For many seniors who have chronic diseases, taking a daily medication is essential for maintaining health and quality of life. But, receiving multiple prescriptions from different doctors, or a miscalculation in dose can also be a source of danger. Too Much of a Good Thing Older adults often take a large number of prescriptions medications — an estimated 25 percent of people age 65 to 69 take five or more prescription drugs and 46 percent of people age 70 to 79 take five or more, a situation called polypharmacy. Taking five necessary prescriptions is one thing, but researchers believe 50 percent of older adults take more medications than necessary. Couple this with the fact that our bodies become less efficient at processing medication as we age and unwanted side effects could become an issue. As our body mass shifts toward fat and away from muscle, fat-soluble drugs have more places to hide and accumulate. And the medication in circulation persists longer because our renal (waste removal) system is slower to break it down and excrete it. This combination means that, for older adults, drugs stay in their systems longer and increase the chances they’ll have drug interaction or other medication problems. Dangerous Drug Side Effects In older adults, common medications can present problematic side effects. Medications you should be wary of include:
- Long-lasting NSAIDs, such as piroxicam and indomethacin, which can cause indigestion, ulcers and bleeding in the stomach;
- Certain muscle relaxants, anti-anxiety medications, anti-depression medications and sleeping pills can cause grogginess and increase the chances of falling, which is the most common cause of fatal injury in the elderly; and
- Heart medications, such as digoxin (in doses greater than .125 mg), which can be toxic in older adults.
These medications can cause ulcers, confusion or even kidney impairment if not monitored closely. Dangerous Drug Interactions As the number of drugs taken increases, harmful interactions can occur. More medications means increased risk of negative interactions. Common drug interactions in older adults include:
- Warfarin, a blood thinner, taken with one of several drugs, notably NSAIDs, can put a person at increased risk of bleeding;
- ACE inhibitors and spironolactone, which are both used to treat high blood pressure, can, when used together, increase potassium levels, which leads to heart problems, and cause renal failure; and
- Theophylline, a bronchodilator used to treat asthma, and norfloxacin, an antibiotic used to treat urinary tract and other infections, can, in combination, cause theophylline toxicity, leading to seizures.
Looking for Warning Signs Because drug-related medical problems are so common in older adults, it’s important to ensure you and your loved one stay on top of what they are taking and be watchful for changes in symptoms, which could be evidence of drug interactions. Specific risk factors to look for include:
- Long-standing prescriptions whose dosages have not been updated to reflect that they are now being taken by an older person or a person with poorer renal function;
- Medication dosages that were prescribed to address a short-term situation, such as an acute event that caused a hospitalization, but are now being taken long-term at home; and
- Medications being taken to alleviate the side effect of a different prescription. Sometimes this is done unknowingly when the side effects are misdiagnosed as a new medical problem, a situation known as prescription cascade. It’s better to reduce the dose of the original medication or find an alternative prescription.
How to Help Managing a prescription regimen is critical to keeping older adults in optimal health. You can help your parent adhere to their necessary medications and reduce their overall drug intake by:
- Making list of all the medications, both prescribed and over-the-counter, they are taking;
- Reading the fine print so you are aware of the active ingredients of all the medications in the house and potential duplications and interactions among the medications (a pharmacist is a great resource for this); and
- Asking their doctor to simplify the regimen by switching to time-release medicines that are taken less frequently and by cancelling prescriptions that are no longer needed.
Medication management is one of the most common reasons older adults pursue living in assisted living communities, where trained professionals are able to administer and monitor medications. Being purposeful about medication usage and vigilant in looking for side effects and interactions can help your loved one prevent adverse drug interactions while also adhering to medications needed to control chronic conditions.