NURS 3325  Discussion Medications Holistic Care of Older Adults

NURS 3325  Discussion Medications Holistic Care of Older Adults

NURS 3325  Discussion Medications Holistic Care of Older Adults

Another potentially detrimental health effect related to smoking that has implications for care of older adults is the potential for altering the effects of medications. Interactions can occur in people who smoke or use nicotine products (including smokeless tobacco) and in people who have recently quit smoking. Interactions can be due directly to the physiologic effects of nicotine or they may be caused by the hydrocarbons in tobacco smoke, which can affect hepatic metabolism of some medications. Additional information and examples of drug–nicotine interactions are discussed in Chapter 8.

Identify 2 medications affected by nicotine. What changes can it cause? How would you address this with your clients?

Methods: An explorative, cluster-randomized controlled trial with general practices as the unit of randomization will be conducted and accompanied by a process evaluation. Patients aged 70 years or older with at least three chronic conditions receiving at least three medications participating in at least one DMP will be included. The control group will receive DMP as usual. In the intervention group, GPs will conduct a spiritual needs assessment during the routinely planned DMP appointments and explore whether the patient has a need for more social contact or self-care. To enable GPs to react to such needs, several aids will be provided by the study: a) training of GPs in spiritual needs assessment and training of medical assistants in patient counseling regarding self-care and social activity; b) access to a summary of regional social offers for seniors; and c) information leaflets on nonpharmacological interventions (e.g., home remedies) to be applied by patients themselves to reduce frequent symptoms in old age.

The primary outcome is health-related self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary outcomes are general self-efficacy (using the General Self-Efficacy Scale (GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)), patient activation (using the Patient Activation Measure (PAM)), medication adherence (using the Medication Adherence Report Scale (MARS)), beliefs in medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction with GP care (using selected items of the European Project on Patient Evaluation of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the mechanisms, feasibility, and acceptability of the interventions.

Discussion: If the interventions prove to be effective and feasible, large-scale implementation should be sought and evaluated by a confirmatory design.