Helping older adults stay healthy and independent often means utilizing medications that treat a specific condition such as high blood pressure, or act as a preventative measure to minimize risk—for instance, using statins to keep cholesterol numbers where they should be. An additional consideration: Physical changes that come with aging can affect how prescription medications work.
“As people age, the body often absorbs, distributes, metabolizes, and clears medications more slowly or differently,” says Theodore Strange, M.D., a specialist in geriatric medicine and chair of medicine at Northwell’s Staten Island University Hospital in New York City. “Older adults may have lower kidney function, slower liver metabolism, changes in body fat and water, and greater sensitivity to certain drugs.”
That means drugs someone has taken for years or even decades may need to be adjusted to account for stronger effects or more intense side effects, even at standard doses. Because of this, it’s essential to review medications and spot any difficulties early, rather than waiting until a medication problem leads to a fall, hospitalization, or loss of independence, he adds.
In This Article
- What Is Polypharmacy in Older Adults?
- Medication Side Effects That Can Look Like Normal Aging
- Signs a Senior May Need Help Managing Medications
- What to Know About Over-the-Counter Medicines and Supplements
- Why a Medication Review Is Helpful
- How to Create a Complete Medication Checklist
- What Is Deprescribing?
- Medication Safety Tips for Older Adults
- Bottom Line
What Is Polypharmacy in Older Adults?
The type of physical and cognitive shifts that come with age often lead to polypharmacy, a term for taking multiple medications at the same time (often defined as five or more medications, says Dr. Strange). According to research, roughly 40% of older adults in the United States living independently take five or more medications regularly, and the number of drugs tends to be even higher for those in nursing homes and assisted living settings.
“In older adults, polypharmacy is a concern because the more medications someone takes, the greater the risk of drug interactions, side effects, falls, confusion, duplication, and medication errors,” says Dr. Strange. “But polypharmacy is not always inappropriate—many seniors truly need several medications.”
Sometimes, a medication side effect is mistaken for a new medical condition, leading to additional prescriptions, a phenomenon called a “prescribing cascade,” according to Dung Trinh, M.D., an internist at MemorialCare Medical Group and chief medical officer of the Healthy Brain Clinic in Irvine, CA.
Issues related to polypharmacy are complicated by the fact that older adults may see multiple specialists for different health issues, and these physicians may not collaborate or be aware of each other’s treatment regimen. For instance, a medication prescribed by one doctor may cause insomnia, which can prompt a visit to another doctor who prescribes a sleep aid, which then leads to gastrointestinal upset, followed by an anti-diarrheal medication from a gastroenterologist, and so on.
A full medication review with a primary care doctor can help identify ways polypharmacy and prescribing cascades are affecting an older adult. “The goal is not necessarily to eliminate medications, but to ensure each one is necessary, effective, and safe,” Dr. Trinh says. “Sometimes, the best medical decision is recognizing when a medication is no longer needed.”
Medication Side Effects That Can Look Like Normal Aging
Medication side effects in older adults are often mistaken for “just getting older,” says Dr. Trinh. Side effects that can be mistakenly attributed to normal aging include:
- Blurred vision
- Brain fog
- Confusion
- Constipation
- Dizziness
- Insomnia or frequent waking
- Loss of appetite
- Memory problems
- Poor balance
- Sleepiness
Sedatives, which can lead to brain fog, balance issues, and fatigue, are particularly challenging when it comes to mimicking age-related shifts, says Jonathan Jennings, M.D., an internist with Medical Offices of Manhattan in New York City. Even over-the-counter sedatives like Tylenol PM or Benadryl can lead to side effects that might look like cognitive decline or depression, he adds, but those aren’t the only potential culprits causing these effects.
“Certain antihistamines, anxiety medications, and bladder control medications can impair memory and concentration, particularly in older adults,” says Dr. Trinh. “This is especially important when evaluating someone for Alzheimer’s disease or dementia. Not every memory problem is Alzheimer’s disease, and not every episode of confusion is a normal part of aging. Reviewing medications can help identify potentially reversible causes of cognitive decline and improve a patient’s quality of life.”
Signs a Senior May Need Help Managing Medications
When assessing whether a loved one might need assistance with medications, keep in mind that signs may be subtle and include logistical issues as well as behavioral and health changes. Dr. Strange says indications to watch for include:
- Difficulty reading labels
- Dizziness and/or more frequent falls
- Frequently forgetting to refill prescriptions
- Missing doses due to confusion over medication schedules
- Sudden mood changes such as anxiety, anger, or sadness
- Taking the wrong amount of pills
- Trouble organizing pills, even with an organizer
- Unexplained fatigue
“Recognizing medication management difficulties early can help prevent avoidable complications and protect both physical and cognitive health,” he adds.
What to Know About Over-the-Counter Medicines and Supplements
Over-the-counter medicines, vitamins, herbals, and supplements may seem benign—after all, they are being sold without needing a doctor’s OK. But ironically, taking medication or supplements bought over the counter without telling a clinician can exacerbate problems related to polypharmacy since they may interact with prescription medications.
