Simple Things for Big Difference (lesson learned from issue of anticholinergic adverse effect of the drug(s) in elderly )

The case: Mrs. Y (70 years old) developed a chest cold that rapidly progressed to pneumonia. She required a week in the intensive care unit of her local hospital and two more weeks of hospitalization. Even then, it was several months before she could return to her normal. At first glance, one would attribute this episode to an unfortunate confluence of bacteria and fragile elderly patient. But there’s more to the story. Subsequent investigations determined that she contracted pneumonia because she was malnourished. She became malnourished because she stopped eating. She stopped eating because of  her difficulty to swallow, due to her dry-mouth condition. On the review from her medication, she has been taking nifedipine, furosemide, celecoxib, and ranitidine for number of years, and six months ago paroxetine was added to her medication.

The point to this story is that no one, not her physician, not her nurse, not her pharmacist, thought to ask her about her discomfort symptom (loss the appetite in this case) generated by her drugs. These health professionals simply forgot, even just “how are you ?” greeting, as an opening question to further reveal patient condition and their preferences. This story had happy ending. She recovered, and she is back to her usual,  but now her physician and pharmacist closely monitor her medication. Of course, there was a cost. Medicare paid a handsome sum of money to the hospital and physician who cared for her during her stay. Her family (not to mention Mrs. Y herself) paid a substantial emotional toll as a result of her battle with a life-threatening illness. All this financial and emotional cost and suffering could have been avoided if someone, some health professional, had looked upon her as a person who was taking the drug(s) with anticholinergic effect and if that someone had been concerned enough to worry about Mrs. Smith’s theraupetic outcomes and ask a few simple questions periodically and especially whenever she renewed her prescription.

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