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Saturday, February 4, 2012

Sharing Prescriptions

I am the wellness coordinator at a senior center in an urban area with a diverse population, culturally, educationally, and economically. One day, over coffee, I overhear some of the elders sharing their aches, pains and remedies. I am interested to hear what they have to say because the ladies may share things with each other that they may not necessarily find important to share with me. First, the conversation is quite innocent, and includes mostly the stories about rheumatism preventing them from knitting, and how the weather is going to change because “the knees are acting up again”.  But shortly, sure enough, I hear something quite disturbing to my nursing ears. A 75-year-old Mrs.D., a black sweetheart with grey hair says how she shares her antihypertensive with a neighbor who "has the same symptoms". Time to act, my inner voice whispers, and I gather myself to come up and to interfere this lovely conversation…
Sounds familiar? I believe I heard this story a few times in my life. Once, when my generous grandmother decided to share her blood pressure medication with her neighbor, because she thought that her physician was much smarter and gave her a better drug that would work miracles. I was ten, and thought the world of my grandmother, so instead of telling her that it was not such a good idea to share, I proudly shared the story with my mom (who happens to be a physician) and could not understand why mom looked so petrified when she heard my story. Another time, fifteen or so years later, while doing medication reconciliation with one of my cardiac patients, I discovered that he occasionally takes a Viagra shared by his much younger friend. In both cases, I interfered and explained explicitly that sharing the medications may lead to dangerous outcomes and death. I proceeded to tell my cardiac patient how everybody’s body is different, and that taking a medication that helps one person may kill another. I told him about the blood vessels around the heart (which he already had a very good understanding about), and how they carry oxygen to the heart itself. I then explained that the medication he took could be very harmful because less oxygen got to his heart, and we both agreed that he would immediately inform his cardiologist about his “recreational activity”. These two cases from my personal experience have something in common, yet they are so different from the community settings.
A community nurse by all means should come up to the ladies and explain in easy to understand language, maintaining eye contact and respect that sharing medications may be dangerous. A nurse may emphasize that although she understands the generosity of the client and her good intentions, and mention that there are other, more effective ways to help. She may explain how people, as they get older, take more and more medications, and like mixing blue and yellow paint produces green color, mixing two medications could produce an ugly result. The individual mini-teaching session would increase the knowledge that the elderly have about their own medications, but it would also uncover the need for further intervention.
A community nurse may plan to conduct a teaching session in the senior center. When searching for effective approaches to teaching elderly about the medications, I came across an interesting non-profit Australian publication. (The publication can be found here: The publication informs the reader about an unusual approach that can be resorted to, namely seniors teaching seniors about medications. Peer educators conduct interactive sessions, which is an innovative alternative to the general education session held by a nurse. Some seniors may be more inclined to listen to a peer because they associate with them more than with a young nurse.
If a nurse chooses to conduct an education session, she must ensure that the physiological needs of the seniors are met, meaning that the room is well-lit and that the letters on the handouts or overheads are large to accommodate for poor vision; the voice should be relatively loud, low-pitched and the sentences short to accommodate for any hearing deficits that the participants may have. The nurse must carefully review the presentation to ensure the absence of scientific terms, and use a simple language to express the ideas since health literacy may vary among the seniors. The nurse may review the lists of the medications the clients take, and ensure the examples are relevant. The nurse must also allow ample time for the seniors to process the information.
Elderly population strives to remain independent, so they assume a lot of responsibility for self-care. It is important for the community nurses to explore all the opportunities to aid the seniors in acquiring skills to maintain this independence and well-being.

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