Prescribing for Older Adults and Pregnant Women Assignment
Generalized anxiety disorder (GAD) is one of the most common and debilitating mental illnesses among the elderly, according to the DSM-V. It is typified by persistent, recurrent anxiety or fear, which results in racing thoughts and a depressing feeling (Ramos & Stanley, 2018). However, several therapeutic interventions have been outlined in clinical practice guidelines using evidence-based techniques and procedures to help manage the illness among this vulnerable group. This discussion is to highlight GAD drugs for older adults that are FDA-approved and off-label, and one nonpharmacological intervention, together with the risks and benefits for the elderly patients associated with each type of treatment. Prescribing for Older Adults and Pregnant Women Assignment
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FDA-Approved Drug
The FDA authorizes the use of SSRIs, such as escitalopram, as the initial line of treatment for GAD in the elderly (Carl et al., 2018). Given its good safety record and effectiveness in treating anxiety symptoms in this susceptible population, escitalopram is advised as the main medication for treating older adults diagnosed with GAD by a number of clinical guidelines, including the National Institute for Health and Care Excellence (NICE) guidelines on GAD and PD (Osborn et al., 2020).
It is recommended that the basic metabolic panel and EKG of elderly patients be assessed before starting the administration of escitalopram, particularly in those with a history of cardiovascular issues such as arrhythmias (Fagan & Baldwin, 2023). It is well-recognized that the medicine increases the risk of hyponatremia and cardiac arrhythmias in older adults. However, compared to other anxiolytic medications, the substance is more effective, well tolerated, and causes fewer cases of disorientation and falls, according to several studies (Ramos & Stanley, 2018). Prescribing for Older Adults and Pregnant Women Assignment
Non-FDA-Approved (off-label) Drug
Despite not having FDA approval for treating GAD, quetiapine is a popular off-label medication for the behavioral and mental symptoms of anxiety in the elderly (Fagan & Baldwin, 2023). However, because this medicine has a higher fatality risk when given to dementia patients, most expert advice does not favor its use (Fagan & Baldwin, 2023). When this is the only option available, low doses are advised to reduce the possibility of side effects; these doses are then gradually increased based on the patients’ reactions (Carl et al., 2018). Additionally, patients are advised to be mindful of the potential for suicidal thoughts to arise. In addition, past research with older GAD patients who did not have co-occurring conditions showed considerable efficacy with higher levels of adherence and tolerance (Carl et al., 2018). Prescribing for Older Adults and Pregnant Women Assignment
Nonpharmacological Intervention
Cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic approach for the care of generalized anxiety disorder (GAD) in older adults, according to the majority of national clinical recommendations and guidelines, including the ones stated above (Xiang et al., 2023). The treatment aim needs to be determined by taking the results of the mini-mental status examination into account in order to guarantee a good result. The patient will be encouraged to actively participate in therapy sessions in order to support the adoption of appropriate coping mechanisms and resistance to anxiety triggers (Xiang et al., 2023). However, because short-term or long-term memory problems can limit the benefits of this approach for those with dementia (Xiang et al., 2023). Prescribing for Older Adults and Pregnant Women Assignment
Conclusion
GAD is one of the most common and debilitating mental disorders among the elderly. Therefore, the FDA has approved SSRIs as the initial course of treatment for elderly individuals with anxiety disorders. In order to prevent potential consequences during pharmacotherapy, the associated risk with these medications needs to be carefully assessed. GAD in the elderly can be treated with a variety of non-pharmacological approaches, including cognitive behavioral therapy, which are covered in this study. A rationale for the suggested treatments was provided, along with clinical guidelines for the management of GAD. Additionally, the advantages of using the FDA-approved drug and the risk evaluation were covered. For the successful management of GAD in the elderly, healthcare providers like nurses need to understand effective pharmacotherapy alternatives, including FDA-approved and off-label drugs, and the risks for consequences must be avoided. Prescribing for Older Adults and Pregnant Women Assignment
References
Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., … & Powers, M. B. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1-21. https://doi.org/10.1080/16506073.2018.1560358
Fagan, H. A., & Baldwin, D. S. (2023). Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Review of Neurotherapeutics, 1-14. https://doi.org/10.1080/14737175.2023.2211767
Osborn, T. L., Wasanga, C. M., & Ndetei, D. M. (2022). Transforming mental health for all. bmj, 377. https://doi.org/10.1136/bmj.o1593
Ramos, K., & Stanley, M. A. (2018). Anxiety disorders in late life. Psychiatric Clinics, 41(1), 55-64. https://doi.org/10.1016/j.psc.2017.10.005
Xiang, X., Kayser, J., Turner, S., & Zheng, C. (2023). Layperson-Supported Internet-Delivered Cognitive Behavioral Therapy for Depression Among Older Adults. Research on Social Work Practice, 10497315231184143. https://doi.org/10.1177/10497315231184143
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Complete the Holmes and Rahe Stress Scale TestLinks to an external site. as a self-assessment exercise. Keep in mind that this tool is just for demonstration purposes, to show you one of many ways to measure stressors. Prescribing for Older Adults and Pregnant Women Assignment
An Adverse Childhood Experience (ACE) score is one way to measure childhood trauma and one way to predict later mental health issues. Remember, it is important to think of this tool as a guideline and not as prescriptive. Explore the tool as a potential resource for your practice.
Instructions
Go to Got Your ACE Score?Links to an external site.
Review the questionnaire. If you feel comfortable, try it out (you do not need to submit your score).
Review the links below and view the “PACEs Science 101†section of the web page to understand how this tool can be used as a predictive tool.
https://preventchildabuse.org/latest-activity/long-term-effects-of-child-abuse-and-neglect/? Prescribing for Older Adults and Pregnant Women Assignment gclid=CjwKCAjw4ZWkBhA4EiwAVJXwqfBqf8Li0TMLPP2wNkv4jmrqoqsZMwQE-sAwW_AKk_JUacn3Cg9sqBoC2J0QAvD_BwELinks to an external site.
https://preventchildabuse.org/images/docs/anda_wht_ppr.pdfLinks to an external site.
Write a reflection on the exercise, the challenges and/or benefits of using the tool, and the potential use with patients. Prescribing for Older Adults and Pregnant Women Assignment
Guidelines
Your response should be a minimum of 250 words in length.
Use a minimum of 2 scholarly sources, other than your textbook, to support your response. All evidence cited must be no more than 5 years old, however, on occasion, where limited material is available, you may use research published within the last ten years. Some research evidence is considered seminal or landmark studies and therefore, regardless of the date of publication, is permissible. Prescribing for Older Adults and Pregnant Women Assignment