Medication and Older People

Welcome to Older People section of Physiopedia

This section is being created as part of a project undertaken through AGILE (Chartered Society of Physiotherapy Clinical Interest Group of Physiotherapists working with Older People in the UK).  Please do not edit these pages until the project is complete, but feel free to contact the author with any comments. 

Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Discussion Point

Older people require special consideration where medication is concerned as many receive multiple medications for concurrent conditions. This practice of ‘polypharmacy’ increases the risk of drug interactions as well as adverse reactions and also affecting compliance.

Basic pharmacology knowledge is core to physiotherapy assessment. New legislature giving physiotherapists non-medical prescribing rights has impacted on this area of practice.

The nervous system is susceptible to common drugs like opioid analgesics, benzodiazepines, antipsychotics and antiparkinsonian drugs prescribed in the older population. They must be used with caution as the adverse drug reactions can be vague and non-specific, such as confusion, drowsiness, constipation, hypotension and falls. Organs and systems may be vulnerable to drugs such as anti-hypertensives and non-steroidal medications used as analgesics. It is therefore vital that medication of older people is reviewed regularly and they are maintained on the lowest dosage of a drug as is possible to gain the desired effect.

Ageing reduces renal clearance so drug excretion is slower with increased impact of nephrotoxic drugs. Acute illness and dehydration exacerbate this effect. Liver metabolism of the drug can also be reduced. Overall, pharmacokinetic changes can increase the tissue concentration of a drug by 50% or more if the person has greater frailty. In the very old, manifestations of normal ageing may be taken as signs of disease and lead to inappropriate prescribing. Self-medication with over-the-counter drugs or leftover tablets from a previous illness may also add to the complication.

Non-pharmacological management is strongly advocated. An example following bereavement would be to provide counselling for low mood as the preferred coping option instead of prescribing sedatives and anti-depressive medication. If a poor prognosis or side-effects anticipated, prophylactic medications should be reconsidered and possibly withdrawn; however the older person should not be denied effective treatments if they are of benefit.

Consider the form of medicine, for example, can it be swallowed easily, needs fluid to wash it down, crushed or given in liquid form. Different containers aid dispensing and concordance with medication e.g. dosage boxes, blister packs, and easy screw topped bottles, but may need to be requested specifically at the local pharmacy.

Further Reading

Dept of Health (2001). Supplement to the National Framework for Older People. London, HMSO.

Milton et al (2008). Prescribing for older people. BMJ; 336 (7644); 706 - 9. Accessed at: http://www.bmj.com/cgi/reprint/336/7644/606 on 07.07.2010 3.

In the UK, the British National Formulary (BNF) provides healthcare professionals with practical information on the selection and clinical use of medicines. It is a joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain with a good section reviewing changes in medicines management for older people.

McKinnon J (2007). Towards prescribing practice. Chichester, John Wiley & Sons. Chapter 1 provides an understanding of basic pharmacology

National Prescribing Centre (2000). Prescribing for the older person. MeReC Bulletin; 11 (10); 37 - 40. Accessed on 09.07.2010 t: http://www.npc.co.uk/ebt/merec/other_non_clinical/resources/merec_bulletin_vol11_no10.pdf