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Medication and Older Adults
You are a partner in your health care. This is a partnership
between you, your doctor, and your pharmacist. You need to be
assertive and knowledgeable about the medications you take.
The Food and Drug Administration is also working to make drugs
safer for older adults, who consume a large share of the
nation's medications. Adults over age 65 buy 30 percent of all
prescription drugs and 40 percent of all over-the-counter drugs.
"Almost every drug that comes through FDA [for approval] has
been examined for effects in the elderly," says Robert Temple,
M.D., associate director for medical policy in FDA's Office of
Drug Evaluation and Research. "If the manufacturer hasn't done a
study in the elderly, we ask for it."
More than 15 years ago, the agency established guidelines for
drug manufacturers to include more elderly patients in their
studies of new drugs. Upper age limits for drugs were
eliminated, and even patients who had other health problems were
given the green light to participate if they were able. Also,
drugs known to pass primarily through the liver and kidneys must
be studied in patients with malfunctions of those organs. This
has a direct benefit for older adults, who are more likely to
have these conditions.
In several surveys, FDA discovered that drug manufacturers had
been using older adults in their drug studies; however, they
weren't examining that age group for different reactions to the
drugs. Now, they do. Today, every new prescription drug has a
section in the labeling about its use in the elderly.
Says Temple, "The FDA has done quite a bit and worked fully with
academia and industry to change drug testing so that it does
analyze the data from elderly patients. We're quite serious
about wanting these analyses."
When More Isn't Necessarily Better
Of all the problems older adults face in taking medication, drug
interactions are probably the most dangerous. When two or more
drugs are mixed in the body, they may interact with each other
and produce uncomfortable or even dangerous side effects. This
is especially a problem for older adults because they are much
more likely to take more than one drug. Two-thirds of adults
over age 65 use one or more drugs each day, and a quarter of
them take three drugs each day.
Not all drug combinations are bad. High blood pressure is often
treated with several different drugs in low doses. Unless
supervised by a doctor, however, taking a mixture of drugs can
be dangerous.
For example, a person who takes a blood-thinning medication for
high blood pressure should not combine that with aspirin, which
will thin the blood even more. And antacids can interfere with
certain drugs for Parkinson's disease, high blood pressure, and
heart disease. Before prescribing any new drug to an older
patient, a doctor should be aware of all the other drugs the
patient may be taking.
"Too often, older people get more drugs without a reassessment
of their previous medications," says Feinberg. "That can be
disastrous."
There is also evidence that older adults tend to be more
sensitive to drugs than younger adults are, due to their
generally slower metabolisms and organ functions. As people age,
they lose muscle tissue and gain fat tissue, and their digestive
systems, liver, and kidney functions slow down. All this affects
how a drug will be absorbed into the bloodstream, react in the
organs, and how quickly it will be eliminated. The old adage
"Start low and go slow" applies especially to the elderly.
Older adults who experience dizziness, constipation, upset
stomach, sleep changes, diarrhea, incontinence, blurred vision,
mood changes, or a rash after taking a drug should call their
doctors. The following suggestions may also help:
* Don't take a drug unless absolutely necessary. Try a change in
diet or exercise instead. Ask your doctor if there's anything
else you can do besides drug therapy for the condition.
* Tell your doctor about all the drugs you take. If you have
several doctors, make sure they all know what the others are
prescribing, and ask one doctor (such as an internist or general
practitioner) to coordinate your drugs.
* Ask for drugs that treat more than one condition. Blood
pressure medicine might also be good for heart disease, for
example.
* Keep track of side effects. New symptoms may not be from old
age but from the drug you're taking. Try another medication if
possible until you find one that works for you.
* Learn about your drugs. Find out as much as you can by asking
questions and reading the package inserts. Both your doctor and
pharmacist should alert you to possible interactions between
drugs, how to take any drug properly, and whether there's a less
expensive generic drug available.
* Have your doctor review your drugs. If you take a number of
drugs, take them all with you on a doctor's visit.
* Ask the doctor, "When can I stop taking this drug?" and, "How
do we know this drug is still working?"
* Watch your diet. Some drugs are better absorbed with certain
foods, and some drugs shouldn't be taken with certain foods. Ask
a pharmacist what foods to take with each drug.
