Medication elderly

Although it is somewhat controversial, certain personality traits in elderly patients may predispose them to using more medications. " Elderly patients and their physicians may also be reluctant to discontinue medications. Often, patients with these views feel it is necessary to use medications and to obtain more prescriptions each time they visit a physician. This may also tie in with the attitudes of healthcare providers, who may be pressured to prescribe more medications for the patient. Finally, polypharmacy may be common in the elderly because they often borrow medication from family or friends, sometimes because of lack of education about the risks of inappropriate medication use. 

Age The very young can have an immature ability to absorb, distribute, metabolize, and excrete medication. Elderly people have a reduced ability to handle medication because of aging systems. Both of these age groups are at higher risk of side effects and adverse effects of medication. 

Various components of drug use in the elderly are worth noting. Problems with health literacy (i.e., the understanding of medical... 

NSAIDs are one of the most widely used classes of medications in the United States, particularly in the elderly.4 More than 20,000 deaths occur in the United States per year as a direct result of adverse events related to NSAID use. Chronic NSAID ingestion leads to symptoms of nausea and dyspepsia in nearly half of patients. Peptic ulceration occurs in up to 30% of patients who use NSAIDs chronically, with gastrointestinal bleeding or perforation occurring in 1.5% of patients who develop an ulcer. NSAID-related peptic ulcers usually occur in the stomach duodenal ulcers are much less common. 

Approximately 8% to 20% of patients with UC and 7% to 26% of patients with CD are elderly at initial diagnosis.42 In general, IBD presents similarly in elderly patients compared to younger individuals. Elderly patients may have more comor-bid diseases, some of which may make the diagnosis of IBD more difficult. Such conditions include ischemic colitis, diverticular disease, and microscopic colitis. Increased age is also associated with a higher incidence of adenomatous polyps, but the onset of IBD at an advanced age does not appear to increase the risk of developing colorectal cancer. Elderly patients may also use more medications, particularly NSAIDs, which may induce or exacerbate colitis. 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Most healthy adults with diarrhea do not develop dehydration or other complications and can be treated symptomatically by self medication. When diarrhea is severe and oral intake is limited, dehydration can occur, particularly in the elderly and infants. Other complications of diarrhea resulting from fluid loss include electrolyte disturbances, metabolic acidosis, and cardiovascular collapse. 

Children are more susceptible to dehydration (particularly when vomiting occurs) and may require medical attention early in their course, especially if younger than the 3 years of age. Physician intervention is also necessary for elderly patients who are sensitive to fluid loss and electrolyte changes due to concurrent chronic illness. 

Obtain a thorough history of prescription, non-prescription, and natural drug product use. Is the patient taking any medications that could contribute to cognitive changes in the elderly ... 

Delirium is characterized by a disturbance of consciousness and a change in cognition that develops over a short period of time, usually hours or days. The course can fluctuate over the course of the day, usually worsening in the evening. Underlying medical problems such as urinary tract infections in the elderly, substance abuse, or withdrawal symptoms in adults may precipitate delirium.1... 

Treatment of elderly patients with bipolar disorder requires special care because of increased risks associated with concurrent non-psychiatric medical conditions and drug-drug interactions. General medical conditions including endocrine,... 

Vigilance for drug-drug interactions is required because of the greater number of medications prescribed to elderly patients and enhanced sensitivity to adverse effects. Pharmacokinetic interactions include metabolic enzyme induction or inhibition and protein binding displacement interactions (e.g., divalproex and warfarin). Pharmacodynamic interactions include additive sedation and cognitive toxicity, which increases risk of falls and other impairments. 

