LIVE AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL

Answer 56

ONE-THIRD

Question 57

Major areas of life in which LGBT elders face particular disparities: A lifetime of discrimination, especially in housing and ___________ , and a long-term lack of legal and social recognition combine to create deep economic insecurity for LGBT elders.

Answer 57

employment

Question 58

Major areas of life in which LGBT elders face particular disparities: A reliance on chosen family, due to family __________ and legalized discrimination, creates social isolation and vulnerability for LGBT elders.

Answer 58

rejection

Question 59

Major areas of life in which LGBT elders face particular disparities: Long-term discrimination, combined with a lack of competent, inclusive health care, leads to specific mental and physical health ____________.

Answer 59

disparities

Question 60

LGBT older adults experience ___________ stress [impact of interpersonal and structural discrimination]. Minority stress has negative impacts on health and well-bein.

Answer 60

minority

Question 61

6-23% of LGBT older adults have experienced: Verbal/Physical Harassment From Other Residents 23% Refused Admission, Attempted/Abrupt Discharge 20% Verbal/Physical Harassment From Staff 14% Staff Refused to Accept Medical Power of Attorney from Resident’s Spouse/Partner 11% Restriction of Visitors 11% Staff Refused to Refer to Transgender Resident by Preferred Name/Pronoun 9% Staff Refused to Provide Basic Care 6% Staff Denied Medical Treatment 6%

Answer 61

Verbal/Physical Harassment From Other Residents 23% Refused Admission, Attempted/Abrupt Discharge 20% Verbal/Physical Harassment From Staff 14% Staff Refused to Accept Medical Power of Attorney from Resident’s Spouse/Partner 11% Restriction of Visitors 11% Staff Refused to Refer to Transgender Resident by Preferred Name/Pronoun 9% Staff Refused to Provide Basic Care 6% Staff Denied Medical Treatment 6%

Question 62

POLYPHARMACY AND OLDER ADULTS - APPROX ___% OF ADULTS 65+ ARE ON 5 OR MORE DRUGS

Answer 62

30

Question 63

POLYPHARMACY AND OLDER ADULTS - NORMAL AGING CAN INCREASE ____________ OF DRUGS

Answer 63

SENSITIVITY

Question 64

POLYPHARMACY AND OLDER ADULTS - OLDER ADULTS PURCHASE ____% OF ALL PRESCRIPTION DRUGS

Answer 64

30

Question 65

POLYPHARMACY AND OLDER ADULTS -ASK ABOUT ____________!!!!

Answer 65

SUPPLEMENTS

Question 66

- POLYPHARMACY: __+ MEDS - HYPERPOLYPHARMACY: __+ MEDS

Answer 66

- POLYPHARMACY: 5+ MEDS - HYPERPOLYPHARMACY: 10+ MEDS

Question 67

ELIMINATION: KIDNEYS - NORMAL _____________ COULD EFFECT HOW DRUGS ARE ELIMINATED. - TEST BUN/CREATININE AND GFR

Answer 67

ELIMINATION: KIDNEYS - NORMAL KIDNEY DECLINE COULD EFFECT HOW DRUGS ARE ELIMINATED. - TEST BUN/CREATININE AND GFR

Question 68

METABOLISM: LIVER THERE IS A DECREASE IN _________________ WITH AGE

Answer 68

HEPATIC BLOOD FLOW

Question 69

________________ EVENT RISK FACTORS: - >85 y/o - Frailty - Low weight/Low BMI - > 6 conditions - Creatinine <50 - Prior ADE - 9+ meds

Answer 69

ADE: ADVERSE DRUG

Question 70

- Brown Bag: bring ___________ to your PCP

Answer 70

all meds

Question 71

3 KEY CHALLENGES FACING LGBTQIA+ INDIVIDUALS: 1. A LIFETIME OF _____________ + LACK OF LEGAL/SOCIAL RECOGNITION 2. RELIANCE ON _________ FAMILY 3. A LACK OF COMPETENT, INCLUSIVE ____________

Answer 71

1. A LIFETIME OF DISCRIMINATION + LACK OF LEGAL/SOCIAL RECOGNITION 2. RELIANCE ON CHOSEN FAMILY 3. A LACK OF COMPETENT, INCLUSIVE HEALTHCARE

Question 72

THEORIES OF AGING: CROSS LINKING/GLYCATION HYPOTHESIS DNA DEVELOPS ___________________________ TO ONE ANOTHER BONDS DECREASE MOBILITY + ELASTICITY OF MOLECULES

