Prescribing for Older Adults 

Prescribing for Older Adults 

Prescribing for Older Adults

According to DSM-V, generalized anxiety disorder is a type of anxiety characterized by a recurrent and persistent worry, causing racing thoughts and the feeling of hopelessness. Studies show that GAD is less prevalent among older adults as compared to young adults (Marinho, Gherman, &Blay, 2019). However, the disorder is more disabling among older adults causing sleeping and concentration problems. The purpose of this paper is to discuss treatment options that have been availed for the management of GAD in older adults.

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FDA-Approved Drug

Selective serotonin reuptake inhibitors (SSRIs) such as escitalopram have been approved by the FDA for the management of GAD among older adults. The National Institute for Health and Care Excellence (NICE) guidelines on GAD and PD, recommend the use of escitalopram as the first choice in the management of GAD among the geriatric population (Subramanyam et al., 2018). Before initiating this drug among the elderly, it is necessary to assess the EKG and patient’s basic metabolic panel, especially among patients with a history of arrhythmias. Escitalopram is associated with increased risks of fatal cardiac arrhythmias and hyponatremia among older adults. However, studies have associated the use of the drug with increased effectiveness, tolerance, and potency, with limited incidences of falls, and confusions common with other anxiolytics in older patients.

Non-FDA-Approved “Off-Label” Drug

Atypical antipsychotics such as quetiapine are however frequently prescribed for the management of behavioral and psychiatric symptoms associated with anxiety in the elderly (Crocco et al., 2017). Limited studies however support the use of atypical antipsychotics among older adults as a result of increased mortality rates among elderly patients with a history of dementia. Low starting doses of the drug are recommended, which will be slowly titrated upwards to reduce the incidences of adverse events. The patients must also be monitored closely for increased risks of suicidal thoughts or behavior. Other associated risks include stroke and transient ischemic attack. The drug has however displayed great effectiveness in the management of GAD among the elderly, with increased tolerance and adherence levels.

Nonpharmacological Intervention

Given that anxiolytics are associated with polypharmacy among older adults, non-pharmacological interventions such as cognitive-behavioral therapy (CBT) have been recommended by most national clinical practice guidelines for the management of anxiety symptoms among older adults (Day, 2018). The patient must undergo a comprehensive mental status examination to determine the goals of the therapeutic approach utilized. With appropriate utilization of CBT, the patient is expected to adopt coping mechanisms and develop a new set of understanding regarding the triggers for her anxiety symptoms, to promote their quality of life. Given the high incidences of dementia among the elderly, CBT can be very challenging among this population, as they tend to display problems with both short and long-term memory.

Conclusion

Studies show that GAD is less common among older adults as compared to the younger ones, but more disabling among the elderly as compared to young people. Through evidence-based practice, several treatment options have however been outlined for the management of GAD among the elderly. Such interventions include the use of FDA-approved escitalopram, with non-pharmacological interventions such as CBT (Marinho, Gherman, &Blay, 2019). Atypical antipsychotics such as quetiapine, have also displayed great effectiveness in the management of GAD among older people. 

References

Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current treatment options in psychiatry, 4(1), 33-46. https://doi.org/10.1007/s40501-017-0102-4

Day, P. (2018). Treatment of anxiety in elderly housebound patients. Journal of Community Nursing, 32(2), 52-55. http://shura.shu.ac.uk/21559/

Marinho, V., Gherman, B., &Blay, S. L. (2019). Anxiety disorder in older adults. In Primary Care Mental Health in Older People (pp. 161-166). Springer, Cham.ISBN : 978-3-030-10812-0

Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines for geriatric anxiety disorders. Indian journal of psychiatry, 60(Suppl 3), S371. https://doi.org/10.4103/0019-5545.224476

 

Discussion: Prescribing for Older Adults and Pregnant Women
After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.

In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.

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To Prepare:
Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5 to use.
Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.
By Day 3 of Week 9
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.
Read a selection of your colleagues’ responses.

By Day 6 of Week 9
Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.

Note: For this Discussion, you are required to complete your initial post before you can view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information
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Week 9 Discussion Rubric

Post by Day 3 of Week 9 and Respond by Day 6 of Week 9
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