“Many people assume these products are harmless, but they can cause bleeding, drowsiness, blood pressure changes, kidney problems, or serious drug interactions,” says Dr. Strange.
Medications found in your medicine cabinet can increase risk on several fronts:
- Antihistamines can cause confusion.
- Pain relievers like non-steroidal anti-inflammatory drugs (NSAIDs) may worsen blood pressure or kidney function.
- Herbal supplements like St. John’s wort or ginkgo biloba can interfere with prescription drug efficacy.
- Sleep aids containing diphenhydramine increase fall risk.
Supplements can be especially confusing. “Many seniors assume that something marketed as ‘natural’ means it’s safe, but that’s not always the case,” says Dr. Trinh.
Why a Medication Review Is Helpful
A medication review is when a doctor, nurse practitioner, physician assistant, or pharmacist goes through everything a person takes including prescriptions, over-the-counter drugs, vitamins, herbals, and supplements to make sure the regimen is safe, effective, and still necessary, according to Dr. Strange.
“This would include knowing what each medication is for, including whether it is working, if the dose is appropriate for age, kidney and liver function, and health status, and to review any possible side effects or drug-to-drug or drug-to-supplement interactions,” he says.
A review should also consider whether any medication may be unnecessary or could be reduced in dosage, adds Dr. Jennings. In some cases, seniors may be taking duplicate medications without realizing it, such as a brand name as well as a generic. Sometimes, factors like cost make medication adherence difficult, and should be mentioned to providers so they can factor that into their assessment.
“This review may lead to stopping a medication, lowering or changing a dose, switching to a safer option, simplifying the schedule, updating the medication list, or identifying medications that need closer monitoring,” says Dr. Strange.
He recommends that seniors have a medication review at least once a year, ideally during an annual physical, but if there are complex medical conditions or polypharmacy, more frequent reviews may be preferable. For instance, it could be helpful to ask for a review after a new medication is prescribed by a specialist, to ensure that drug doesn’t have any interactions with what’s already being taken.
As a caregiver, if you have concerns about a loved one’s ability to understand all the information being discussed in a review, ask to attend as well.
How to Create a Complete Medication Checklist
To prepare for a comprehensive medication review, you’ll want to have the most up-to-date information at the ready to share with the doctors. This includes:
- Medication and supplement names. Write down the full name (both brand and generic) of each prescription, as well as brand names of over-the-counter medicines, vitamins, herbal products, and dietary supplements.
- Dosage, strength, and type. Record how much medication is taken and on what schedule. Include any special instructions, such as taken with meals or only at bedtime. Also include how it’s taken (pill, liquid, inhaler, injection, or topical cream).
- Reason for taking. List the symptom or condition that the medication treats.
- Prescriber and location. For each medication, include the name of the healthcare professional who prescribed it, where that clinician is located, and their contact information.
- Start date and duration. Record when the medication was started and whether it is intended for short-term or long-term use. Include an expected stop date if a medication is meant to be used for only a certain timeframe.
Also, jot down any challenges related to taking one or more medications, suggests Dr. Strange. This is where you can include side effects, missed dosages, and other difficulties.
What Is Deprescribing?
After a medication review, it’s possible that your provider will recommend making changes to the prescription schedule, including deprescribing.
“This is the medically supervised process of reducing or discontinuing medications that may no longer be necessary or whose risks outweigh their benefits,” says Dr. Trinh. “As people age, their medical needs change, and medications prescribed years earlier may no longer be appropriate.”
Deprescribing involves carefully evaluating risks and, when appropriate, gradually reducing medications under medical supervision. He adds that patients should never stop prescription medications without consulting their healthcare provider.
“Good medicine is not just knowing when to start a medication, it is also knowing when to stop one,” he says.
Medication Safety Tips for Older Adults
In addition to scheduling a regular medication review, there are some other tips that can be useful in helping older adults and their caregivers manage medications more effectively. Dr. Trinh suggests:
- Keep an updated medication list. Maintain a list of all prescription medications, over-the-counter drugs, vitamins, and supplements, including their dosages and how often they’re taken. Keep a separate list of medications that have been taken on a short-term basis and are no longer part of a regular routine.
- Know the side effects. When a medication is prescribed, ask about common side effects and warning signs. Also make sure to understand when medications may affect balance, memory, or alertness.
- Take medications as directed. Follow your healthcare provider’s instructions and never change your dosage or stop taking a medication without consulting that provider or specialist.
- Refill in advance. Put refill schedules on the calendar on your phone and tape a hard copy to your fridge to ensure that there won’t be any gaps between the last dosage of a medication and its refill.
- Use a medication organizer. When it comes to keeping meds organized, options include reminder apps and pill organizers to help prevent missed doses and inappropriate timing.
Bottom Line
Most of all, speak up quickly about any concerns, Dr. Strange recommends. Tell a healthcare provider if a medication seems to be causing side effects, or if your loved one is skipping doses or not adhering to a regular medication schedule due to forgetfulness or concerns about cost. Even if someone has been on the same medication for years, changes in efficacy occur with aging, so keep a watchful eye.
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