Prescription medications offer the elderly an improved quality of life. But, with medications, as with so many things in life, very often less is more.
Individuals over 65 years old receive a full one-third of all prescription medications and purchase about 70% of all over-the-counter medications. Because of physiological changes, the elderly are at higher risk for adverse drug reactions. Taking numerous medications for one or more chronic conditions increases the risk even further. In fact, studies show that when taking 10 or more medications, the risk of side effects is 100%. While adverse drug reactions are estimated to occur in 2–10% of younger adults that number soars to 20–25% in the elderly.
Among the most common side effects of medications are: cognitive changes, such as confusion, memory loss and sedation; changes in blood pressure; and incontinence or other changes in bladder and bowel functioning. Taking more than three different medications increases the risk of a fall. Some of the changes that may be dismissed as part of aging are in fact the result of the adverse effects of medications.
There are inherent risks in every medication. How does one ensure the greatest benefit from medications with the fewest side effects? We suggest the following steps:
- Bring a list of all medications to every physician visit, ask that it be reviewed and keep the list updated. Inform all physicians of all medications that have been prescribed. An increasing problem in medication management has resulted from multiple medications being prescribed by different specialists for concurrent problems.
- Find out what each drug is intended to do and if there are non-medicinal ways to treat a problem, such as a change in diet or exercise.
- Ask about possible side effects. Are there any foods, medications or activities that should be avoided when taking a medication, and conversely, can foods or activities enhance a medication’s effectiveness? How long will the medication be needed? How will you know if it is effective in treating the problem?
- Use one pharmacy and establish a relationship with the pharmacist, often an untapped wealth of information. Make sure pharmacy records are up to date regarding allergies and drug reactions. Ask your pharmacist about prescription drug interactions with over-the-counter medications.
- Review medications with physicians and pharmacists each time a new medication is prescribed to ensure that the new medication does not adversely interact with others. Review all medications with the physician at each visit and ask if each is still necessary or if a “drug holiday” for one is possible. Medications are frequently added, but not often eliminated.
- Don’t stop medications without consulting your physician. Some medications need to be gradually reduced to prevent detrimental side effects.
Medical doctors are not immune to marketing. Certain older medications can be just as effective and much less expensive that newer medications. Ask your doctor about generic medication that may be cheaper and /or other medications that may be less costly than the “new and improved” (and more costly) brand.
Of special note is the growing use of “off label” medications. That is, medications prescribed for purposes/illnesses for which the medication was not originally intended and for which its effects and side effects have not been studied in clinical trials. If uncertain, ask the doctor if the medication prescribed has been studied in older adults and for the condition it is prescribed to treat.
Many older individuals ask few questions of their doctor for fear the doctor will think they are “questioning” his or her judgment. Let your elder know you want to be involved to ensure their well-being and your peace of mind.
Responses to medications vary from individual to individual. They are life saving and life preserving in many instances, but they do not come without risks. Family and elder involvement in medication management creates a healthy relationship with your health care provider and in turn can be an important safeguard to ensure against health-threatening drug reactions.
Updated from an original post in 2010.