.JPG)
Older adults who have everal chronic illnesses are at risk for polypharmacy, meaning the use of several medications at one time. Every medication has the potential to cause adverse effects. In addition, the more medications one uses, the higher the incidence of harmful interactions between them.
Even beneficial medications can have adverse effects. These effects may be due to the medication itself or interactions with other medication or food. The result may be impaired thinking, sustaining a fall that results in hip fracture, changes in mood, or incontinence.
There are two aspects of medication use that require special attention in the older adult. First, the medication must be taken properly and second normal physiological changes of aging alter the way medication affects the body.
Medications must be taken properly to work effectively. As the number of medications increases the act of taking the medication is more complex. Studies show that the older adult with cognitive impairment, who is living alone, or who is seeing multiple prescribers is especially at risk for taking medications improperly (see Table 1).
| Category | Characteristic |
| Age | Over 75 |
| Living situation | Lining alone |
| Medications | Taking multiple medication, over-the-counter medications, or social drugs |
| Medical | • Multiple prescribers, such as physicians, psychiatrists, dentists, podiatrists, or nurse practitioners • Multiple medical problems • Multiple caregivers • Poor communication between older patients and health professionals |
| Cognition | • Impaired alertness or memory • Psychiatric problems • Inability to take medications as directed |
| Physical | • Appears weak and with impaired mobility • Needing a walker or cane |
Those who are at risk may need assistance to assure medications are taken properly.
Once taken, a medication must be absorbed. Normal changes of aging affect these processes. Decreased blood flow to the skin and gastrointestinal tract can impede absorption, whether the medication is taken orally, topically, or injected. Changes in stomach acidity can affect how much medication is absorbed. Calcium, iron, and Vitamin B12 are examples of supplements not absorbed well by older adults.
After absorption medications enter the bloodstream. They are either excreted in the urine unchanged or metabolized first by the liver. Most older adults have good liver function, but many have reduced kidney function.
Beginning about age 50 kidney function decreases, resulting in increased time to eliminate medications from the body. People with certain chronic diseases, such as hypertension and diabetes, can have marked decreases in kidney function.
When kidney function is impaired, medications may not be excreted rapidly and therefore will remain in a person’s system longer than is usual. Some antibiotics can remain in an active form in the body for days whereas a younger person might excrete them in a matter of hours.
In addition, older adults are more vulnerable to medications that can damage the kidneys. Non-steroidal anti-inflammatory medications, such as ibuprofen, are commonly used medications that can affect the kidney.
Because of these changes in physiology, older adults may need a lower dose of a medication than a younger person to get the same effect. Some medications are not appropriate for use in an older person even at a low dose because the risk of ill effects is so high. For example, some cold and allergy preparations can cause confusion in older adults.
All older adults are at risk for polypharmacy because of normal physiological changes of aging. In addition, those who are on multiple medications, have impaired thinking, are over 75, or live alone are more prone to making errors when taking medication. Part three will discuss measures that can reduce your risk.
Part 2 Who is at risk?
Part 3 Tips for managing medication use
Comments