Antihistamines such as diphenhydramine are known for their sedating properties and are frequently used over-the-counter medications (usual doses 25-50 mg) for difficulty sleeping. Diphenhydramine is approved by the FDA for the treatment of insomnia and can be effective at reducing sleep latency and increasing sleep time.43 However, diphenhydramine produces undesirable anticholinergic effects and carryover sedation that limit its use. As with TCAs and BZDRAs, diphenhydramine should be used with caution in the elderly. Valerian root is an herbal sleep remedy that has inconsistent effects on sleep but may reduce sleep latency and efficiency at commonly used doses of 400 to 900 mg valerian extract. Ramelteon, a new melatonin receptor agonist, is indicated for insomnia characterized by difficulty with sleep onset. The recommended dose is 8 mg at bedtime. Ramelteon is not a controlled substance and thus may be a viable option for patients with a history of substance abuse. 

Huang, W. F. Lai, I. C. (2005). Patterns of sleep - related medications prescribed to elderly outpatients with insomnia in Taiwan. Drugs Aging, 22( 11), 957-65. 

Elder is intended solely for informational and educational purposes, and not as medical advice. Please consult a medical or health professional if you have questions about your health. 

Hippocrates mentioned elder as a purgative around 400 B.C. Pliny (circa 2379 A.D.) recorded the use of elder by the Romans. Pedanius Dioscorides, a first-century army surgeon who traveled throughout the Roman Empire, also wrote about the medical value of elder. Elder was widely used in the early Italian medical schools. 

Within the medical community it has been acknowledged that elderly patients often respond to drug therapy differently from their younger counterparts. Aside from alteration of various pharmacokinetic and pharmacodynamic processes, elderly patients tend to suffer from a number of chronic conditions and, thus, have more complex dosage regimens. Additionally, a variety of physical limitations prevalent among the elderly may hinder their ability to self-administer medication. 

Most of those involved in health care administration agree that elderly patients are the primary consumers of drug products. The actual extent to which this occurs is shown quite clearly in Fig. 1, which lists by age group the distribution in the United States of the drug mentions those medications that have been prescribed, recommended or given in any medical setting... 

The decrease in the ability of the aging body to respond to baroreflexive stimuli can result in very serious consequences for elderly patients [115-117]. Because of this decrease in sensitivity and the decreased cardiac output witnessed in elderly patients, they are predisposed to the effects of orthostatic hypotension that can occur when one is taking antihypertensive medication (e.g., prazosin). Indeed, the fact that elderly persons are prone to accidental falls may be due to this change in sensitivity [115-117]. 

Vision. Many people experience visual decline as they age (Fig. 3) [135]. Impaired vision may also hinder one s ability to self-administer medication. Listed in Table 10 are some of the effects that are associated with impaired vision in the elderly. Some of the processes of self-administration that are affected by impaired vision are as follows (a) the ability to accurately measure liquids (b) the ability to correctly read instructions and (c) the ability to differentiate between various types of medications (both the labeling of these drugs and their physical characteristics) [137,151-153],... 

Liquids and Suspensions. Most liquid formulations are not packaged in unit-dosage form. Therefore, before administration, the proper amount of medication to be taken for each dose must be measured. This additional requirement may compound any difficulties a patient may have in following a prescribed schedule. Patients suffering from visual impairment, arthritis, or tremors associated with neurological disorders are particularly likely to become frustrated with this type of formulation. Visual impairments make it difficult, if not impossible, for many elderly patients to measure the prescribed amounts of medication accurately. Impaired dexterity, owing to tremors or arthritis, may have effects on a patient s ability to hold both a spoon and a bottle at the same time while pouring out the desired amount of liquid. 

Additional difficulties are encountered by elderly patients if a medication is in the form of a suspension. Problems may occur because a patient cannot see, or disregards, the words Shake Well on the label or is not able to exert the amount of agitation necessary to provide a uniform suspension. Certainly, unevenly distributed amounts of active ingredients throughout a suspension may result in serious consequences for a patient in terms of either under- or overdosing. 

Effervescent Tablets. Effervescent tablets are another means of supplying medications to the elderly. This type of formulation provides the patient with an easy-to-swallow product that is aesthetically pleasing (i.e., forms a clear solution, rather than a cloudy... 

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