Safety Worries as Older Adults Mix Prescription & Nonprescription Medication
Over 175,000 emergency department visits a year are due to adults over the age of 65 experiencing adverse drug events. According to a study published in the December 24 issue of the Journal of the American Medical Association, nearly 30 percent of older adults use at least five prescription medications, but nearly half of older adults use a combination of prescription and over-the-counter medications. The combined effect is estimated to put around four percent of older adults (around 2.2 million) at risk of an adverse drug reaction.
A survey conducted by Dima M.Qato, and colleagues, of the University of Chicago, looked at the medication patterns of 3,005 community-residing individuals in the 57 to 85 year age range. A combination of interviews and medication records were administered between June 2005 to March 2006, in order to assess the extent of prescriptions, over-the-counter medications and dietary supplements consumed.
Results showed that 91 percent of the sample regularly used at least one medication. Prescription medication was the most common, at 81 percent, with people in the age range 75 to 85 years taking proportionally higher levels. Almost half of older adults topped up prescription medication with at least one over-the-counter medication or dietary supplement.
Researchers estimated that one in every 25 older adults were at risk of a major potential drug reaction. The level of risk increased with age with more than half involving the use of nonprescription therapies. Nearly half involved the use of anticoagulants (e.g., warfarin) or antiplatelet agents (e.g., aspirin).
The authors attribute the problem to the increase in prescription medications for older adults over the past decade. This, they say, is due to increased efforts in tackling common chronic diseases such as heart disease and diabetes. Yet, little is really known about the effects of regular long-term prescription medication, and the combined effects of over-the-counter medications and dietary supplements.
Previous warnings about the effects of multiple medications have been voiced by Jerry Johnson, M.D., member of the American Geriatrics Society and Chief of the Division of Geriatric Medicine at the University of Pennsylvania. According to Dr. Johnson, it is the aging process itself that increases sensitivity to drug effects. The effect of multiple medication is, according to a report by the U.S. Census Bureau, "the most common cause of delirium in the geriatric population."
Dr. Johnson offers a few simple tips to geriatricians and caregivers to work with their patient:
- Read labels as these can highlight negative drug interactions.
- Stay loyal to one pharmacist.
- Create a list and keep hold of it. List the pill, the strength, how often it is taken plus any herbal remedies, vitamins, homeopathic remedies or any other dietary supplements.
- Study the medications. Read up on them and get to know what they are intended to do.
- Question the medication. You can ask your pharmacist to run your medication list through a drug interactions database to identify possible problems, especially if you are on five or more drugs.
- Communicate with health professionals, especially if the person sees more than one doctor. Make sure everyone in the care team knows what the other person is prescribing.
Clinical Geriatrics, "Delirium in the Elderly", volume 7, issue 3, March 1999