Older people are at increased risk of medicine-related problems. Learn how to take your medications safely and how to quiz your doctor. Show
Why your risk increases as you ageYour risk of problems with medicines increases as you age for 2 main reasons. Changes in your bodyYour body changes in many ways as you age. For example, how much water, fat and muscle you have changes. Some health conditions also create further changes in your body. Because of such changes, you might:
Your brain and nerves also change with age, so problems like memory loss or poor eyesight might start to affect the practical aspects of taking medicines. For example, it is easier to accidentally take your medicine twice, or forget to take it at all. Multiple medicinesYou might have been prescribed many different medicines. If you take 5 or more medicines daily, you are twice as likely to have side effects than other people. You are also far more likely to be taking medicines that could interact with each other. Taking multiple medicines can also mean a greater chance of making mistakes, because you have more medicines to manage that often need to be taken at different times of the day or even week. How to improve your medicine safetyAsk questionsYour doctor might have already considered your age and increased risk of side effects or mistakes. But it’s worth asking some important questions, such as:
You can also use the Question Builder tool to create your question list for the appointment. Prepare your list, then print or email it so you remember what you want to ask. Keep a medicines listYou can use a medicines list to keep track of:
To learn how to create your medicines list, go to NPS MedicineWise. You can also put an app on your phone to remind you when to take your medicines and help everyone involved in your healthcare know what you are taking. You can download the free MedicineWise smartphone app from Google Play or the App Store. Having an up-to-date medicines list also helps to make sure all of your medicines get reviewed. Ask for a medicines reviewIf you take several medicines, ask your doctor or pharmacist for a regular medicines review. Medicines are ideally reviewed every 6 to 12 months. But you can ask for a medication review at any time, especially when changes are made, including starting new or stopping medicines. You may be able to have a Home Medicines Review (HMR), where a pharmacist visits you in your home. The review gives you the opportunity to ask the pharmacist about your medicines and how to manage them well. Your doctor will use the results of your review to develop a medication management plan with you. You will need a referral from a GP to have the review. Talk to your pharmacist or doctorIf you’re taking a lot of medicines, talk to your pharmacist. They might be able to make you a pharmacy pack (also called a blister pack or a Webster pack) that will help you take the right medicines at the right time. If you have any concerns, talk to your doctor or pharmacist. After discussions, you might have the dose changed or even the medicine changed. But don’t suddenly stop taking your medicines. Last reviewed: October 2020
Older people require special consideration where medication is concerned as many receive multiple medications for concurrent conditions. This practice of Polypharmacy increases the risk of drug interactions as well as adverse reactions and also affecting compliance. Basic pharmacology knowledge facilitates therapy clinical reasoning for assessment and treatment . New legislature giving physiotherapists non-medical prescribing rights has impacted on this area of practice.[1] Polypharmacy[edit | edit source]Drug therapy is by far the most common form of medical intervention for many acute and chronic conditions due to its effectiveness at preventing disease or slowing disease progression. Problems occur when multiple clinical guidelines are implemented which lead to the increased risk of adverse drug events and incidences where patient’s preferences are neglected.[2]
Inappropriate polypharmacy is present when one or more drugs are prescribed that are not or no longer needed, either because: [2]
The video below gives a music fun version of the risks and issues of polypharmacy. Who needs a medications review?[edit | edit source]In the absence of definitive evidence on which patients are most likely to benefit from a holistic review of their medication, the following two groups of patients will be identified as potential candidates for medication review:[2]
A medicines review should also be considered when a patients has the following:[2] Medicines and falls[edit | edit source]Falls can be caused by almost any drug that acts on the brain or on the circulation. The mechanism that leads to a fall is one or more of the following:[3]
Sedatives, antipsychotics, sedating antidepressants cause drowsiness and slow reaction times. Some antidepressants and antipsychotics also cause orthostatic hypotension.[3] Any drug that reduces the blood pressure or slows the heart can cause falls. Symptoms are associated with feeling faint, loss of consciousness or “legs giving way”.[6] In some patients the cause of the fall is clear. Objectively they may be hypotensive, or have a systolic drop on standing. Other patients may have normal blood pressure but have syncope or pre-syncope from carotid sinus hypersensitivity or vasovagal syndrome. Stopping cardiovascular medication reduces syncope and falls by 50%.[7][8] Pain management for the elderly patient[edit | edit source]Managing persistent pain in older adults is a complex task and the relevant presence of multiple comorbidities, polypharmacy and physiological vulnerability in this age-group need all be considered.The paucity and diversity in research approach of the published literature makes it difficult to report the prevalence of pain in elderly people. There is disparity within the literature as to whether or not pain increases or decreases in this age group, and if there are gender differences. There is a body of evidence that describes a higher prevalence of pain within residential care settings.[9] Paracetamol should be considered as first-line treatment for the management of both acute and persistent pain[10], particularly that which is of musculoskeletal origin, due to its well documented efficacy and there that are few absolute contraindications. It is, however, important that the maximum daily dose of 4g per hour is not exceeded.[9] Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution with older people. The recommendation is that the lowest dose should be provided, for the shortest duration. For elderly people taking NSAIDs, they should also be prescribed a proton pump inhibitor (PPI) to reduce the incidence of stomach ulcers. NSAIDS are associated with gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. It is important for older people taking NSAIDs to be routinely monitored.[9] NSAIDs can also increase the risk of falls, increase geriatric psychiatric events, and increase the risk of stroke. These risks and benefits should be balanced carefully in individual patients to optimize overall outcomes, especially in the elderly.[11] NSAIDs have also been linked with impairment in bone healing. A systematic review conducted by Marquez-Lara et al. state that there is no consensus on whether they should be recommended post orthopaedic surgery .[12] Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. When this form of analgesia is used it is important that regimes are individualised and monitored carefully. Side effects of opioids include nausea, vomiting and constipation which should be anticipated and suitable prophylaxis provided.[9] Tricyclic antidepressants and anti-epileptic drugs are effective in the management of neuropathic pain. Intolerance to the medication and the occurrence of side effects limit their use in an older population.[9] Intra-articular corticosteroid injections in osteoarthritis of the knee is effective short term analgesia with a small risk of complications or joint damage.[9] Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients. Current evidence suggests that intra-articular hyaluronic has a longer effect than intra-articular steroids but has a slower onset of action.[9] Epidural steroid injections in the management of sciatica is not recommended due to conflicting evidence and the lack of larger studies.[9] Exercise, Manual Therapy, Acupuncture, Transcutaneous Electrical Nerve Stimulation (TENS), Massage and psychological approaches are non-pharmalogical approaches to pain relief which are well supported by the literature.[9] These modalities should be considered in parallel with drug therapy. Medicines support[edit | edit source]The video below gives good advice re adherence and medication management at home. [13] People should be routinely encouraged in actively participate in their own care[14]. It is essential to take steps to supporting people to manage their medicines by involving family members or carers. 'Medicines support' is defined as any support that enables a person to manage their medicines. Medicines support should be individualised and depending on their specific needs.[15] Physical and cognitive impairments can effect an individuals ability to take medication therefore alternatives to packaging and delivery should be considered. Consider can it be swallowed easily, needs fluid to wash it down, crushed or given in liquid form. Different containers aid dispensing and concordance with medication e.g. dosage boxes, blister packs, and easy screw topped bottles, but may need to be requested specifically at the local pharmacy.[16] Further Reading[edit | edit source]
References[edit | edit source]
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