The value of a thorough medication regimen review is without question important in accessing recent or persistent changes in a resident’s condition such as worsening of an existing problem or the emergence of new signs or symptoms. Acting upon possible medication-related causes can prove impactful in resolving many of these circumstances when they occur. The purpose of this article is to give insight to possible conditions that could be the negative outcome of a medication regimen that has gone awry and to stimulate the need for a consultant pharmacist’s evaluation.
Changes Potentially Related to Medication Use
The following are examples of changes potentially related to medication use that could occur at any age, however, some of the changes are more common in the geriatric population and may be unrelated to medications:
- Anorexia and/or unplanned weight loss, or weight gain;
- Behavioral changes, unusual behavior patterns (including increased distressed behavior);
- Bowel function changes including constipation, ileus, impaction;
- Confusion, cognitive decline, worsening of dementia (including delirium) of recent onset;
- Dehydration, fluid/electrolyte imbalance;
- Depression, mood disturbance;
- Dysphagia, swallowing difficulty;
- Excessive sedation, insomnia, or sleep disturbance;
- Falls, dizziness, or evidence of impaired coordination;
- Gastrointestinal bleeding;
- Headaches, muscle pain, generalized aching or pain;
- Rash, pruritus;
- Seizure activity;
- Spontaneous or unexplained bleeding, bruising;
- Unexplained decline in functional status (e.g., ADLs, vision); and
- Urinary retention or incontinence.
In the event that you notice any of these events notify first the attending physician, then take into consideration that it maybe medication- related and communicate to a consultant pharmacist the need to perform a medication regimen review.
Boockvar KS, Carlson LaCorte H, Giambanco V, Fridman B, Siu A. Medication reconciliation for reducing drug discrepancy adverse effects. Am J Geriatr Pharmacother. 2006 Sep; 4(3): 236-43.
Centers for Medicare & Medicaid Services: State Operations Manual (SOM), Appendix PP- Guidance to Surveyors for Long-Term Care (LTC) Facilities and Chapter 4: 309-310