As we age, changes in our body can affect the way medications are absorbed and utilized. We become more sensitive to medications, and we are more likely to experience increased side effects, drug interactions and other adverse drug reactions. The reasons are:
Amount of chronic illness: Older adults are more likely to have one or more chronic illnesses, such as high cholesterol, coronary artery disease, high blood pressure, type 2 diabetes, arthritis and depression. These chronic medical conditions can effect the way you use drugs. For example, type 2 diabetes may cause an eye condition, known as diabetic retinopathy, which can make it difficult for you to read a prescription label.
Multiple medications: Due to the increased risk of chronic illness, many older people may be taking five or more medications. The more drugs you take, the more likely you are to have a drug interaction with other medications, food or alcohol.
Types of medication: It is not uncommon for older adults to have a group of chronic conditions. For example, many older adults with type 2 diabetes also have high blood pressure, high cholesterol and depression. Typical medications for this group of people may include an oral diabetes medication (Glucophage), a blood pressure medication (Diovan HCT), a medication to lower cholesterol (Zocor) and an antidepressant (Zoloft). The combination of these medications has significant potential for causing adverse reactions.
Complicated dosage schedules: Taking multiple medications at different times of the day can be complicated and increase your risk of making a mistake. For example, you may forget to take medication at the correct time or you may take a dose twice.
Effects of the Normal Aging Process
For medications to be effective, they have to be absorbed in to the body (usually through the intestine), distributed in the body to where they are needed (usually via the bloodstream), chemically changed or metabolized (often in the liver) and then removed from the body (usually through the urine).
The normal aging process can change the way medications are absorbed, metabolized, distributed and removed from the body, causing challenges to the correct use of medications. These include:
Increase in the Percentage of Body Fat
As we age, our bodies have more fat relative to our bones and muscles. Although our weight may remain the same, the percentage of body fat increases. Medications that dissolve in fat may get trapped in your body’s fat cells and be less effective. They also may remain in your system for a long period of time.
Decrease in Body Fluid
As we age, the cells in our body lose some of their water, and they are less able to dissolve water-soluble medications. As a result, some medications may become too concentrated in the body, possibly increasing the medication's effect.
Decrease in Digestive System Function
As we age, there are changes in our digestive system that can affect how quickly medications enter our bloodstream. The movements in our stomach slow down, and it takes longer for medications to get in to our intestines, where they are later absorbed. Also, our stomachs produce less acid, and it takes longer for some drugs to break down. These changes may cause the action of a medication to be decreased or delayed.
Decrease in Liver Function
The liver is one of the most important organs in our body for metabolizing or breaking down medications. As we age, the liver gets smaller, blood flow to the liver decreases and the chemicals (enzymes) in the liver that break down medications decline. This can result in medications collecting in the liver, thereby causing unwanted side effects and possible damage to the liver.
Decrease in Kidney Function
Similar to the liver, changes in our kidney function occur as we age. The kidneys may get smaller, blood flow to the kidneys may decrease and our kidneys may become less effective at eliminating “left-over” medications. Starting around age 40, our kidney function declines approximately 1% each year. As a result, medication stays in the body longer, increasing the risk of side effects.
Decrease in Memory
Memory lapses are common in older adults, and as we age, the risk of Alzheimer’s disease and other types of dementia increases. Memory problems can cause people to forget to take medications, which can lead to poor control of their chronic illness. Furthermore, people with dementia may not be able to understand or follow a healthcare provider’s instructions, especially managing complex medication schedules.Decrease in Vision and Hearing
Visual problems, such as diabetic retinopathy, glaucoma and cataracts, are common in older adults and people with eye conditions, causing difficulty in reading labels on prescription medication containers and over-the-counter products. Hearing problems can make it difficult for people to hear instructions from their doctors and pharmacists.
Decrease in Dexterity
Many older people have arthritis, physical disabilities and nervous system disorders, such as Parkinson’s disease. These conditions can make it difficult to open bottles, pick up small pills or handle medications (eye drops, inhalers for asthma and COPD and insulin injections).
ASK FOR HELP!
If you are experiencing any difficulty taking medications because of your age, speak with your doctor and pharmacist for advice on how to better manage. Also, reach out to a family member, friend or local senior center for assistance. Finally, before you start a new medication, make sure you understand the drug’s side effects and potential interactions with other drugs and food. To ask me a question about medication, please e-mail me at firstname.lastname@example.org.
Suggested Reading from Dr. Mike:
- Side Effects - What You Need to Know
- Drug Interactions: Reducing Your Risk
- Aging changes in organs, tissues, and cells
- Find Your Drug: Using Drugs A to Z
Aging in the Know: Drug Treatment. American Geriatric Society Foundation for Health in Aging. July 25,2008. www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=6
Medication Use and Older Adults. FDA Consumer Magazine. U.S. Food and Drug Administration. www.fda.gov/fdac/features/2006/406_olderadults.html