Drugs and the older person
My mother, now in her 70s, has for the past couple of years been on an increasing number of tablets for her heart, arthritis, depression and blood pressure problems.
Following a recent hospital stay some of these medications were discontinued while others were decreased. Why does she not need them any more?
The way drugs are broken down by the body and how they interact with other medications changes as we get older. It is therefore very important that these changes are taken into consideration when drugs are being prescribed for the older person, in particular when a variety of drugs are used for the treatment of concurrent illnesses.
When multiple treatments are used there is an increased risk of adverse problems arising due to drug interactions.
Your mother's physicians undoubtedly reviewed her continuing need for the medication, not only ensuring she was on the most appropriate medication for her problems but also minimising the risk of side effects or drug interaction.
She was admitted to hospital because she had had a number of falls. Although no specific reason was ever found for these her doctors think they may have been related to all the tablets she was taking.
All drugs have the potential to cause toxicity, side effects or react with other medicines and these effects can be exaggerated in the older person. Several different types of drugs are known to increase the likelihood of falls, and include medications that act on blood pressure, sleeping tablets and antidepressants.
All have the potential to cause balance and mobility problems in older people leading to an increased risk of falls.
Can the risk of drug-related side effects in older people be reduced?
Yes, there are a number of important factors to remember when it comes to prescribing for the older person. Needless to say medications should be used only when absolutely necessary.
New medication should be started at a low dose and increased slowly until a therapeutic level is reached.
Another important consideration is the time it takes for the medication to be cleared from the body.
Where possible, medications should be prescribed in a once daily administration - to promote compliance - and side effects from one medication should ideally not be treated with another medication.
It is important to have all long-term medication reviewed from time to time to avoid over prescribing.