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| Medication and elderly people |
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Reviewed by Helen Marshall, pharmacist
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As we get older, our use of medicines will often increase as we
treat ailments that occur as a result of ageing. Medicines are taken to ease,
control or cure ailments. They are effective and safe if used correctly.
However, elderly people can be at increased risk from medicines
for various reasons.
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Medicine usage
Four out of five people aged over 75 years take at least one
medicine.
36 per cent of this age group take four medicines or
more.
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The ageing body can be more susceptible to the side effects of
medicines.
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Elderly people with multiple diseases can often end up taking
multiple medicines at the same time. With multiple medicines, there is an
increased chance of side effects, interactions between different medicines and
problems taking them correctly.
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The physical effects of ageing, such as arthritis and failing
eyesight and memory, can also cause issues in taking medicines the way your
doctor intended.
Although your healthcare team will do their best to minimise
such problems, there are a number of things you and your carers can do to
ensure medicines provide the desired effect with minimal problems.
General advice
Discuss your medication with your doctor or pharmacist.
Learn the names of the medicines you are taking and find out why
they have been prescribed.
You also need to know how often you should take them, and for
how long. If it helps, write this information down.
Medicines often have more than one name:
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a generic name eg
sildenafil. This
is the medical name for the active ingredient of the medicine.
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a brand name eg
Viagra. This is
the trade name a manufacturer gives to a medicine.
This means the same medicine may have several different names
or types of packaging.
If your pharmacist gives you a medicine that looks different to
the one you are used to, make sure you ask for an explanation before leaving.
Taking medicines
Always try to take your medicines as intended by your doctor.
Make sure you know what to do if you miss a dose or take too much.
To avoid mistakes, never take medicines in the dark. Always read
the label before you take the medicine and check the expiry date.
Storage
Never mix different medicines in one container. Always store
your medicines in the containers they were supplied in.
If you transfer medicines to other containers, you may not be
able to identify them or know when they expire.
The stability of certain medicines can also be affected if they
are transferred from their specially designed packaging.
Side effects
Talk to your doctor or pharmacist about possible side effects
of your medicines so you know what might be expected.
Some side effects may disappear after a few days, while others
may indicate that your dose needs reducing.
If any side effects are troubling you, talk to your doctor or
pharmacist. Similarly, if you think your medicine is not effective, talk to
your doctor or pharmacist.
Keep a permanent record of any allergies you have to medicines.
Herbal medicines
Always check with your pharmacist before taking
non-prescription or herbal medicines alongside your prescribed medicines.
Some medicines should not be taken together because they affect
each other once inside the body.
In the longer-term
Do not expect a prescription each time you visit your doctor.
Advice may be enough.
If you are admitted to hospital, make sure you know whether any
changes have been made to your usual treatment, and why, before you are
discharged, such as discontinued medicines, dose changes or new medicines. This
can help avoid confusion at a later date.
At least once a year, ask your doctor or pharmacist to review
all your medicines to see if they are still needed, particularly if you are
taking four or more medicines.
How can ageing cause problems using medicines?
Declining liver and kidney function
As we age, our livers become less efficient at breaking down
medicines, our kidneys less efficient at excreting them.
This means that normal adult doses of certain medicines may be
more likely to cause side effects.
To avoid this, your doctor may prescribe you a lower dose of a
medicine.
Brain and nervous system
The brain and nervous system become more sensitive to certain
medicines as we get older.
For example, elderly people are particularly susceptible to the
side effects of opioid painkillers such as morphine and sleeping tablets such
as diazepam.
Your doctor may prescribe lower doses of these medicines and
for short periods only.
As we age we can also become more forgetful and may have
trouble remembering what medicines are for, or whether we have taken them that
day.
There are various strategies to help, including medicine
reminder charts and pill boxes that can be filled with all the daily or weekly
pills needed. A pharmacist or health visitor can help you arrange this.
Eyesight
Failing eyesight can cause problems with reading small print
labels and information leaflets supplied with medicines. If this is a problem,
ask your pharmacist for large print labels and leaflets.
