Elderly - Pharmacology

More than 30% of all prescriptions and more than 50 percent of all over-the counter medications in the United States are consumed by patients who are over 60 years of age. It is this group of patients who are three times more likely to be admitted to a healthcare facility for an adverse reaction to medication.

Fifty-one percent die from these reactions; 70 to 80 percent of the adverse reactions are dose related.

There are several important reasons for such a high occurrence of adverse response to medication. These include:

  • Poly pharmacy (multiple medications are prescribed without discontinuing current medication, causing an interaction between drugs);
  • Medication can impair the mental and physical capacity leading to accidental injury;
  • Age can increase the sensitivity to drugs and drug-induced disease;
  • Absorption of medication is altered due to an increase in gastric pH;
  • Distribution of the medication is affected because of a decrease in lean body mass, increased fat stores, a decrease in total body water, decreased serum albumin, and a decrease in blood flow and cardiac output;
  • Metabolism changes as enzymatic activity decreases with age, and liver function;
  • Excretion is impaired due to decreased kidney function.

    Begin assessing an elderly patient by obtaining a complete history of medications used by the patient. This includes all prescription drugs, over-the-counter drugs, home remedies, vitamins, and herbal treatments. Make sure that you determine the medications that have been prescribed and medications that the patient actually takes. Include those that are taken at the patient’s discretion. Some patients don’t take all of the medications that are prescribed to them because of the cost of the medication or some unpleasant or undesirable side effects. Also note how often the medications are taken.

    List all practitioners who prescribed medications for the patient, including the patient’s primary physician, orthopedist, and cardiologist. Create a list of all pharmacies providing medication to the patient. Review the expiration dates for all medications. Ask the patient how they self-medicate, if they maintain a medication schedule, and if they ever forget to take their medication. If they do, ask what medications they’Ave skipped and what they do when they forget or skip a dose. Determine if the patient has any barriers to taking medication safely such as allergies, physical handicaps, memory loss, cultural beliefs, and financial constraints.

    Also, learn if the patient has support from family, friends, and neighbors. Most importantly, be aware of the cost of medication prescribed to the patient. The elderly typically live on a fixed income and may be unable to purchase expensive medication seven if the benefit outweighs the cost. Always keep medication for the elderly simple and to a minimum.

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