Drug experts have called for caution in the prescription and administration of medications to the elderly, warning that some drugs can cause serious health problems for senior citizens.
According to the experts who are pharmacists, the normal biological and physiological processes slow down in old age and often affect the metabolism and excretion of drugs in the body, adding that extra care is, therefore, necessary when prescribing and administering drugs to the elderly.
Speaking with our correspondent, the experts, Managing Partner, Pharmamed Spectrum Care Limited who is also the Programme Manager, Bloom Public Health, Olutoun Sanusi-Oladunni; and the Chief Operating Officer, IPharma Nigeria, Babayeju Olusegun, stressed that caution was necessary while prescribing, dispensing and administering drugs to the senior citizens.
Speaking with PUNCH HealthWise, Sanusi-Oladunni said unknown to many people, the production of saliva reduces as people age, noting that this often impacts the elderly, particularly when trying to swallow, adding that this affects the absorption of oral medications.
She noted that as a result of having difficulty with swallowing, giving medications to the elderly needs to be properly supervised and done with care to avoid untoward outcomes.
Some medications, she added, are also high risks to the elderly because of their effect on the system, adding that the elderly often have reduced reflexes and decrease in sensitivity and sensory reactions, adding that some drugs could pose risks to them as a result of these changes.
She said, “Anti-anxiety agents are quite sedative and have a high risk of being abused. Hence, their use in the elderly may result in falls, fractures, and respiratory depression. Also, antiemetics, makes geriatrics more susceptible to anticholinergic adverse events. This includes urine retention and confusion. So caution is necessary.
“Geriatrics are more susceptible to decreased renal function, hence the use of nitrofurantoin could increase the risk of pulmonary toxicity, neuropathy, and hepatotoxicity. Also, estrogens and estrogen/progesterone products – when used long-term, can cause breast and endometrial cancer in the elderly.
She also called for caution in the prescription and administration of narcotic analgesics for the elderly, warning that their ingestion can cause, confusion and hallucinations as well as increase the risk of falls and seizures. Some proton pump inhibitors (PPIs), she said, may also cause loss of bone mass, which increases the risk of fractures with a fall and should thus be taken with caution.
Skeletal muscle relaxants drugs, she added are also not good for the elderly.
“Most muscle relaxants are poorly tolerated in the elderly due to anticholinergic effects, sedation, and cognitive impairment. In addition, these agents can easily be abused,” she said.
Speaking further, the pharmacists explained that the most common inappropriately prescribed drugs for the elderly include calcium channel blockers, corticosteroids, anti-inflammatory and antirheumatic drugs, muscle relaxants medications, analgesics, antiepileptic drugs, antiparkinsonian drugs, psycholeptic drugs, and psychoanaleptic drugs.
She also warned that some over-the-counter drugs may be dangerous for the elderly, adding that some OTC drugs used as a sleep aid or anti-histamine for allergies have side effects which include confusion, drowsiness, and dry mouth that are not good for the elderly.
Some non-steroidal anti-inflammatory drugs such as ibuprofen, she said, should also be taken with caution by the elderly because they may increase the risk of gastrointestinal (GI) bleeding and cardiac events.
She urged family members and caregivers of the elderly to ensure medicines for senior citizens are administered exactly as prescribed, adding that they should also urgently reach out to their physician in case there is a side effect or adverse reactions.
Medicines, she stressed further should equally be properly stored and not left carelessly where children could reach them.
“Be aware of potential medication interactions and
side effects. It’s best to read the literature on drugs even after the physician has explained the pharmacology of the drug to you so that you would be familiar with what to watch out for.
“Also, elders and in fact, everyone should keep a medication list to enable them at a glance to know all the drugs prescribed for them and that they are currently taking.
“Also, have a list of medications that were discontinued and a short note on the reason. Was it an adverse effect? Was it a reaction to another medication you were taking concurrently?
This is to ensure that treatment is being closely monitored by physicians to avoid complications,” she said.
Also speaking with our correspondent, Mr. Olusegun, also a pharmacist stressed that ageing affects the way drugs are absorbed, distributed, metabolized, and eliminated in the body.
He added that even though elderly patients may have multiple medical conditions and take multiple medications, they have to know that this can increase the risk of drug interactions, adverse reactions, medication errors, and the fact that some drugs are risky for them.
He said, “Some medicines are particularly risky for the elderly. Medicines like sedatives, antipsychotics, opioids, benzodiazepines, anticholinergics, and non-steroidal anti-inflammatory drugs. All these can cause all sorts of problems like falls leading to bone and joint injuries, breathing issues, confusion, sedation, hallucinations delirium, and more.
“That is why it is important to ask questions and make sure there aren’t safer alternatives or non-drug treatments option available before commencing treatment.
“Unfortunately, there are some medicines that may even be prescribed for the elderly that aren’t actually the best option.
The most common inappropriate prescribed drugs for the elderly are proton pump inhibitors (PPIs), antipsychotics, benzodiazepines, and nonbenzodiazepine hypnotics. These drugs are often prescribed for conditions that can be managed with non-drug therapies or less risky medications”.
He also affirmed that some over-the-counter medicines can be dangerous for the elderly, noting that drugs like aspirin, ibuprofen, cough and cold medicines, and herbal supplements, “can interact with prescription medications, cause adverse reactions, and increase the risk of falls and other injuries”.
Family members and caregivers of the elderly, he said, should have an updated list of all medications they are taking, including over-the-counter drugs and supplements, and ensure that medications are taken as prescribed, while also monitoring their side effects and adverse reactions.
“It is important to consult your doctor or pharmacist before starting or stopping any medication or supplement, Store medications safely and securely to prevent the elderly from accidentally taking their drugs when they are not meant to or overdosing on them. Encourage regular medication reviews with
your pharmacist to ensure appropriateness and safety as well,” he said.
According to a study published online by the US Pharmacist – a clinically-focused monthly pharmacy publication, older people react differently to medications than younger patients.
The study stated further that while ageing does not significantly change the absorption rate of most drugs, it can alter body fat and water composition.
“With age, body-fat stores increase while total body water decreases. These are important changes that can alter therapeutic drug levels, resulting in greater concentrations of water-soluble drugs and longer half-lives for fat-soluble medications.
“Additionally, it should be noted that the liver metabolizes many drugs and that age-related changes can reduce hepatic blood flow and alter drug clearance. Drug elimination may also be affected by age-related decreases in renal blood flow, as well as by changes caused by chronic diseases,” the study said.
Another study published by the US Food & Drug Administration (FDA) noted that as people get older, they are often confronted with managing more health conditions, noting that it is, however, important for them to know that more use of medicines and normal body changes caused by ageing can increase the chance of unwanted or maybe even harmful drug interactions.
“The more you know about your medicines and the more you talk with your health care professionals, the easier it is to avoid problems with medicines.
“As you get older, body changes can affect the way medicines are absorbed and used. For example, changes in the digestive system can affect how fast medicines enter the bloodstream.
“Changes in body weight can influence the amount of medicine you need to take and how long it stays in your body. The circulatory system may slow down, which can affect how fast drugs get to the liver and kidneys. The liver and kidneys also may work more slowly, affecting the way a drug breaks down and is removed from the body,” the study says.
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