Answer 72

INAPPROPRIATE CROSS LINKS

Question 72

THEORIES OF AGING: EVOLUTIONARY SENESCENCE - THE FAILURE OF NATURAL SELECTION TO AFFECT ____________ - MUTATIONS THAT OCCUR IN THE AGING INDIVIDUAL WILL NOT BE PASSED ONTO OFFSPRING

Answer 72

LATE LIFE TRAITS

Question 73

THEORIES OF AGING: GENOME MAINTENANCE HYPOTHESIS FREE RADICALS CAUSE ____________ MITOCHONDRIAL AGING

Answer 73

MUTATIONS

Question 74

THEORIES OF AGING: REPLICATION SENESCENCE: - ____________ NO LONGER DIVIDE OR DON’T DIVIDE AS WELL

Answer 74

TELOMERES

Question 75

Understand older adults may display and communicate ______ differently than other groups of people

Answer 75

pain

Question 75

Racial minorities, people with limited ability to communicate, older adults, and people with past or current substance abuse, are at higher risk for inadequate _______________

Answer 75

pain management.

Question 76

· About ______ of older adults in the developed world take 5 or more medications (polypharmacy).

Answer 76

3/10

Question 77

· Older adults are often initially prescribed medications at or ______ ________ drug doses, due to their physiologic and sensory changes.

Answer 77

below “Normal”

Question 78

· eGFR (estimated glomerular filtration rate) can be used to evaluate the kidney function of a patient taking __________.

Answer 78

vancomycin

Question 79

· An ADE (adverse drug event) is an injury that results from __________________

Answer 79

use of a medication.

Question 80

__________ ___________ _____________ are evidence-based pharmacology tools available to guide healthcare providers in making pharmacologic decisions for older adults (Be able to fill-in the blank from memory).

Answer 80

BEERS, START, and STOPP

Question 81

___________ __________ is a focus of the replicative senescence hypothesis of aging.

Answer 81

Telomere length

Question 82

Cumulative race-related stress can negatively impact a patient’s mental health, such as being withdrawn and less interactive. If you are caring for a patient that is displaying these behaviors (withdrawn and less interactive) you’ll want to discuss with the provider, the need for ___________________________________________________ consultation and treatment. (This covers at least two questions).

Answer 82

culturally competent mental health service

Question 83

At least 3 challenges faced by LGBT older adults: A lifetime of discrimination and lack of legal and social _____________, A ____________ on chosen family, A lack of competent inclusive ____________.

Answer 83

A lifetime of discrimination and lack of legal and social recognition, A reliance on chosen family, A lack of competent inclusive healthcare.

Question 84

Training opportunities on culturally competent geriatric care would be beneficial for a new nurse who has started working with a ______________________ care clients.

Answer 84

diverse group of long-term

Question 85

________ percent of older LGBT older adults are from a racial/ethnic minority group.

Answer 85

Twenty

Question 86

Being LGBT and from a racial/ethnic minority ________ your risk for disparities across many measures of wellbeing, including physical and mental health outcomes, economic security, and experiences of discrimination.

Answer 86

increases

Question 87

Essay: Describe one specific take-away from Michelle's story in Baltimore.

Answer 87

African american adults are 50% more likely to die prematurely from a heart disease or stroke

Question 88

Essay: Provide an example of "breaking the script" in conversations with older adults, using the PBS Newshour "A brief but spectacular take on breaking the script" as the reference.

Answer 88

Do not assume their heterozexuality; instead of asking "are you married" ask who is your biggest support?

Question 89

When considering pain management in older adults, ___________________ goals are one of the most important aspects.

Answer 89

individual pain management

Question 90

________________ of health (SDH) are a common underlying cause of racial and ethnic minority older adults having increased chronic disease burden compared to the majority White population.

Answer 90

Social determinants

Question 91

Be able to List three risk factors for an adverse drug event in an older adult.

Answer 91

Age >85 y Frailty Low body weight or body mass index Six or more chronic health conditions Memory problems Estimated CrCl <50 mL/min 9 1 medications (prescribed and over the counter) 12 1 doses of medications/d Prior ADE Multiple prescribers Multiple pharmacies No regular reviews of patient’s medication list Poor communication among providers Prescription of complex medical regimens

Question 92

Be able to describe the prescribing cascade (essay).

Answer 92

when a side effect or adverse drug reaction of a medication is misinterpreted as a new health condition, thus resulting in the prescription of a new medication

Question 93

· Checking your patient’s liver function tests may be warranted because decreased hepatic blood flow and decreased hepatic size and mass, might result in the older adult’s ___________________________________________________

Answer 93

hepatic metabolism of medications being reduced.