Pharmacology, Nutrition, and the Older Adult: Interactions and

ImplicationsChapter 17

Introduction

• Medication can affect– Basic functions – Obtaining and utilizing nutrition

• Potential for medication interaction• Polypharmacy– When a person uses multiple medications

Common Classes of Medicationsin the Older Adult

• Cardiovascular/antihypertensives– Decrease appetite– Can cause dysgeusia– Can cause dehydration

• Hypoglycemics– Can cause increase fat formation and stability

Common Classes of Medicationsin the Older Adult

• Analgesics– Can cause gastric and espohageal injury and

bleeding – Can affect renal function– Can cause constipation and depress consciousness

• Psychiatric medications– Can affect consciousness and appetite

Medicare Part D

• Medicare Part D pharmacy plan – A three-tiered approach to cost and cost-sharing– Deductible,– “Doughnut hole”– Out-of-pocket threshold

• The Center for Medicare and Medicaid Services (CMS)– Offers assistance for those who cannot afford the

medication costs under Part D

Use of Complementaryand Alternative Medicines

• Use of herbal remedies has increased dramatically

• High risk for potential problems– Polypharmacy– Decreased metabolism– Elimination of medication• Increased sensitivity to the effects of

medications

Food and Medication Interactions

• Food and nutrients can alter a medication’s effectiveness in many ways– Increases or decrease absorption of medication– Interferes with a medication’s metabolism or

action– Prohibits the removal of a medication from the

body– Affects the medication’s absorption– Medication-nutrient interaction

Pharmacokinetic and Pharmacodynamic Changes in Aging• Absorption– Age-related changes in GI tract

• Distribution– Volume of distribution– Decrease in cardiac output and plasma protein

concentrations • Metabolism– Liver’s ability to metabolize medications becomes

less efficient

Pharmacokinetic and Pharmacodynamic Changes in Aging• Elimination– Medications excreted by the kidney

• Effect of Medications on Target Cells Homeostasis– Related to homeostatic functions and receptor

responses• Receptors– Functionality of various tissue receptors changes

with age

Normal Physiology of Nutrition

• Requires consciousness and appetite• Nutrition from appetite to elimination– Various medications can affect this process in

both positive and negative ways

Consciousness

• Medications that Affect Consciousness– Sedation can lead to a disinterest in eating– Some medications can cause increase in food

intake or stimulate appetite

Appetite

• Regulated by peripheral messengers, central messengers, and monoamines

• Intact sensation of taste and smell are important in stimulating appetite

• Concerns with GI problems• Several medications can influence appetite in

a positive or negative manner• Attention to potential anticholinergic effects

of medications

Physical Manipulation

• Chewing, Bolus Formation, and Swallowing– Effected by disordered consciousness and

disordered coordination• Coordination and Motor Function– Predisposed to movement disorders– Extrapyramidal symptoms– Medication-induced parkinsonism

• Peristalsis– Controlled by a complex system of

neurotransmitters

Medications that HaveGastrointestinal Effects

• Affect digestion of food by– Causing dysphagia• Side effects of the medication• Complication of the medication’s therapeutic

action• Medication-induced esophageal injury• Xerostomia

– Affecting peristalsis– Altering the acidity in the stomach

Medications that Cause Gastrointestinal Injury

• Older adults more susceptible due to:– Decreased saliva production– Esophageal motility– Greater incidence of cardiomegaly

• Medications have different mechanisms for inducing esophageal injury

Medications that AffectGastrointestinal Motility

• Common use of medications that cause either diarrhea or constipation

• Medications that affect the CNS, nerve conduction, and smooth muscle functions

Medications that AffectGastric Acidity

• Increased risk for peptic ulcer disease and gastroesophageal reflux disease

• Some medications require an acidic environment for absorption

Absorption and Utilizationof Nutrients

• Generally not subject to pharmacological interaction

Conclusion

• Awareness of medication-nutrient and medication-diet interactions is fundamental to delivery of sound medical treatment

• Medication kinetics can vary widely within an individual with alterations in diet

• Clear communication must exist between older adults and/or their caregivers and medical professionals to avoid potential adverse consequences