309 Nursing Care of the Postmenopausal Woman, 3rd Edition
EVIDENCE-BASED PRACTICE
switch between pharmacies, including mail-order pharmacies, and poor commu- nication between providers, specialists, pharmacists, and patients increases the risk of potential adverse consequences (Van Wilder et al., 2022). The nurse should request that the wom- an bring in all of her medications, both prescription and over the counter, each time she presents to the office and should create an accurate, up-to-date list of all the drugs the woman is currently taking. This approach provides the nurse with an opportunity to discuss the patient’s medications, including their purposes, administration practices, and signs of ad- verse effects. The nurse or other health- care provider can assess the benefits and harms of each medication to reach ideal pharmacotherapy. As computerized med- ical health records become the norm, the nurse and the provider will be able to re- view the medications and notes from oth- er providers and know why a woman was receiving a particular medication. Most of the records will also alert the provider if there is a potential for a reaction between the medication the provider wishes to prescribe and one the woman is already taking. The primary healthcare provider should act as the gatekeeper and stay up to date on the specialists the woman is seeing, and which medications are be- ing prescribed by which provider. Phar- macists can be helpful in determining if any of the medications are likely to react with one another and whether safer al- ternatives are available. Providers should be encouraged to discontinue or reduce dosages of medications when possible (Van Wilder et al., 2022).
All patients should be surveyed by the nurse, at every visit, whether inpatient, outpatient, or at home, about the medications they are currently taking. Nurses should consider using a screening tool to review current medications, assess the need before new medications are added, and advocate for deprescribing when appropriate (Dahal & Bista, 2022). Safety As a woman moves beyond meno- pause, she may find that she needs to start considering the risk of falls. Among women ages 65 and older, falls are the leading cause of injuries. More than one in four older people has a fall each year, and less than half of them will tell their provider about it (CDC, 2021). Between 25% and 50% of elderly women fall each year, and the incidence is rising. Each year, approximately 3 million emergency department visits are attributed to non- fatal falls in older adults. Approximately a quarter of these visits ended in hospi- talization. The direct medical costs of falls in older adults are approximately $50 bil- lion. Medicaid and Medicare pay 75% of these costs (CDC, 2021). A fall can be a sign of progressing disease/illness, or it may indicate that the woman has a new serious medical problem that needs treatment. An older woman who has had one fall is at much higher risk of falling again, so it is essen- tial to find out the cause of the fall (CDC, 2021b). Injuries associated with falls in older adults can include lacerations, bro- ken bones (wrist, arm, ankle, hip), and head trauma. Falls are the most common cause of traumatic brain injuries and bro-
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