As individuals age, their bodies change, affecting how medications are processed and their potential effects. Understanding these changes is important for safe medication use, as some drugs pose higher risks for older adults. Recognizing problematic medications can help manage health proactively.
Physiological Changes and Medication Response
Aging causes physiological changes that alter how the body handles medications. Absorption, distribution, metabolism, and excretion (ADME) of drugs are affected, leading to different concentrations and responses. Reduced kidney and liver function, common with age, means medications clear more slowly, potentially accumulating to higher levels and increasing adverse effects.
Body composition also changes, with less total body water and more fat. This influences drug distribution; water-soluble drugs may concentrate, while fat-soluble drugs might have prolonged action. Receptor sensitivity can change, requiring lower doses for desired effects. Many older adults also take multiple medications (polypharmacy), increasing drug interactions and cumulative side effects.
Medication Categories to Approach with Caution
Several medication categories pose higher risks for older adults. Anticholinergic medications, found in some antihistamines, tricyclic antidepressants, and overactive bladder drugs, can cause confusion, memory impairment, constipation, and urinary retention. These effects are often more pronounced in older individuals.
Benzodiazepines and other sedative-hypnotics, prescribed for anxiety or insomnia, significantly increase the risk of falls, fractures, and cognitive impairment. These can cause excessive sedation and impaired balance, making daily activities hazardous. Prolonged use can also lead to physical dependence and withdrawal symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, can cause gastrointestinal bleeding, kidney dysfunction, and elevated blood pressure. Older adults are more susceptible to these side effects. Muscle relaxants also carry a high risk of sedation, anticholinergic effects, and falls, often with limited effectiveness for musculoskeletal pain.
Certain antiarrhythmic drugs and digoxin, used for heart conditions, have narrow therapeutic windows, meaning a small difference between an effective and toxic dose. Some diabetic medications, specifically sulfonylureas, can cause severe hypoglycemia in older adults, leading to falls, confusion, and other serious complications.
Long-term use of proton pump inhibitors (PPIs), for acid reflux, has been linked to increased risks of bone fractures, kidney disease, and Clostridioides difficile infection. While effective short-term, prolonged use needs careful consideration.
Opioids, effective for pain, can cause increased sensitivity, severe constipation, sedation, and respiratory depression, requiring careful dosing and monitoring.
Identifying Adverse Drug Reactions
Recognizing adverse drug reactions in older adults can be challenging, as symptoms are often subtle or mistaken for other conditions. Changes in cognitive function, such as sudden confusion, memory problems, or disorientation, can indicate a medication issue.
Dizziness and unsteadiness are common adverse effects that increase fall risk. Gastrointestinal disturbances like persistent nausea, vomiting, diarrhea, or constipation, especially if new, may signal a drug reaction. Increased fatigue, unusual drowsiness, or a general feeling of malaise could also point to medication side effects.
Behavioral changes, such as increased agitation, anxiety, or unusual mood swings, can sometimes be linked to medication effects. Swelling in the ankles, feet, or hands, or unexplained weight gain, could indicate fluid retention. Any new or unexplained symptom, especially after starting a new medication or changing a dose, warrants careful evaluation.
Collaborating with Healthcare Professionals for Medication Management
Effective medication management in older adults relies on open communication with healthcare professionals. Regularly schedule comprehensive medication reviews with a doctor or pharmacist. Bring all current medications, including over-the-counter drugs, supplements, and herbal remedies, in their original containers for these reviews.
Never discontinue or alter the dosage of any prescribed medication without first consulting a healthcare provider, as abrupt changes can lead to serious complications or withdrawal symptoms. Patients and caregivers should ask about potential alternatives or lower-risk options.
Understanding each medication’s purpose, benefits, and side effects is important. Ask questions about how and when to take medications, and what to do if a dose is missed, to ensure proper adherence. Maintain an accurate, updated list of all medications, including dosages and frequency, for all healthcare encounters.