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The Elderly Should Be Careful in Taking Medication

Smart medication assures safe medication.
You need to check how you take medicines.

Masahiro Akishita, Professor, Department of Geriatric Medicine

Polypharmacy causes side effects

As people get older, they suffer from an increasing number of chronic diseases, including lifestyle-related conditions. As their treating physicians prescribe an increasing number of medicines, an elderly patient aged 70 or over takes an average of six or seven medicines. Polypharmacy for the treatment of multiple diseases poses many problems. First, it can cause a number of side effects. According to our survey, the overall incidence of side effects increases in elderly patients who take six or more medicines, while the incidence of falls increases in elderly patients who take five or more medicines (Fig. 1). In principle, drugs are prescribed in lower doses to elderly patients to take into account their compromised drug metabolism and excretion functions. However, polypharmacy may cause unexpected drug interactions that provoke adverse drug reactions through the excessive enhancement of the drug effects. The concomitant taking of many drugs causes a gradual decline in the memory and muscle strength. These elderly patients usually suffer from dementia, or experience falls and bone fractures.

Remember to take your medicines as instructed

Elderly patients often forget to take their medicines. A large variety of drugs are prescribed to them, and each must be taken as instructed. As they cannot memorize complicated medication instructions, they often skip a dose before meals or in the afternoon. Their treating physicians, who do not know about the missed doses, find the medicines less effective and increase their dosages. If the patients miss doses, they waste money spent on the drugs (and polypharmacy itself raises their drug costs). Many elderly patients unwillingly forget to take their medicines, and may find many prescribed drugs left over at home. They should bring these leftover medicines to pharmacies for consultation, or ask their treating physicians how to handle them.

Patients should be correctly informed about medication and healthcare

Medicines generally improve pathological conditions, including symptoms and test results. Symptoms usually return after the drug therapy is stopped. In light of the aforementioned problems with medicines, elderly patients should fully understand the significance and use of their medication. Some drugs are highly likely to cause side effects in elderly patients, and physicians are advised not to prescribe these drugs to them. The Japan Geriatrics Society developed guidelines for safe drug therapy for the elderly. However, patients should not stop taking medication at their individual discretion. They must always consult with their treating physicians or pharmacists.
Lifestyle improvement is also important. The elderly suffer from lifestyle-related diseases, including insomnia and constipation. Lifestyle habits to be culled include staying in bed until late in the morning, eating a poor diet, not getting enough exercise, and going to bed extremely early in the evening (causing interrupted sleep and resulting in sleeping pill dependence).
Elderly patients should also consider the best way to use hospitals. If a single physician takes care of an elderly patient, he or she can manage his/her entire drug therapy and reexamine his/her prescriptions in order of priority. However, elderly patients are generally followed by several physicians. Therefore, the latter cannot take a holistic approach to prescription management. An elderly patient should ask his/her primary care physician to manage all of his/her prescriptions. The patient can visit a different medical specialist if needed. If this prescription management system does not work, the selection of a single dispensing pharmacy is recommended. This way, someone can have a full picture of the medicines taken by an elderly patient. The smart use of medicines is strongly recommended to elderly patients.

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