Medications can be very beneficial to the lives of older adults, but there are risks that must be considered. Medications can help control symptoms of chronic diseases and prevent adverse health outcomes such as heart attacks and strokes.
Know What the Meds Can or Cannot Accomplish
Many elders, however, may have different goals for medication use. Maintaining quality of life and independence, or improving functional status may also be important goals to them.
Adverse drug effects in elders are often misinterpreted as symptoms of a new disease or simply attributed to “old age.” However, the truth may be that the doses may need adjusting because of body size or reduced kidney and liver function. In addition, certain medicines should be avoided because they may increase the risk of falls or delirium, or cause mental confusion or cognitive impairment.
Red Pill, Green Pill, Round Pill, Flat Pill
Because older adults often take multiple medications, the risks of drug interactions or adverse drug reactions increase exponentially when more drugs are added into a medication regimen. Medications do have the potential to elevate quality of life and to save lives, but there is a downside if not carefully monitored.
Adverse drug reactions are common in older adults. And because these symptoms are often unrecognized or misattributed to other causes, often a new drug will be prescribed to treat the adverse effect of the first drug. Sometimes the second drug incites another adverse effect, triggering more prescriptions until one reaches a “prescribing cascade.” This cascade effect contributes to polypharmacy, or drug overuse in older adults.
Does the Primary Doc Know What the Specialist Prescribed?
Advance conversations with elderly parents about their medication lists can be very helpful in the event of a medical crisis or emergency. Regimen reviews are vital, especially when elders are experiencing transitions of care. Errors or miscommunications frequently occur during transitions. Most older adults rarely, if ever, have a comprehensive drug regimen review performed.
Tips for Evaluating Drug Regimens
The following are four key questions to ask when evaluating older adults’ drug therapies:
- Is the medication indicated?
- Is the medication effective?
- Is the medication safe?
- Is the patient taking the medication correctly?
Medications Should Support the Whole Patient.
It is not sufficient to focus on each medication, or each disease, in isolation. One must consider the total drug regimen, ensuring that the cumulative effect of all the prescribed and nonprescription medication is producing intended results. What is needed is a philosophy that includes a set of principles and practices meant to help elders, families, friends, and caregivers. The emphasis needs to go from focusing on diseases and their treatments to appreciating the individual patient and his or her values and concerns at each point in the aging journey.
Lois Young-Tulin, PhD, is an Assistant Geriatric Care Manager at Complete Care Strategies