* Follow directions. Read the label every time you take the
medication to prevent mistakes, and be sure you understand the
timing and dosage prescribed.
* Don't forget. Use a
memory aid to help you--a calendar, pill
box, or your own system. Whatever works for you is best.
Medicine and Special Needs
Arthritis, poor eyesight, and memory lapses can make it
difficult for some older adults to take their medications
correctly. Studies have shown that between 40 and 75 percent of
older adults don't take their medications at the right time or
in the right amount. About a quarter of all nursing home
admissions are due at least in part to the inability to take
medication correctly.
A number of strategies can make taking medication easier.
Patients with arthritis can ask the pharmacist for an oversized,
easy-to-open bottle. For easier reading, ask for large-type
labels. If those are not available, use a magnifying glass and
read the label under bright light.
Invent a system to remember medication. Even younger adults have
trouble remembering several medications two or three times a
day, with and without food. Devise a plan that fits your daily
schedule. Some people use meals or bedtime as cues for
remembering drugs. Others use charts, calendars, and special
weekly pill boxes.
Mary Sloane, 78, keeps track of five medications a day by
sorting her pills each evening into separate dishes. One is for
morning pills, the other for the next evening. Then she turns
each medicine bottle upside down after taking the pill so she
can tell at a glance if she has taken it that day.
"You have to have a system," Sloane says. "Because just as soon
as I get started taking my pills, the phone rings, and when I
come back to it, I think, 'Now have I taken that?'"
Drug-taking routines should take into account whether the pill
works best on an empty or full stomach and whether the doses are
spaced properly. To simplify drug-taking, always ask for the
easiest dosing schedule possible--just once or twice a day, for
example.
Serious memory impairments require assistance from family
members or professionals. Adult day-care, supervised living
facilities, and home health nurses can provide assistance with
drugs.
Active Lives
Not all older adults are in danger of drug interactions and
adverse effects. In fact, as more and more people live active
lives well into their 80s or beyond, many take few medications
at all. Among healthy older adults, medications may have the
same physical effects as they do in younger adults. It is
primarily when disease interferes that the problems begin.
To guard against potential problems with drugs, however, older
adults must be knowledgeable about what they take and how it
makes them feel. And they should not hesitate to talk to their
doctors or pharmacists about questions and problems they have
with a medication.
Says the University of Maryland's Feinberg: "We need to have
educated patients to tell us how the drugs are working."
Rebecca D. Williams is a writer in Oak Ridge, Tenn.
Cutting Costs
The cost of medications is a serious concern for older adults,
most of whom must pay for drugs out of pocket. Even those who
have insurance to supplement Medicare must often pay a
percentage of the cost of their medicines.
For a new prescription, don't buy a whole bottle but ask for
just a few pills. You may have side effects to the medication
and have to switch. If you buy just a few, you won't be stuck
with a costly bottle of medicine you can't take.
For ongoing conditions, medications are often less expensive in
quantities of 100. Only buy large quantities of drugs if you
know your body tolerates them well. But be sure you can use all
of the medication before it passes its expiration date.
Call around for the lowest price. Pharmacy prices can vary
greatly. If you find a drug cheaper elsewhere, ask your regular
pharmacist if he or she can match the price.
Other ways to make your prescription dollars go further include:
* Ask for a senior citizens discount.
* Ask for a generic equivalent.
* Get drug samples free. Pharmaceutical companies often give
samples of drugs to physicians. Tell your doctor you'd be happy
to have them. This is especially convenient for trying out a new
prescription.
* Buy store-brand or discount brand over-the-counter products.
Ask the pharmacist for recommendations.
* Call your local chapter of the American Association for
Retired Persons (AARP) and your local disease-related
organizations (for diabetes, arthritis, etc.) They may have
drugs available at discount prices.
* Try mail order. Mail-order pharmacies can provide bulk
medications at discount prices. Use this service only for
long-term drug therapy because it takes a few weeks to be
delivered. Compare prices before ordering anything.
For the complete article click on Medication and Older Adults.
About the author:
M. Sanders is a long term care insurance marketing specialist.
She is appointed throughout the United States as a long term
care insurance representative with several major insurance
carriers. Her website, About
Long Term Care and LTC Insurance, contains information and
articles pertaining to long term care, insurance and other
related senior topics. It is her goal to inform the public about
these
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