Doc Talk: Medication use gets more complicated for seniors

07/01/2013 12:10 PM

08/08/2014 10:17 AM

Adverse effects of multiple medication use are very common and complex, especially among the elderly. A recent study found that 12 percent of people over the age of 65 took more than 10 medications and 23 percent took five or more. Problems related to multiple medication use can include unwanted side effects, metabolism of the medications, high costs and interactions among medications.

Drugs can affect people differently as they age. Elderly people often have changes in the amount of body fat that binds medications; changes in their kidneys’ ability to eliminate drugs from the body; and changes in the liver, which helps metabolize and deactivate medications. The combination of these changes, along with other factors, directly alters how much and how many medications can be tolerated. The prescribing physician must always consider whether the benefits of a medication outweigh its side effects.

Rising costs continue to be a problem. The Medicare Part D bill passed in 2006 helped make prescription medications more accessible, yet many elderly still struggle with the cost. Recent studies show that up to 30 percent of elderly patients are not taking their medications due to cost, and this percentage rises with the number of medications to be taken. Solutions that have helped in recent years include prescription assistance from drug companies, based on the patient’s income, and the availability of $4 monthly drug plans through various pharmacies.

Interactions between medications can lead to a variety of symptoms ranging from mild to potentially severe. Most physicians and pharmacists work well together to attempt to keep side effects to a minimum. Computer software utilized by professionals can cross-check a patient’s entire medication list in minutes. However, despite all the technology, mistakes and adverse effects of medicine continue to occur. Recent studies suggest that 2 to 6 percent of hospitalizations are a direct result of adverse medication effects. These problems usually occur when a patient takes too much medication, takes a dangerous combination of drugs, or takes the medication incorrectly.

Many other aspects of medications are complicated. Patients don’t always remember to take their medications on schedule or to take them as instructed (such as on an empty stomach). Patients’ expectations also can be a factor. Advertisements often try to convince us that by taking a medication we will suddenly want to go throw a football through a tire or kayak down a river. Unrealistic expectations can cause the patient to discontinue the medication before it has had a chance to take effect.

Patients may make changes in their medications without checking with their doctor. An individual taking two blood pressure medications may be tempted to increase the dose of one and eliminate the other. However, a higher dosage, especially in the elderly, may be associated with more side effects.

There are no easy solutions in medical care. The best approach is to work with your physician and start with three general questions.

First, ask for the specific diagnosis associated with each medication.

Second, if a medication is causing side effects, ask if you can eliminate the drug, decrease the dosage, or check for interactions with other medications you are taking.

Finally, if cost is an issue, ask if alternative or generic medications are available or if you can obtain assistance from the drug company.

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