Medication and Older People

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

Top Contributors - George Prudden, Admin, Shaimaa Eldib, Lucinda hampton, Evan Thomas, Kim Jackson and Aminat Abolade  

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 supports physiotherapy clinical reasoning for assessment and treatment . 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 If a poor prognosis or side-effects anticipated, prophylactic medications should be reconsidered and possibly withdrawn; however the older person should not be denied effective treatments if they are of benefit.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.
• Milton et al (2008). Prescribing for older people.
• British National Formulary (BNF) - 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. Chapter 1 provides an understanding of basic pharmacology
• National Prescribing Centre (2000). Prescribing for the older person. MeReC Bulletin

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