Drugs and the Elderly

hen it comes to medications, the elderly are just like everyone else--only more so. They have more health problems, take more medicines, get more side effects, and sustain more deaths from improper use. In fact, some two-thirds of all people over age 65 take medication regularly. The elderly spend upwards of $10 billion per year on drugs, about 25 percent of the national pill bill, though they comprise only about 12 to 15 percent of the population. Today more elderly live longer, better lives than ever because of the many new medicines that keep jumpy hearts in line, arteries unclogged, aging bones from breaking, and eyesight from diminishing.

In fact, those over age 65 are among the main beneficiaries of the revolutionary advances in medicine during the twentieth century. Three key developments have especially helped the aging population have healthier and more productive lives: heart and high blood pressure medications, medicines that treat pain and injuries, and medications that overcome the mental health problems encountered in the aged. Medications that fight diabetes and kidney problems have also benefited the elderly.

Along with better nutrition and low cholesterol, low salt diets, the development of drugs that help us as we age has reduced death rates from heart attacks, strokes, and suicides significantly in the past few decades. But medications used by any aging person are truly the proverbial double-edged sword, since as many as 80 percent of the elderly are on confusing multiple-drug regimens. Indeed, some studies show that less than 30 percent of the aged use their drugs properly.

What Do We Mean By Aging ?

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Aging isn't just "getting old." It's a process that involves biological, emotional, social, and even financial changes that affect a person's overall health. Disease and mental attitude are the wild cards that affect the speed of the aging process. Certainly, we all know people over age 65 who differ widely in their ability to get around. Some run marathons in their eighties and beyond, and others are so debilitated by illness that just getting up in the morning is a major effort. How do we explain this disparity among older people? Age is less a chronological marker than a combination of factors that determine the overall functioning of people in their mid-sixties and beyond.

First, genetics plays an important part in the aging process. Aging is associated with the development of chronic diseases such as high blood pressure that contribute to wear and tear on the body. Most of us who develop a chronic condition do so because we have a genetic predisposition to the disorder. High cholesterol, heart disease, cancer, diabetes, and other problems "run in families," just as eye color and hair color do. Some experts feel that our body's immune system is also affected by aging, gradually losing its ability to recognize outside threats--a virus, for example--and hence putting us at greater risk of disease.

Emotional and psychological issues have a major impact on overall health and the aging process. Even though an older person is well physically, he may still be at risk for mental illnesses such as Alzheimer's disease, depression, and anxiety. According to the American Psychiatric Association, 15 to 25 percent of the elderly in the U.S. suffer from "significant symptoms of mental illness." The aged--especially elderly men--are more likely to commit suicide than the rest of the population (some 6,000 do each year), but most do not seek professional help. Despite the fact that over one million elderly have some sort of abnormal memory loss (senility or dementia), they are often too embarrassed or too ill to seek help.

Social and financial changes are commonly overlooked as part of the aging process, but they can contribute to both physical and mental illness in the elderly. First of all, many elderly live on fixed budgets. If their income is modest, then every fluctuation in the economy, change in interest rates and cutback in government care has an impact on their lives. This can affect their nutrition (the elderly often skip meals to save money), which can lead to reduced body weight and, in turn, a change in the effects of medications they are taking. If their budget problems are too severe, they may even skip doses or stop their medications entirely.

Many older people also suffer severe stress from radical changes in life-style. Frequently this happens to aging widows who outlive their spouses. Retirement itself can be a source of stress for the elderly, whether financially secure or not. Some who have worked all their lives have no idea how to "slow-down" or may find it hard to adjust to full-time life with their spouses. These massive changes, when added to a heart condition, for example, increase stress on already inefficient organ systems.

How Does Aging Affect Medication Use?

