The Body, Aging, and Medication
Drugs are the most common medical intervention and are an important part of medical care for older people. It is important to be aware that as we age, changes in our body can affect the way medications are absorbed and utilized. This leads us to become more sensitive to medications, and we are more likely to experience increased side effects, drug interactions, and other adverse drug reactions.
Furthermore, older people tend to take more drugs than younger people because they are more likely to have more than one chronic medical disorder, such as high blood pressure, diabetes, or arthritis. Most drugs used by older people for chronic disorders are taken for years, while other drugs may be taken for only shorter periods to treat such problems as infections, some kinds of pain, and constipation. In nursing homes, residents are prescribed, on average, 7 to 8 different drugs to take on a regular basis! On top of prescription drugs, older people also take many nonprescription (over-the-counter, or OTC) drugs, many of which, are potentially hazardous for older people (see Precautions With Over-the-Counter Drugs: Older People).
Effects of Medication Types, Interactions, and Dosing Schedules
As you age, it is important to know about your medicines to avoid possible problems. As you get older you may be faced with more health conditions that you need to treat on a regular basis. It is important to be aware that more use of medicines and normal body changes caused by aging can increase the chance of unwanted, or maybe even harmful, drug interactions. The more you know about your medicines and the more you talk with your health care professionals, the easier it is to avoid these potential medication problems.
Medication Interactions: Due to the increased risk of chronic illness, many older people may be taking five or more medications. The more drugs you take, the more likely you are to have a drug interaction with other medications, food, or alcohol.
Drug-drug interactions happen when two or more medicines react with each other to cause unwanted effects. This kind of interaction can also cause one medicine to not work as well or even make one medicine stronger than it should be. For example, you should not take aspirin if you are taking a prescription blood thinner, such as warfarin, unless your health care professional tells you to.
Drug-condition interactions happen when a medical condition you already have makes certain drugs potentially harmful. For example, if you have high blood pressure or asthma, you could have an unwanted reaction if you take a nasal decongestant.
Drug-food interactions result from drugs reacting with foods or drinks. In some cases, food in the digestive tract can affect how a drug is absorbed. Some medicines also may affect the way nutrients are absorbed or used in the body.
Drug-alcohol interactions can happen when the medicine you take reacts with an alcoholic drink. For instance, mixing alcohol with some medicines may cause you to feel tired and slow your reactions.
It is important to know that many medicines do not mix well with alcohol. As you grow older, your body may react differently to alcohol, as well as to the mix of alcohol and medicines. Keep in mind that some problems you might think are medicine-related, such as loss of coordination, memory loss, or irritability, could be the result of a mix between your medicine and alcohol. For more information about alcohol and medicines, visit the U.S. Substance Abuse and Mental Health Services Administration.
Aging Process on the Effectiveness of Medication
The risk of side effects related to the use of drugs starts increasing in late middle age . Older people are more than twice as susceptible to the side effects of drugs as younger people. Side effects are also likely to be more severe, affecting the quality of life, and more likely to result in visits to the doctor and in hospitalization.
In order for medications to be effective, they have to be absorbed into the body (normally through the intestine), the medication is distributed (usually through the bloodstream) in the body to where they are needed, chemically changed or metabolized (most often the liver or kidneys), and then removed from the body (through urine).
The normal aging process can change the way medications are absorbed, metabolized, distributed and removed from the body, causing side effects to become more pronounced. These include:
Increase in the Percentage of Body Fat
As we age, our bodies have more fat relative to our bones and muscles. Although our weight may remain the same, the percentage of body fat increases. Medications that dissolve in fat may get trapped in your body’s fat cells and remain in your system for a longer period of time.
Decrease in Body Fluid
As we age, the cells in our body lose some of their water, and they are less able to dissolve water-soluble medications. As a result, some medications may become too concentrated in the body, possibly increasing the medication's effect.
Decrease in Digestive System Function
Digestive system changes as a result of getting older can affect how quickly medications enter our bloodstream. The movements in our stomach slow down, and it takes longer for medications to get into our intestines, where they are later absorbed. Also, our stomachs produce less acid, and it takes longer for some drugs to break down. These changes may cause the action of a medication to be decreased or delayed.
Decrease in Liver Function
The liver is one of the most important organs in our body for metabolizing or breaking down medications. As we age, the liver gets smaller, blood flow to the liver decreases and the chemicals (enzymes) in the liver that break down medications decline. This can result in medications collecting in the liver, thereby causing unwanted side effects and possible damage to the liver.
Decrease in Kidney Function
Similar to the liver, changes in kidney function occur as we age. The kidneys may get smaller, blood flow to the kidneys may decrease and they may become less effective at eliminating leftover medications. Starting around age 40, kidney function declines approximately 1% each year. As a result, medication stays in the body longer, increasing the risk of side effects.
Decrease in Memory
Memory lapses are common in older adults, and as we age, the risk of Alzheimer’s disease and other types of dementia increases. Memory problems can cause people to forget to take medications, which can lead to poor control of their chronic illnesses. Furthermore, people with dementia may not be able to understand or follow a healthcare provider’s instructions, especially related to managing complex medication schedules.
Decrease in Vision and Hearing
Visual problems, such as diabetic retinopathy, glaucoma, and cataracts, are common in older adults and people with eye conditions, causing difficulty in reading labels on prescription medication containers and over-the-counter products. Hearing problems can make it difficult for people to hear instructions from their doctors and pharmacists.
Decrease in Dexterity
Many older people have arthritis, physical disabilities and nervous system disorders, such as Parkinson’s disease. These conditions can make it difficult to open bottles, pick up small pills or handle medications (eye drops, inhalers for asthma and COPD, and insulin injections).
