Medication and the elderly
The way our bodies handle medication, changes as we age. This science is called pharmacokinetics and describes the Absorption, Distribution, Metabolism and Excretion of medication, sometimes referred to as ADME reactions.
Before we can discuss medication and the elderly, it is important to define what an “older person” is, according to the law, an older person is any male older than 65 years and any female older than 60 years of age. In pharmacology (the study of medication), an older person is any person older than 65 years. Why is this relevant? The way our bodies handle medication, changes as we age. This science is called pharmacokinetics and describes the Absorption, Distribution, Metabolism and Excretion of medication, sometimes referred to as ADME reactions.
As we age, there are certain physiological changes that a doctor needs to keep into account when prescribing medication. Common changes are thinning of the skin (making us more susceptible to bruising and skin tears), weakened immune system, smell and hearing senses become blunted, decrease in renal function, slower metabolism through the skin, body composition change (more total body water, less muscle in relation to fat tissue) and reduced albumin (protein building blocks) where to medication can attach.
The disease profile of the older person naturally also changes as we grow older. There is a higher incidence of cancer, heart and valve pathology, insomnia, strokes, dementia, gastro-intestinal problems as well as emphysema. It is common to have more than one chronic disease and therefore multiple medications on your prescription. Taking more than 5 medications a day, is called polypharmacy. The issue with polypharmacy is the interactions between different medications that can have an adverse effect or can change the efficacy of the medication taken. The more medications taken; the more interactions possible.
There are certain guidelines and rules that doctors can and should follow when prescribing medication. The BEERS criteria and the STOP/START criteria are examples of international guidelines that are applicable in the older population. The former is a guideline suggesting medication best avoided in the older person and the safer alternatives, the latter refers to the principles of de-prescribing, “less is more”. The American Geriatric Association also cautions against the use of certain medication combinations in the older person, for example opioids and sleeping tablets, certain antibiotics and antihypertensive medications.
It often happens that medication side effects are attributed to a new diagnosis (for example motion disturbances like what is experienced in Parkinson’s, known as parkinsonism) instead of recognising it as a side effect of current chronic medication. A patient’s clinical needs, as well as their wishes should be considered. They should have a say in the risk-benefit profile of their medication, “is the side effect worth the benefit” in this instance.
It is important that medication is stopped if it is not indicated any longer. Some doctors are hesitant to stop medication, de-prescribing is important and underutilised. Remember less is more, always.
Common side effects that we can expect in the older person due to the nature of their physiology, disease profile and the typical medication prescribed in this population are:
- Life- threatening cardiac toxicity with cardiac medication
- Peptic ulcers due to pain medication
- Motor vehicle accidents due to sedating and sleeping tablets
- Hip fractures due to sleeping tablets
- Mental health issues (amnesia, dementia) caused by or aggravated due to medication
- Motion disturbances (parkinsonism) due to psychiatric and anti-hypertensive medication
- Anti-clotting medication causing a bleeding tendency
- Addiction to sleeping tablets
To ensure that medication management runs smoothly, it is important to take responsibility yourself and to be actively involved in this process.
Make a list of all the medication you are taking, including vitamins, minerals, and any other medication that you request OTC (Over the Counter) at the pharmacy.
Keep this list in your purse, it is important that the doctor considers all the preparations that you take especially with medications’ interactions in mind.
Never miss a dose of your medication to “stretch” your prescription. Dosing schedules are based on sound research (pharmacodynamics: what the medication does to your body).
Fill your script in time in order not to miss any dose.
Don’t exchange medication with someone else although you have the same clinical condition, there might be a good reason why your doctor is prescribing A for you and not B.
Inform your doctor if there is any change in your medication (cessation of treatment or changes made by a specialist).
As we age, the taking of medication is unavoidable. Maintain a healthy lifestyle, exercise, and eat a balanced diet. Do what you can, it is your responsibility to look after your health. Prevention is always better than cure!
Dr. Janet Strauss is a Medical Doctor and the Chief Operational Officer at Medwell SA – The Home Health Care Specialists. For more information visit www.medwell.co.za
