Given that four out of every five people who are older than 75 years take a minimum of one medicine, and 36% of the over-75s take over four different types of medication, it shouldn’t come as a surprise that there are unique points to bear in mind with medication use in the elderly. However, the issues arise from far more than increased use, and it’s imperative to ensure you understand all issues affecting medication use in the elderly in order to ensure benefit is maximised, and potential harm minimised.
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Why Is It Necessary to View Elderly as a Unique Group When it Comes to Prescription Medication?
Various factors collide making those in the 65+ age group more susceptible to problems resulting from prescription medication. With age comes an increased likelihood of medical conditions, frequently more than one at a time, meaning that it is possible to end up on a cocktail of prescription medications without health care professionals truly linking them all together. Prescription Cascading (prescribing a new medication to combat the side effects of another) mean that you can quickly end up on many different medications. In addition taking medications combined with the normal body changes brought about by aging means that there is an increased change of either unwanted or indeed harmful drug interactions.
The Body Changes Affecting Elderly Use of Prescription Medications
As we age there are numerous natural processes that begin to change the way our body works. These changes can also change the way our body reacts to food, supplements, and of course, prescription medication.
- Digestion: as human bodies age there is a general ‘slowing down’ of the organs. One notable area affecting our ability to absorb and process prescription medications is the digestive system.
- Liver & Kidney Function: With age, the liver can become less effective and efficient at processing prescription medication, and the kidneys in turn become less effective at excreting them. The result is that usual adult doses may need modifying for use in the elderly, or be more likely to cause side effects.
- Body Weight: whether you’ve had variable weight throughout your life, or have been a constant weight for years, age affects body weight. In turn, body weight affects the dosage required for many medications.
- Circulation: Like digestion, circulatory systems may slow with age, or be affected by changes in blood pressure due to aging.
- Brain and Nervous System: With age, the brain and nervous system can become more sensitive to some medications such as opioid painkillers and sleeping medications. In addition, with age comes more memory problems, and forgetfulness can play a key role in efficacy of medication if the patient simply forgets to take it.
- Eyesight: Printed labels and patient information leaflets can be harder to read.
- Bones and Joints: Age-related arthritic conditions may make it more difficult for elderly patients to open childproof containers and self-administering certain medications.
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The Types of Interactions That Cause Problems with the Elderly and Prescription Medications
Our bodies are a system, and as such operate under conditions where interactions may take place. The types of interactions that may be problematic where prescription medications are concerned are:
- Drug to Condition Interaction: Certain medical conditions can increase the potency of certain medications, and in some cases they may make certain prescription medications harmful. An example of Drug to Condition Interaction is decongestants, notably nasal ones, being harmful in patients with high blood pressure.
- Drug to Food Interaction: Our digestive systems change as we get older, however, some foods can negatively interact with medication regardless of age. For example, grapefruit juice should not be drunk with certain blood pressure-lowering medications, and likewise, some dairy products shouldn’t be consumed with some anti-biotics and anti-fungals.
- Drug to Alcohol Interaction: Many medications are known to interact negatively with alcohol. Long term medications used in the elderly, combined with regular drinking habits, may pose potential problems.
What Should You Do to Minimise Problems?
Both you and any care-givers can take certain steps and precautions to ensure you maximise the benefit from your prescription medication as well as minimising the risks.
- Communication: Communication with your health care professionals and care givers is essential. Be honest about your concerns, and be honest about what you take, what you take it for, and relay this information from one health care professional to another. Make lists, both of the medications you take and the conditions they are for, and any questions you have. Take these to all appointments. Mention your dietary habits as these can be vital to medication management.
- Utilise Your Pharmacist: Become loyal to one pharmacist. This enables them to take an overview role of your medication and your health. Pharmacists are a valuable knowledgeable tool when it comes to medication, interactions and side-effects. This becomes particularly vital if you want to add in an over-the-counter medication for a short time.
- Medication Systems: If you take regular medication then instigate systems that will ensure you take the medication regularly and on time in the right dosage. This may be a pill dispensary box, or perhaps a reminder alarm on your mobile phone.
- Self-Interest in Your Medication: Don’t simply assume each health care professional knows best without questioning it. Make sure you can answer the questions: what do I take? Why do I take it? What are the generic and brand names? Do I understand any changes?
- Watch the Herbal Supplements: Don’t assume all herbal supplements are safe to take with your prescription medications. Again, use the expertise of your pharmacist before taking over-the-counter medication or herbal supplements and medication to be sure they are safe in your personal situation. For example, St John’s Wort can inhibit certain enzymes in the liver from processing prescribed medications, making them less effective.
- Bring in a Third Party: Utilise the support of a trusted friend or relative to accompany you to appointments, help with reading labels and leaflets, and helping you to oversee and understand your medication.
- Annual Reviews: Ensure you have an annual review with your GP where you take along all medications and supplements you take, discuss them and their efficacy and side effects.
Remember, medications are both effective and safe, whether you are elderly or not, if you use them appropriately and correctly. The problems arise when instructions aren’t adhered to, or when medications are taken without due consideration to the whole person and all of their prevailing conditions. For further detailed information on medications and supplements and potential problems in the elderly, see the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
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