Over-medication and mis-medication are serious problems for older people. One study found that as much as 50% of all medication used by seniors is used inappropriately. Caregivers and professionals who are involved with older people need to be aware of the reasons this occurs and the symptoms which indicate there is a problem with medications.
It has been estimated that the average 85 year old is on eight different medications; the number for nursing home residents,perhaps due to their frailty, is even higher. With this many medications, it is easy to understand some of the confusion which can occur and how easy it could be to have unanticipated drug interaction side effects.
As people age, physiological changes in the body can change the effects and effectiveness of medications. Kidney and liver functioning decrease. The digestive system slows down.The percentage of water and muscle in the body decreases, and fat tissue increases. Drugs may take longer to be absorbed, broken down, and excreted. This means that the effects of medication on an eighty year old may be different from the effects on the body of someone who is forty.
Other reasons for medication problems include:
- Multiple medications prescribed by different physicians
- Prescriptions of medication inappropriate for older people
- Cognitive impairment/Dementia
- Visual impairment
- Depression
- Use of prescription, over the counter, and herbal medications without telling anyone
- Confusion about how and when to take them
- Self -medicating for pain or other conditions
The effects of mis- and over-medication can be subtle, and may take a while to develop to the point where they are noticed or something happens. This is over and above the "normal" side effects that occur from medications. Watch for:
- Confusion
- Falls
- Retarded motor skills
- Irritability or other mood changes
- Sudden changes in behaviour
- Bowel or bladder incontinence
- Constipation
- Dry mouth
- Lightheadedness
Problems with medication management can lead to falls, broken hips, and hospital and nursing home admissions. In a worst case scenarios improper medication use can cause death. Because of these concerns, risk management is something that needs to be considered and discussed between caregiver and the older person.
There are many systems available to help people with their medications. A plastic container divided into days, called a dosette, can be purchased, and medications divided up for the older person. Pharmacies will often bubble or blister pack medications, so all pills are in separate little bubbles on a card, and they are pushed out. There are machines that can be purchased that will dole out medications on a pre-timed basis and alert someone if they are not taken. There are services that will electronically call someone to remind them to take pills.
The best way to prevent problems is to be vigilant on an ongoing basis. Do not assume everything is all right and medications are being taken properly.
