Taking Medication: Special Concerns in Older Adults
Have you ever been concerned about relapse after missing a few doses of antibiotic pills? Do medications tie knots in your stomach and make eating a chore? Did you ever forget if you’ve already taken a dose of medication? Then perhaps you have some idea of the medication-taking hardships older adults face every day.
Many older adults must take several medications each day as they strive to keep their health in balance and remain independent. As many as 10 percent of people over age 65 take five or more prescription drugs, requiring them to juggle potentially dozens of pills every day. Painful arthritis may make opening a pill bottle seem as difficult as crushing a stone. Failing vision might prevent some older adults from reading key warning labels or instructions.
While a medication organizer, pill bottle opener or magnifying glass can help to overcome some medication-taking obstacles; we cannot prevent the normal aging process. “Both the liver’s ability to inactivate drugs and the kidney’s ability to [get rid of] drugs slow with age,” according to Dr. Mark H. Beers, Editor-in-Chief of The Merck Manuals and author of the widely used “Beers’ criteria for inappropriate medication use by the elderly.” A doctor must lower the dosage of certain drugs to prevent over-medicating and avoid causing side effects, Beers warns.
Several key factors put older adults at greater risk for reactions to medication such as falls, confusion or drowsiness, and medication-related hospital admissions. Both you and your doctor must work together to minimize potential pill-related pitfalls.
The Wrong Medication
There are a number of medications that are best avoided in older adults. “Some drugs present a high risk to the elderly and others pose low risk,” Beers explains. He warns that some doctors may use high-risk medications such as over-the-counter antihistamines (diphenhydramine or chlorpheniramine), older sleeping pills (flurazepam, diazepam, meprobomate), or inappropriately used antipsychotic drugs in those suffering from dementia. High-risk medications are more likely to cause side effects like drowsiness, dizziness, or urinary difficulties in older adults and safer alternatives are usually available. Other high-risk medications listed in the Beers’ criteria include muscle relaxants (methocarbamol and cyclobenzaprine) and older antidepressants such as amitriptyline.
Excessive or inappropriate use of amitriptyline or sleeping pills may increase the older adults’ risk for falls and confusion, according to Anne L. Hume, Pharm.D., professor and chair, department of pharmacy practice at the University of Rhode Island. Beers adds that hip fractures caused by falls are a major cause of disability and death in older adults. “We know that some of these hip fractures are related to medication side effects such as confusion, drowsiness, and imbalance.” Beers cites the example of older sedatives and sleeping pills. These medications can accumulate in an older person’s body and have been found to double their risk of fracturing a hip.
Even if low-risk medications are correctly prescribed, certain drugs may aggravate medical conditions that are common in this population. Over-the-counter cold remedies that contain antihistamines or certain antidepressants can worsen confusion in those who suffer from Parkinson or Alzheimer disease, for instance. These same medications can trigger a prostate problem as well. Aspirin-like medications can tip the balance of control in those who suffer from heart failure or high blood pressure.
What’s more, drug side effects can be difficult to accurately identify and this can have serious consequences. It is not uncommon for doctors to mistakenly believe that a problem caused by a medication reaction is a new illness. Some beta-blockers, commonly used to treat high blood pressure and heart problems, can cause depression. A doctor may inadvertently prescribe yet another medication -- an antidepressant – rather than stopping the drug causing the problem, writes Dr. Rosanne M. Leipzig, associate clinical professor in the department of geriatrics and adult development, Mount Sinai School of Medicine in New York.
Leipzig, in her article published in the February issue of the journal Geriatrics, mentions another example of a drug that can precipitate or worsen a disease. Aspirin-like anti-inflammatory pain medications can raise the blood pressure of those who are susceptible. In such a case, the doctor should not prescribe a blood pressure-lowering medication, but instead should stop the pain reliever.
Chronic medical illnesses and waning liver and kidney function put the body in delicate balance as people age.
Tips For Medication Use By Older Adults
The more medications someone takes the greater the risk for a drug reaction, particularly with increasing age. Furthermore, it is not unusual for doctors to prescribe the same dose of a medication for both a 200-pound athlete and a 90-pound older adult with chronic illnesses. Weight and size do matter. Muscle (lean body) mass drops with aging as the body stores more fat cells. Body size, percent fat, and how lubed and primed the kidneys are can significantly affect dosing of popular drugs such as antibiotics (cephalosporins, penicillins, quinolones), heart drugs (digoxin, atenolol, ACE inhibitors), and even the household pain reliever acetaminophen. Taking medication comes down to a risk versus benefit analysis and a few basic guidelines:
- Always try available non-drug treatments such as dietary changes and exercise as your first approach to managing a medical condition.
- Be certain your doctor periodically reevaluates all medications you take for possible dosage adjustments, drug-drug reactions, drug-disease side effects, and if a drug can be safely discontinued.
- Hume advises older adults to always ask if a drug can make them drowsy or dizzy and if there are ways to reduce those effects.
- Tell your doctor about any over-the-counter medications you take as well as herbal remedies. These may interact with prescription medications or have side-effects.
- Each time you renew a prescription, be sure you receive the same generic product. Different formulations of a medication can actually contain up to 10% more or less of the active ingredient.
- When you get a new prescription, clarify with your doctor how long you must use that medication and how it should be taken.
- Beers advises patients to use their pharmacist as a resource for reviewing all medications to check for interactions. This strategy is particularly useful if your doctor seems rushed when going over your medication.
- Be prepared with the right tools for the job. Purchase a pill splitter if you take only half a pill, as long as your pharmacist says that drug can be split. A large magnifying glass can be useful for reading directions or warnings in small print. Many inexpensive pill bottle openers can help those who have difficulty opening child safety caps. In fact, if you tell your pharmacist you cannot open safety caps and you have no children prancing around your house, the pharmacist will use a cap that opens with less effort.
- Consider buying one of many pill-dispensing gadgets to help you develop a system for properly taking all your medication. Check your local pharmacy or search the Web.
- Consider signing up for one of many available Internet services that send medication-taking reminders. Reminders can be in the form of telephone calls, emails, or a beeper.
Last reviewed: By John M. Grohol, Psy.D. on 9 Oct 2013
Published on PsychCentral.com. All rights reserved.
My doctor told me to stop having intimate dinners for four. Unless there are three other people.
-- Orson Welles