People are living longer. Life expectancy has grown from 66 years old in 2005 to 78 years old in 2011 with women living 2 to 4 years longer. Typically, the longer a person lives the longer their medication list grows. Chronic illness, such as heart disease, requires medication to treat and control symptoms. Specialists are also collected along the way; cardiologist, gastroenterologist, pulmonologist … the list goes on. Ideally, each physician has a firm understanding of how medication can sometimes be hurtful to seniors. Additionally, it is important that each specialist is communicating their medication plan with the person’s primary care physician, but that is not always the case. Many older adults take daily supplements and herbal supplements or remedies that they don’t think to tell their doctors about because they don’t consider them “medication”. Supplements, herbal remedies and over the counter medications (for example, cold medicine) can have an effect on the way prescription medications are metabolized by the body and need to be added to the medication list.
The medication that was prescribed when the person was younger tends to stay on the medication treatment list without further evaluation. Medication doses can now be too high. There may be medication on the list that interacts with or duplicates the actions of other medications which will double the effect of the drug. It’s important to know if the medication is still necessary and how certain medications might affect the person now that they are older.
Why is this important for older adults? What the body does with a medication is effected by:
- Absorption – the process of the drug entering the blood circulation. This process is effected by physiological changes that occur with aging such as decrease in gastrointestinal blood flow. It can also be effected by supplements a person is taking.
- Distribution – how a drug is dispersed in the body through bodily fluids and tissue.
Changes in body weight and dehydration in older adults effect distribution.
- Metabolism – the process by which the body breaks down and convers a drug into active chemical substances. Overall, the system involved in drug metabolism decreases with age and effects the way doses are managed.
- Elimination – how the body eliminates the drug. Elimination in older adults is reduced because of changes in blood flow in the kidneys, and other organ changes.
These four elements increase the potential of drug toxicity in older adults.
Signs to look for that may indicate a medication concern are sleepiness, loss of appetite, confusion and/or hallucinations, anxiety, dizziness, falls, tremors, constipation or diarrhea.
First, make sure the primary care physician as an accurate medication list from all specialists. This list must include all supplements and herbal remedies a person is taking. Ask for the doctor’s evaluation of the medication list and recommended changes. Ask if the medication is necessary and if there are other treatments that can be considered instead of medication. A rule of thumb is that 5 or more medications are too many. In the event that the person is hospitalized, make sure the primary care physician is aware of medications that were added to the regiment while in the hospital.
Older adults often do not feel comfortable asking questions of their doctor; seeing them in a position of authority. Attending an appointment with your loved one and asking on their behalf may be necessary to ensure correct medication management and the resulting increase in quality of life.