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Optimising medicines use in care homes: case study
Mr Davies is an 81-year-old resident of a local care home. He takes ten different medicines including oral hypoglycaemic agents, several antihypertensive medicines, simvastatin, betahistine and tramadol. A member of care home staff is concerned because he is physically frail and has fallen four times over the past two weeks. His blood pressure on examination is 115/70 mmHg and his blood glucose measurements have been erratic over the past few weeks ranging from 3.3 to 6.3 mmol/L.
What further information would be helpful?
What are the three most important medication-related issues that you would address?
How would you respond to a request from a member of staff one month later for Mr Davies to be prescribed zopiclone to help him sleep?
Mrs Evans is 85 years old and has dementia. A member of the care home staff telephones to notify you that Mrs Evans has been refusing all her medication and asks if they can crush her risperidone tablet to give with her tea-time yoghurt as she has become aggressive on occasions.
How would you respond to this request?
You decide to review Mrs Evans list of medication to reduce her ‘pill burden’. How will you decide which, if any, can be stopped or reduced?
Following the medication review, Mrs Evans’ family are concerned that she has been “written off”. How would you respond?
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