Medications and Older Adults
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, new prescription drugs are generally required to have a section in the labeling about their 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." In 1999, these analyses became a regulatory requirement.
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. The average older person is taking more than four prescription medications at once plus two over-the-counter medications.
It's not always bad to take drugs in combination. High blood pressure is often treated with several different drugs. Many older people have multiple cardiovascular risk factors (high blood pressure, diabetes, abnormal cholesterol) and may need multiple drugs to treat them. Unless supervised by a doctor, however, taking a mixture of drugs can be dangerous.
For example, a person who takes a blood-thinning medication 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."
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, many 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, how it will 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, a rash or other symptoms after taking a drug should call their doctors. The following suggestions may also help:
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.
Keep track of side effects. New symptoms may not be from old age but from the drug you're taking.
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?"
Ask a pharmacist what foods to take with each drug. Some drugs are better absorbed with certain foods, and some drugs shouldn't be taken with certain foods.
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 to take your medicines. Use a memory aid to help you -- a calendar, pill box, or your own system. Whatever works for you is best.