Maximizing the Benefits and Reducing the Risks of Taking Drugs
Older people and the people who care for them can do many things to maximize the benefits and reduce the risks of taking drugs. Any questions about or problems with a drug should be discussed with a doctor or pharmacist. Taking drugs as instructed and communicating with health care providers is essential for avoiding problems and promoting good health.
Know about the drugs and disorders being treated:
Keep a list of all medical problems and drug allergies.
Keep a list of all drugs being taken, including over-the-counter drugs and supplements, such as vitamins, minerals, and medicinal herbs.
Learn why each drug is taken and what its benefits are supposed to be.
Learn what side effects each drug may have and what to do if a side effect occurs.
Learn how to take each drug, including what time of day it should be taken, whether it can be taken with food, or taken at the same time as other drugs, and when to stop taking the drug.
Learn what to do if a dose is missed.
Write down information about how to take the drug or ask the doctor, nurse, or pharmacist to write it down (because such information can easily be forgotten).
Use drugs correctly:
Take drugs as instructed.
Before stopping a drug, consult the doctor about any problems
Discard any unused drug from a previous prescription, unless instructed not to do so by a doctor, nurse, or pharmacist.
Do not take another person’s drug, even if that person’s problem seems similar.
Check the expiration date on drugs, and do not use the drug if it has expired.
Remembering to Take Drugs as Prescribed
To benefit from taking drugs, people must remember not only to take their drugs but also to take them at the right time and in the right way. The more complex the schedule, the more likely that mistakes will happen..
The following things can help people remember to take their drugs as prescribed:
Memory aids Memory aids can help older people remember to take their drugs. For example, taking a drug can be associated with a specific daily task, such as eating a meal.
Drug containers A pharmacist can provide containers that help people take drugs as instructed. Daily doses for 1 week or 2 weeks may be packaged in a plastic pack marked with the days or with the times of the day so that people can keep track of doses taken by noting the empty spaces. Some pharmacies can package drugs in blister packs so that the daily dose can be easily removed and kept track of. However, such packaging may cost a little more. Additionally, many pharmacies can adjust refill schedules so that regularly used drugs are picked up on a single day each month. This decreases confusion, helps reduce trips to the pharmacy, and minimizes mistakes filling pill organizers.
Medication Organizer More elaborate containers with a computerized reminder system are available. These containers beep, flash, or talk at dosing time.
Smartphone apps (cell phone apps) Apps that help people manage their drugs can be downloaded to multiple smartphones and tablets. These apps can help older people or their family members remember to take their drugs on time. Many of these apps include reminder alerts, which are sent to the device. Some of these apps may cost money.
Work closely with the doctor and pharmacist:
Get all prescriptions from the same pharmacy, preferably one that provides comprehensive services (including checking for possible drug interactions) and that maintains a complete drug profile for each person.
Consult the doctor or your pharmacist before taking any new drugs, including over-the-counter drugs and supplements.
Report to the doctor or pharmacist any symptoms that might be related to the use of a drug (such as new or unexpected symptoms).
If the schedule of taking drugs is too complex to follow, ask the doctor or pharmacist about simplifying it.
Your pharmacist may be able to give you written information to help you learn more about your medicines. This information may be available in large type or in a language other than English.
Additional Questions to Ask Your Doctor or Pharmacist
Your Pharmacist Is Here to Help You!
One of the most important services a pharmacist can offer is to talk to you about your medicines. A pharmacist can help you understand how and when to take your medicines, what side effects you might expect, or what interactions may occur. A pharmacist can answer your questions privately in the pharmacy or over the telephone.
What is the name of the medicine and what is it supposed to do? Is there a less expensive alternative?
How and when do I take the medicine and for how long?
What do I do if I miss or forget a dose?
Should it be taken before, during, or after meals?
What is the proper dose? For example, does "four times a day" mean you have to take it in the middle of the night?
What foods, drinks, other medicines, dietary supplements, or activities should I avoid while taking this medicine?
Will any tests or monitoring be required while I am taking this medicine? Do I need to report back to the doctor?
What are the possible side effects and what do I do if they occur?
When should I expect the medicine to start working, and how will I know if it is working?
Will this new prescription work safely with the other prescription and OTC medicines or dietary supplements I am taking?
Is there written information about my medicine? Ask the pharmacist to review the most important information with you.
What is the most important thing I should know about this medicine?
Can I get a refill? If so, when?
How and where should I store this medicine?
Ask your pharmacist to place your prescription medicines in easy-to-open containers if you have a hard time taking off child-proof caps and do not have young children living in or visiting your home. Remember to keep all medicines out of the sight and reach of children.
Learn about your medicines. Read medicine labels and package inserts and follow the directions. If you have questions, ask your doctor or other health care professionals. Talk to your team of health care professionals about your medical conditions, health concerns, and all the medicines you take (prescription and OTC medicines), as well as dietary supplements, vitamins, and herbals. The more they know, the more they can help. Don't be afraid to ask questions. Keep track of side effects or possible drug interactions and let your doctor know right away about any unexpected symptoms or changes in the way you feel. Make sure to go to all doctor appointments and to any appointments for monitoring tests done by your doctor or at a laboratory. Use a calendar, pillbox or other things, to help you remember what you need to take and when. Write down information your doctor gives you about your medicines or your health condition. Take along a friend or relative to your doctor's appointments if you think you might need help to understand or to remember what the doctor tells you. Have a "Medicine Check-Up" at least once a year. Go through your medicine cabinet to get rid of old or expired medicines and also ask your doctor or pharmacist to go over all of the medicines you now take. Don't forget to tell them about all the OTC medicines or any vitamins, dietary supplements, and herbals you take. ****Keep all medicines out of the sight and reach of children.****