*For many people care of elderly parents or relatives is more and more a reality in life. However, most are unaware of issues with overmedication issues for seniors and the elderly.
Often overmedication in the elderly can happen for a number of reasons:
- Mixing prescription drugs with over-the-counter drugs, under the assumption that nothing one can buy without a prescription will be harmful, no matter how it is taken
- Not admitting discomfort or pain
- Assuming that whatever a doctor says is the best option for the situation
- Not knowing what a medication is supposed to treat or how long to take it
- Having multiple doctors who all prescribe medication without consulting each other
- Failing to inform one’s doctor of all over-the-counter medications and supplements one is taking
No one denies that prescription drugs do save lives, and improves the quality of life, but they are not completely free of risks or side effects. Naturally, the more drugs that are taken at the same time by a person, the greater the risk of adverse interactions and potentially devastating side effects.
People 65-years and older are the largest consumers of prescription and nonprescription medications in America. The Centers for Disease Control and Prevention (CDC) notes that although the 65-and-over age group makes up only 15% of the U.S. population, they account for nearly one-third of drug prescriptions. And drug use by the elderly is expensive. According to Medicare, each senior currently averages 28.5 new prescriptions and refills per year at a cost of $42.30 per drug.
As we get older, our use of medicines will often increase as we treat ailments that often occur as a result of aging.
Medicines are taken to ease, control or cure ailments. They are effective and safe if used correctly.
However, elderly people can be at increased risk from medicines for various reasons:
- Four out of five people aged over 75 years take at least one medicine.
- 36 per cent of this age group takes four medicines or more.
- The ageing body can be more susceptible to the side effects of medicines.
- Elderly people with multiple diseases can often end up taking multiple medicines at the same time. With multiple medicines, there is an increased chance of side effects, interactions between different medicines and problems taking them correctly.
- The physical effects of ageing, such as arthritis and failing eyesight and memory, can also cause issues in taking medicines the way your doctor intended.
- As we age, our livers become less efficient at breaking down medicines, our kidneys less efficient at excreting them.
- This means that normal adult doses of certain medicines may be more likely to cause side effects.
As a result of these natural changes associated with aging, prescription medications can affect the elderly in some very specific ways:
Brain and Nervous system
- The brain and nervous system become more sensitive to certain medicines as we get older.
- For example, elderly people are particularly susceptible to the side effects of opioid painkillers such as morphine and sleeping tablets such as diazepam.
- Your doctor may prescribe lower doses of these types of medicines and for short periods only.
- As we age we can also become more forgetful and may have trouble remembering what medicines are for, or whether we have taken them that day.
- There are various strategies to help, including medicine reminder charts and pill boxes that can be filled with all the daily or weekly pills needed. A pharmacist or health visitor can help you arrange this.
- Failing eyesight can cause problems with reading small print labels and information leaflets supplied with medicines. If this is a problem, ask your pharmacist for large print labels and leaflets.
Bones and Joints
- Arthritis is a common problem affecting elderly people, and it can cause particular problems with getting medicines out of childproof containers and administering medicines such as eye drops and inhalers.
- Since medicines are of no use if you can’t get into them, your pharmacist can supply your medicines in non-click lock containers on request. He or she can also provide devices to make using medicines such as eye drops and inhalers easier.
- But you will need to remember to keep medicines that are in non-click lock containers well out of the reach of children.
- If you have difficulty getting to the doctor’s to collect prescriptions or to the pharmacy to get them dispensed, tell your doctor or pharmacist. Home visits and delivery arrangements can be made.
- Many elderly people have trouble swallowing tablets and capsules. You should always take tablets and capsules with plenty of water.
- Tell your doctor or pharmacist if you have difficulty swallowing them, because many medicines also come in liquid or soluble forms that are easier to swallow.
Here is some information on some specific categories of medications commonly prescribed for seniors:
Diuretics (sometimes called water tablets)
Diuretics are used most commonly to treat high blood pressure. They are also used to treat conditions such as heart failure and cirrhosis of the liver, in which they remove excess fluid that has been retained in the body.
Diuretics are designed to draw water out of the body, which means you may need to go to the toilet more frequently. For this reason, try to make sure you can easily get to a toilet quickly.
It is usually best to take diuretics in the morning to avoid disturbing your sleep with trips to the toilet at night.
Another possible side effect of diuretic medication is it can cause a drop in your blood pressure when you get up from lying down or sitting. This may make you feel dizzy or light-headed.
If you find this is a problem, get up slowly. If you do start to feel light-headed, sit or lie down until the symptoms pass.
Because the aim of diuretic medication is to remove fluid from the body, you should try not to counter its effect by drinking too much. Just drink enough to satisfy your thirst.
Some forms of diuretic medicine also remove salts (potassium and sodium) from the body. For this reason, your doctor may want to monitor your levels of these salts using a blood test.
Pain and stiffness in the back and joints is common in old age. Many stronger painkillers such as morphine cause constipation as a side effect, so a laxative may also be needed.
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and others can cause bleeding from the stomach or bowel.
Elderly people are at particular risk from this side effect, particularly those with heart and kidney problems.
More than one NSAID should not be taken at the same time. If you’ve been prescribed an NSAID by your doctor, you should not buy aspirin, ibuprofen, or naproxen over the counter to take as a painkiller as well. Ask your pharmacist for advice when buying painkillers.
Talk to your doctor or pharmacist if painkillers do not provide effective relief.
Older people often take a handful of pills every day. Some are prescribed to treat side effects from other medications. Far too many senior citizens may be overmedicated. In some cases this can lead to depression, confusion or a false diagnosis of dementia.
If you think you, your parent, or other elderly loved one, is overmedicated, you have every reason to be concerned. But the last thing you should consider doing is stopping the medication!
Only a doctor can tell you whether you or your older relative is suffering from medication side effects or from an actual disease.
Take good care of yourself and live the best life possible!
The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.
Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. A health columnist and radio commentator who lectures, nationally and internationally on health related topics, Ellis is an active media contributor on Health Equity and Medical Ethics.
For more good health information, visit: www.glennellis.com