Walter Smithers is an 86-year-old divorced man who lives alone in a public housing project for the elderly. He describes himself as a loner and expresses a great deal of pride at being independent for his entire life.

Mr. Smithers was admitted to the hospital after a fall from which he received scalp lacerations. He was alert, well read, but quite suspicious of the health care givers. He weighed 138 pounds and was 5'10" tall. He has very poor vision and hearing.

Mr. Smithers was diagnosed with hypertension, arteriosclerotic heart disease, atrial fibrillation, eczematous dermatitis of his legs, and a urinary tract infection. He spent 3 days in the hospital and was discharged on the following medications. (You can look these up in your pharmacology textbook.)

Valisone cream 0.1% to legs twice daily Digoxin 0.125 mg daily Lasix 20 mg daily Aldomet 250 mg bid Isordil 5 mg qid

Feosol spansule 1 bid Vitamin C 1 capsule daily Dicloxacillin 500 mg qid for 10 days Darvocet-N 100 mg qid as needed

Before this hospitalization, Mr. Smithers had relied heavily on self-care an self-medication, which he resumed upon discharge. He consumed large quantities of natural vitamin and mineral supplements. He used Corn Huskers Lotion on his legs. One week after discharge, the visiting nurse found that Mr. Smithers had fallen twice during the week but had sustained only minor bruises. He was weak, and although he was oriented to place and person, he was uncertain as to time and showed memory loss and incoherence in thought processes. He had trouble describing his medications but complained that they were expensive and caused him to experience incontinence. His blood pressure was 98/64.

The nurse convinced Mr. Smithers to visit a physician he knew and liked. The physician was tolerant of Mr. Smith's need to remain in his home and his health practices. Mr. Smithers insisted on using the corn Huskers Lotion instead of the "too expensive" cream. The MD agreed to this change and in addition was able to reduce Mr. Smithers medication of digoxin of 0.125 mg daily, Isordil 5 mg qid, and Lasix 20 mg daily. Mr. Smithers agreed to take his heart medications and to use fewer of his nonprecription vitamins and minerals.

1. Why is polypharmacy a common problem with elderly clients?
2. What assessment data should the nurse obtain to understand the client's beliefs and practices regarding medications?
3. How might the following have contributed to the confusion Mr. Smithers experienced?
1. Effects of age-related changes in circulatory, renal, and hepatic function on the drugs taken
2. The specific actions or adverse effects of the following drugs:
• Digoxin
• Lasix
• Aldomet
• Darvocet-N
4. What factors affected Mr. Smithers ability and willingness to carry out the medication regimen?