It is not just the number of diseases, drugs or doctors that is the problem. Age-related changes in physiology can worsen matters significantly, even if just two or three drugs are being taken. Just as a child is not the same as a small adult, pharmacologically speaking, an elderly person is not just an older young adult.
Major organ systems function less efficiently in older people. The heart's ability to pump blood declines with age, as does absorption by the gut, the breakdown of drugs by the liver and the ability of the kidneys to excrete them. With aging, the percentage of lean body mass declines, and body fat increases. Thus, aging affects how much of a drug reaches the bloodstream, how well it is distributed in the body and how effectively it is cleared from the system.
Drugs like digitalis and coumadin, which are primarily distributed in lean tissues, are likely to reach higher blood levels in people older than 65. So the prescribed dosages should be lowered to reduce the risk of toxic side effects. Other drugs, like Valium and barbiturates, that are distributed in fatty tissue can accumulate in the elderly body and remain active longer, increasing side effects like sedation.
Aging also results in fewer protein binding sites for drugs, resulting in a higher blood level of the drug that loses the competition for sites.
Furthermore, aging can affect the responses to certain medications. This is especially true for those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Stern wrote.
PREVENTING PROBLEMS
Keep a list of all medications you take and their dosages and dosing schedules. This should include prescription drugs, over-the-counter and herbal remedies and vitamin and mineral supplements. Take the list whenever you go to the doctor, and make sure that the doctor reviews it before prescribing something else. In addition, because doctors are not always familiar with the actions of all drugs, take the list to the pharmacy when ordering a new prescription and ask the pharmacist to review it for potential interactions.
It also helps to order all medications from the same pharmacy, which should keep a computerized record of everything you take. That way, a possible hazard will not be missed if different pharmacists are on duty.
Never take an over-the-counter or herbal remedy without checking with your doctor. If your doctor is hard to reach or ill informed, ask the pharmacist whether the remedy is safe in view of the other drugs you take.
Carefully review and abide by all dosing directions, especially: "Take with food," "Take one hour before meals," "Do not consume alcohol while on this drug," or, "Do not take this medicine if you are also taking"
Ask the prescribing doctor what side effects to expect and what should prompt an immediate call to the doctor. Do not assume that a decline in well-being is caused by a disease or age. It could be a drug side effect.
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