Frail elderly people are at high risk of negative outcomes related to medications as their bodies do not process them as quickly as younger people. The risk to these elders includes toxicity, hypotension (low blood pressure), kidney failure, dehydration, etc. So why do we continue to give these medications? Simple, it is the standard of care, and in the event you are sued, it is important that you show you were following best practice and doing what a prudent professional would do in like circumstances.
Let’s briefly discuss hypertension and the ramifications of under/untreated disease. Uncontrolled hypertension is a leading cause of morbidity and mortality, despite availability of effective antihypertensives, many adults with hypertension are untreated, and up to 80% have uncontrolled disease. Now, let’s give a big shout out to the researchers of KARDIA-1! This medication, administered in a single injection (still in the investigational phase) effectively lowered blood pressure in adults with mild to moderate hypertension for up to 6 months. Bonus? KARDIA-1 also has an “encouraging side-effect profile” in the phase 2 dose-ranging study (fewer/less severe side effects). Wow, that is encouraging and add to that, this medication has the potential to improve medication adherence and reduce cardiovascular risk in people with hypertension.
We are likely a long way off from having access to this medication, however, there are things we can do now that will assist in maintaining our resident’s blood pressure levels in an acceptable range. First and foremost, be sure medications are available and administered as ordered by the physician. Encourage less sodium in the diet (be reasonable), encourage fluids, encourage exercise and activities, educate your residents on the risk of hypertension and what it does to the body. But remember, our residents are human, they enjoy snacking and don’t like the taste of low sodium foods. That’s okay, moderation is the key! Unless the resident has acute renal failure, talk to the attending physician, develop a plan to follow best practice in maintaining blood pressure levels BUT also include quality of life interventions. It matters, it just does. Stay well and stay informed!