Despite the eternal search for the "fountain of youth," there are no medications that prevent or "cure" aging. The drugs used by the elderly are the same as those that a younger person might take--yet they can have a far different effect. It doesn't matter whether a person has heart disease or arthritis, osteoporosis, or high blood pressure, the story is the same: Because our organ systems tend to function less efficiently as we age, medications are handled differently by our bodies. Here are some of the most common changes affecting our health and our response to medicines:

• Our stomachs may not absorb food and medication as well as they did before.
• Our kidneys and livers don't eliminate fluids and toxins in the same efficient manner.
• Skin "dries up," making us more vulnerable to bruises.
• Our lung capacity diminishes, which increases risk of pneumonia and diseases caused by smoking or air pollution (emphysema).
• Muscles and joints weaken and wear out, making injury to hips, legs, and wrists more likely from even a simple fall.
• The heart and circulatory system loose peak efficiency.
• The senses we depend on--hearing, sight, taste--change subtly and affect mobility (driving a car) or pleasure (sexuality).
• The body's weight and composition changes, so that "usual" doses of medication require adjustments.
• Our immune systems decline, making us more prone to both infection and cancer.
• Our memories may deteriorate as chemical changes or clogged arteries cause brain cell damage.

All of the above contribute to the potential harm that medications can cause in the aging body. If a kidney can't eliminate a drug after it has done its work, it remains in the body longer, perhaps causing an overdose or an adverse effect. If someone forgets to take a medication that regulates the heart or blood pressure, a stroke or heart attack could be the result.

Any person over the age of 65 who is taking medications in the following categories should be aware of the potential for increased side effects, overdose, and diminished efficacy:

• Antibiotics
• Antihistamines
• Antihypertensives
• Antiulcer medicines
• Blood thinners
• Bronchodilators
• Calcium or potassium supplements
• Cardiac medications
• Corticosteroids
• Estrogens
• Over-the-counter drugs containing alcohol (cough and cold medications) or caffeine
• Pain relievers
• Psychiatric medications
• Skin medications and creams

Aging, Mental Health and
Medications--a Special Note

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Among the first signs that a drug may not be working properly in an older person is a change in mood, energy, attitude, or memory. Too often, these alterations are overlooked, ignored, or chalked off to "old age" or senility. Older people may themselves feel that their blue mood is caused by something external such as the death of a friend or simply by boredom. Nothing could be farther from the truth. Virtually every heart medication, blood pressure drug, sleeping pill, and tranquilizer has been known to trigger depressive symptoms.

When a psychological symptom appears in an older person, examine his or her medication or drug use first. Consider, too, factors like alcohol intake, poor nutrition, and hormone imbalance. And never dismiss the possibility that a real psychological problem has developed and may itself require medication. Any older person with feelings of hopelessness, worthlessness, unexplained crying, thoughts of suicide and similar symptoms could be among the five percent of the elderly who have a treatable, reversible depression.

Likewise, up to 15 percent of the aging population suffer from the symptoms of dementia: memory loss, disorientation, and confusion. Dementia can be a side effect of medicines. It may also be related to high blood pressure or conditions like Huntington's disease (a genetic disorder), Parkinson's disease (involuntary tremors), or Creutzfeldt-Jakob disease (a viral infection). Treatment of these can, to a small extent, reverse the dementia. However, some 60 percent of those with symptoms of dementia have Alzheimer's disease, a slow, progressive mental deterioration that, so far, can't be cured.

Alzheimer's disease is a particularly tragic disorder. It can affect people in their forties, but is more common among the elderly. Among the first signs of Alzheimer's are loss of short-term or recent memory--forgetting to shut off a light or the stove, or pick up the kids on time. As the disease gets worse, the person tends to become lost more easily and begins to forget how to do simple tasks like adding up numbers or reading the newspaper. Later on, all mental functions deteriorate, although the body is usually spared.

Treatment today consists largely of keeping the patient nourished, reducing agitation through tranquilizers, and helping the family cope through support groups. There is one medication -- Cognex -- that can alleviate the symptoms of Alzheimer's in some victims. It's not a cure and doesn't work for many people; but it's definitely worth trying if someone in your family suffers from this devastating disorder.

Safe Medication Use for the Aged

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Safe medication use for the elderly requires vigilance on the part of the older person and those assisting him. It is especially important to keep track of maintenance drugs and make sure they are taken regularly. For a chronic condition such as high blood pressure, these medications are a key to maintaining good health.

Remember, too, that perfectly ordinary medications really can lead to unexpected results--especially in the elderly. Be alert for gradual changes that may signal an unwanted side effect. And guard against harmful drug interactions by making sure the doctor knows about all the medicines the older person is taking, including those prescribed by other doctors and any over-the-counter drugs.

 

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