Bones and joints
Arthritis is a common problem
affecting elderly people, and it can cause particular problems with getting
medicines out of childproof containers and administering medicines such as eye
drops and inhalers.
Since medicines are of no use if you can’t get into them, your
pharmacist can supply your medicines in non-click lock containers on request.
He or she can also provide devices to make using medicines such as eye drops
and inhalers easier.
But you will need to remember to keep medicines that are in
non-click lock containers well out of the reach of children.
Mobility
If you have difficulty getting to the doctor’s to collect
prescriptions or to the pharmacy to get them dispensed, tell your doctor or
pharmacist. Home visits and delivery arrangements can be made.
Swallowing
Many elderly people have trouble swallowing tablets and
capsules. You should always take tablets and capsules with plenty of water.
Tell your doctor or pharmacist if you have difficulty
swallowing them, because many medicines also come in liquid or soluble forms
that are easier to swallow.
Advice for specific groups of medicines
Diuretics (sometimes called water tablets)
Diuretics are used most commonly to
treat high blood pressure. They are also used to treat conditions such as heart
failure and cirrhosis of the liver, in which they remove excess fluid that has
been retained in the body.
Diuretics are designed to draw water out of the body, which
means you may need to go to the toilet more frequently. For this reason, try to
make sure you can easily get to a toilet quickly.
It is usually best to take diuretics in the morning to avoid
disturbing your sleep with trips to the toilet at night.
Another possible side effect of diuretic medication is it can
cause a drop in your blood pressure when you get up from lying down or sitting.
This may make you feel dizzy or light-headed.
If you find this is a problem, get up slowly. If you do start
to feel light-headed, sit or lie down until the symptoms pass.
Because the aim of diuretic medication is to remove fluid from
the body, you should try not to counter its effect by drinking too much. Just
drink enough to satisfy your thirst.
Some forms of diuretic medicine also remove salts (potassium
and sodium) from the body. For this reason, your doctor may want to monitor
your levels of these salts using a
blood test.
Sleeping tablets
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Good advice
The following may help if you can't sleep.
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Keep to regular bedtimes - don't sleep or doze during the
day.
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Don't drink tea or coffee in the evening.
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Have a set time for getting up in the morning.
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Make sure your bed and bedroom are comfortable; not too
cold or too warm.
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Sleeping problems are common. Try not to get frustrated if
you can't sleep.
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Sleeping tablets should only be used
as a short-term treatment. This is because the tablets lose their effect after
a while because the body gets used to the medicine.
Common side effects of sleeping tablets include unsteadiness
and feeling drowsy the next day. Such side effects are more common in the
elderly and increase the risk of falls.
Don't drive if affected by sleeping medication.
Sleeping tablets should not be stopped suddenly. Your doctor
will advise on how to stop them gradually.
Painkillers
Pain and stiffness in the back and joints is common in old
age. Weight reduction, warmth and exercise may all help.
If the pain does not settle, see your doctor.
Simple painkillers such as
paracetamol (eg Panadol) can be
effective for arthritic pains.
Many stronger painkillers such as
co-codamol (eg Solpadol),
co-dydramol and
morphine (eg MST continus) cause
constipation as a
side effect, so a
laxative may also be
needed.
Aspirin and non-steroidal anti-inflammatory drugs
(NSAIDs) such as
ibuprofen (eg Brufen,
Nurofen),
naproxen (eg Naprosyn, Synflex)
and
others can cause bleeding from the stomach or bowel.
Elderly people are at particular risk from this side effect,
particularly those with heart and kidney problems.
More than one NSAID should not be taken at the same time. If
you've been prescribed an NSAID by your doctor, you should not buy aspirin or
ibuprofen over the counter to take as a painkiller as well. Ask your pharmacist for advice when buying painkillers.
Talk to your doctor or pharmacist if painkillers do not
provide effective relief.
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Based on a text by Professor Marion McMurdo, honorary consultant in medicine for the elderly, Dr Patrick Davey, Dr Jens-ulrik Rosholm, Dr Erik Skjelbo, Dr Lotte Fonnesbaek, pharmacist and Jens Peter Kampman, consultant
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Last updated 28.03.2007
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