Drug therapy in older adults often consists of preventing illnesses by decreasing the risks so an illness will never affect them. Several factors should be considered when older adults are prescribed drugs, as reported by Tufts University School of Medicine clinicians in an article recently published in the American Family Physician.
An older patient that is taking at least five medications has a 1 in 3 chance of experiencing an adverse drug reaction each year. Approximately 2/3’s of these patients will require medical attention. Surprisingly, 95% of these reactions are predictable, with 28% being preventable as reported by the researchers.
Beers Criteria is a widely-adopted list of medications that are “potentially inappropriate” for older patients or for older patients with a specific medical condition. The study suggests physicians avoid the drugs on this list and to use alternatives. If an alternative is not available, then start with the lowest effective dose and discontinue use when possible.
As the number of medications prescribed to a patient increases so does the risk of adverse drug interactions. To reduce the danger of potential drug interactions the study suggests the “brown-bag” approach, which is when a patient brings all of their medication to the physician’s office. About 20% of the patients can drop at least one of their drugs, while 29% of the patients can have a change in medication.
There is also the risk of under prescribing in older patients. Sometimes symptoms may be thought of as symptoms of a degenerative disease or old age when they are really treatable conditions, such as heart disease, depression, osteoporosis, and pain.
Another factor concerning older patients is noncompliance, which can be caused by a variety of issues like physician-patient communication, cognitive decline, and the cost of medication. The researchers suggest the best solution is to focus on education by using cognitive aids. When cost is a factor the patient may not raise the issue, which can be addressed by the physician asking whether the patient plans to use his or her prescription and hopefully begin a dialog about the costs of a patient’s prescriptions. Sometimes a generic substitute or a combination of less expensive drugs can be prescribed.