Medication in old age - A critical examination
Due to physical changes in old age, medications taken for decades have a different effect than before. In addition, more and more health complaints arise that require more medications to be taken. From three to five medications upward (sources disagree), the mix of medication intake becomes unpredictable. This creates risks for seniors to significantly harm their health status. In this article, you'll learn...
- ...the background of drug interactions.
- ...how to control your medication intake.
- ...how natural measures can help.
The underestimated danger
If we start purely from the meaning of the word "medicament", we end up in Latin: Medicamentum translates into German as cure. Phonetically, a term to feel good about. But especially in old age, it becomes apparent what a double-edged sword medications are. Interactions involving dangers such as dizziness and falls are not uncommon among the older generation; nor are home pharmacies with seven to ten prescribed medications per patient. The NDR documentaryMedikamente im Alter - Die unterschätzte Gefahr (Drugs in old age - the underestimated danger ) uses real life stories to bring home just how far-reaching the effects of patients taking more medication can be.
Increasing use of medications in old age
The Ärzteblatt , citing several studies, states:
- One-third of chronically ill patients over age 65 record taking four or more medications
- Among 85- to 94-year-olds, medication use amounts to more than four fixed daily doses
- Among 100 patients with cardiovascular disease aged 58 to 87 years, 78 percent take more than four agents; the older the respondent, the higher the doses
These numbers in relation to studies and surveys in younger age groups reflect an increase in medication use with age. Underlying this is the risk of polypharmacy. As soon as more than three medications are used simultaneously by a patient, polypharmacy is given (definition of the World Health Organization WHO, 2006).
Danger of drug interactions
Polypharmacy is accompanied by the fact that the interaction of the substances with each other can no longer be predicted. While the substances have been tested individually for efficacy in studies and have undergone approval procedures, there is rarely any well-founded knowledge about their interaction. The risk of drug interactions increases exponentially with the number of drugs taken; in other words, the probability of interactions increases many times over with each additional drug taken! You can learn more about this topic in our article on polypharmacy.
Similarly, taking a single drug that previously worked perfectly is associated with previously unknown risks. But how can a drug, which was taken for 30 years without any complaints, suddenly bring a multitude of side effects?
The changes in metabolism with age are decisive here: the fact that on average 35% more body fat and 17% less water are present than in a younger body causes altered absorption and storage of drugs. This means that certain substances accumulate in the body and may have a toxic effect. In addition, the blood flow to the organs changes, which results in a slower breakdown of the drugs in relation to the kidneys and liver.
Why is the use of medication stronger in old age?
On the one hand, health changes in old age provide a reason for the increase in the use of medications: the increase in illnesses is accompanied by an increase in the number of medications required for therapy. On the other hand, a change of doctor is a factor to be included in the discussion: relocation, dissatisfaction with the doctor currently treating the patient, and appointment bottlenecks due to a shortage of doctors are motives for changing doctors. The change results in a lack of detailed background knowledge, which would be important for proper treatment.
As a solution to the latter problem, it is recommended to stay with one treating physician. When changing doctors, in turn, it is necessary to take into account to accurately reflect the medical history, so that the best possible continuation of the previous therapy takes place.
If there is a large number of health problems that require additional medication, it is advisable to prioritize the therapy of individual complaints and diseases. This means that, in close consultation with the doctor, a decision is made as to which complaints should be given priority in the therapy and which should be put on the back burner. Above all, the question is:
Life extension before quality of life or the other way around?
You decide with the doctor whether you primarily want to live a high-quality life or primarily a long life. Until now, the doctors' guideline has been to prolong the patient's life as much as possible, but this has been at the expense of well-being. If you express a different wish, doctors prove willing to talk.
This is how you find out if you are taking too many medications!
If we assess the situation on the basis of when polypharmacy occurs, more than three different drugs per day already means that too many drugs are being taken. In the AgeCoDe study of the University Medical Center Hamburg-Eppendorf with the collaboration of the Hannover Medical School, an increase from 3.3 tablets per patient to 6.2 tablets per day was shown in 1,942 patients aged between 75 and 89 years over an observation period of four and a half years. This study suggests the justification of the judgment that "too many" medications are taken in old age.
Nevertheless, each patient must be judged individually, which is why in individual cases polypharmacy is unavoidable from a medical point of view. If you are wondering how to assess your medication intake, the following three-step guide will help you:
- Check medications for presence on the 2019 Priscus list.
- Talk and test with your doctor
- Discontinue medication or continue vigilant use
Have a conversation with the doctor
If you do not experience any side effects, you can still ask the doctor about the Priscus list, as he will provide you with a range of helpful information to study on your own. If you notice side effects that are also on the Priscus list, it makes sense to go to the doctor. The doctor has tests at his disposal, with the help of which he can check the side effects.
- Money counting test: Diabetics are tested to see how long it takes the person to add up €9.80. If the duration exceeds 45 seconds, it can be assumed that the person is unable to take the medication himself and to dose it correctly.
- Test with hand dynamometer: This acts as a grade meter for the muscles. The hand dynamometer deflects when pressure is applied with the hand. If the mean values of the individual age groups are not reached, the muscle strength is too low.
- Balance tests: Highly innovative are the pressure-sensitive carpets that indicate even the finest imbalances on the computer. With their help, gait stability is measured.
These are examples of possible procedures for a physician to determine the side effects as well as their extent.
Question side effects or continue vigilant medication regimen
Together with the physician, the side effects and their origin are questioned. If possible, the medication is discontinued in order to find out whether the side effects are due to taking the medication. Discontinuation of medication requires courage and experience on the part of the physician. In this respect, the recommendation to older patients to seek out an experienced physician for treatment is justified, so that the necessary measures are actually taken. If no side effects can be detected, the medication should be continued attentively with regular checks for emerging side effects. In this regard, the Priscus list is a permanent help.
Overview of natural measures
In addition to medication, there is scope for optimizing health through natural measures. Already a healthy lifestyle in the period of aging is a central support:
- Healthy diet
- Physical exercise
- Refraining from alcohol, drugs and other harmful substances
The fact that it is never too late to make improvements by changing one's lifestyle is underpinned by a real-life case from the NDR documentary mentioned at the beginning of this article. In the first few weeks of filming, Lieselotte Gärtner has clear problems getting up from a sitting position to a standing position. Her strength is increasingly fading. In the course of a three-week rehab program, she receives extensive mobilization training. Following rehab, she succeeds in sitting down and standing up several times in a row. This is a milestone for her: Whereas it used to take her around five seconds to get up from a chair, it now takes less than one second.
In addition to exercise therapies, natural medicines from the naturopathy segment open up further possibilities as an alternative to chemically manufactured drugs.
Conclusion: Regular control and adaptation to the patient
The use of medications in old age is increasing in a considerable number of people. This is accompanied by interactions that reduce the quality of life in favor of longevity. The interactions go so far that safety in everyday life is impaired. Accordingly, it is necessary to make the consumption of medication in old age as tolerable and low as possible. This means adapting the medication to the changing metabolism with consideration for interactions. Regular monitoring of blood values, tests as well as consultation with the physician are essential in order to maintain the quality and safety of all patients. A healthy lifestyle provides a decisive contribution.
