People ages 65 and older consume more prescription and over-the-counter (OTC) medicines than any other age group, according to the National Institute on Aging. Older people tend to have more long-term, chronic illnesses such as arthritis, diabetes, high blood pressure and heart disease than do younger people.
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The Food and Drug Administration is working to make drugs safer for older people, who consume a large share of the nation’s medications. People over age 65 buy 30 percent of all prescription drugs and 40 percent of all OTC drugs.
“Almost every drug that comes through FDA [for approval] has been examined for effects in the elderly,” meaning people over 65, says Robert Temple, M.D., director of one of the FDA’s offices of drug evaluation. “If the manufacturer hasn’t done a study that includes the elderly, we would usually ask for it.”
More than 15 years ago, the agency established guidelines encouraging drug manufacturers to include more elderly patients in their studies of new drugs. The FDA suggested that upper age limits be eliminated in drug studies, and that even patients who had other health problems be allowed to participate if they are able. Including older people in these studies gives information about whether they will respond to the drug differently because of their age or health conditions common in this age group.
In several surveys in the 1980s, the FDA discovered that drug manufacturers had been including older people in their drug studies, but they weren’t examining the study results to see if the older participants responded differently to the drugs. Now, they do. Today, new prescription drugs are generally required to have a section in the labeling about their use in the elderly.
Says Temple, “The FDA has done quite a bit and worked fully with academia and industry to change drug testing so that it does analyze the data from elderly patients. We’re very serious about wanting these analyses.” In fact, The analyses have been a regulatory requirement since 1999.
When prescribed and taken appropriately, drugs have many benefits: They treat diseases and infections, help manage symptoms of chronic conditions, and can contribute to an improved quality of life. But medicines can also cause problems, and the medical and physical needs of older people can sometimes make being aware of potential problems especially important.
Of all the problems older people face in taking medication, drug interactions are possibly the most dangerous. When two or more drugs are mixed in the body, they may interact with each other and produce uncomfortable or even dangerous side effects. This is especially a problem for older people because they are much more likely to take more than one drug. The average older person is taking more than four prescription medications at once plus two OTC medications.
It’s often necessary to take drugs in combination; it just requires care. High blood pressure, for example, is often treated with several different drugs. Many older people have multiple cardiovascular risk factors–high blood pressure, diabetes, abnormal cholesterol–and will often need multiple drugs to treat them. Unless supervised by a doctor, however, taking a mixture of drugs can be dangerous.
For example, a person who takes a blood-thinning medication should not combine that with aspirin, which will thin the blood even more. And antacids can interfere with absorption of certain drugs for Parkinson’s disease, high blood pressure, and heart disease. Before prescribing any new drug to an older patient, a doctor should be aware of all the other drugs the patient may be taking.
“Too often, older people get more drugs without a reassessment of their previous medications,” says Madeline Feinberg, Pharm.D., a pharmacist and former director of the Elder Health program of the University of Maryland School of Pharmacy. “That can be disastrous.”
Older people tend to be more sensitive to drugs than younger people are, due to changes in organ function and, in some cases, loss of muscle tissue that can cause the drug to be more concentrated in the blood. They also may be more susceptible to certain side effects, such as a drop in blood pressure. The adage “Start low and go slow” is good advice for the elderly.
Older people who experience dizziness, constipation, upset stomach, sleep changes, diarrhea, incontinence, blurred vision, mood changes, a rash, or other symptoms after taking a drug should call their doctors.
1. Make sure you tell your doctor and pharmacist about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. You may sometimes have more than one doctor, each prescribing different medicines. Make sure they all know what the others are prescribing, and ask one doctor (such as an internist or general practitioner) to coordinate your drugs.
“You are a partner in your health care,” says Feinberg. “This is a partnership between you, your doctor, and your pharmacist. You need to be assertive and knowledgeable about the medications you take.”
2. Get all your prescriptions filled at one pharmacy. Your pharmacist can serve as a central point to maintain a list of all your medicines, and can screen for drug interactions to avoid harmful situations.
3. Tell your doctor if you are allergic to any medicines.
4. Keep track of side effects. New symptoms may not be from old age but from the drug you’re taking.
5. Learn about your drugs. Find out as much as you can by asking questions and reading the package inserts. Both your doctor and pharmacist should alert you to possible interactions between drugs, how to take any drug properly, and whether there’s a less expensive generic drug available.
6. Have your doctor review your drugs. If you take a number of drugs, take them all with you on a doctor’s visit.
7. Ask the doctor, “When can I stop taking this drug?” and, “How do we know this drug is still working?”
8. Follow directions. Read the label every time you take the medication to prevent mistakes, and be sure you understand the timing, dose prescribed, and how long to take it. Ask a pharmacist what foods to take with each drug. Some drugs are better absorbed with certain foods, and some drugs shouldn’t be taken with certain foods.
9. Don’t forget to take your medicines. Use a memory aid to help you–a calendar, pill box, or your own system. Whatever works for you is best.
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