Introduction:
As individuals age, both psychosocial and physiological changes occur, affecting the pharmacokinetics and pharmacodynamics of the body. This alteration results in variations in drug responses and raises the likelihood of interactions, contraindications, and adverse effects. Older populations, often grappling with a higher prevalence of comorbidities, engage in multiple medication use. This heightened medication usage amplifies the occurrence of problems among older adults, encompassing the intricacies of comorbidities, their complications, adverse events, and the use of inappropriate medications.
Proper and timely medication usage is crucial for therapeutic effectiveness. Various steps, such as reading user information, unpackaging, preparation, and ingestion, contribute to this process. However, physical limitations like impaired vision, weakened handgrip, motor skill loss, and dysphagia (difficulty swallowing) can impede these actions, especially with aging. Understanding the practical challenges older individuals face in medication use is limited.
What Are Oral Medication Problems in Elderly People?
Medication use problems in older adults span five stages: prescribing, communicating orders, dispensing, administering, and monitoring. Definitions vary, with Elliott emphasizing inappropriate prescribing, polypharmacy, and nonadherence, encompassing issues like suboptimal drug monitoring and poor communication.
Accessibility barriers to primary health care, especially for medication, persist among older adults due to disability, cognitive impairment, and transportation challenges. Targeting beliefs about medication is crucial for adherence, but socioeconomic status and transportation barriers can hinder access. Optimizing polypharmacy through collaboration with prescribers and older adults predicts high-quality health outcomes. Despite the rising aging population, primary care services have yet to adapt to meet the needs of older adults significantly.
What Medication Use Problems Can Occur in Elderly People?
1. Medication Nonadherence:
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Various studies emphasize the complexity of medication adherence among older adults.
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Nonadherence is a major concern, with rates ranging from 31 % in Ireland to 53 % in primary and tertiary health care centers.
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Educational interventions are suggested to address difficulties in managing medications.
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Improper medication administration and nonadherence are prevalent among older adults with dementia, emphasizing the need for home medication reviews.
2. Adverse Drug Events:
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Adverse drug events pose significant challenges, with varying perspectives on prevalence.
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A study revealed adverse events in 410 older adults, impacting disease progression.
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Knowledge and communication with health care providers contribute to better adaptation to medication side effects.
3. Accessibility:
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Geographical accessibility to primary care providers varies, with implications for medication access among older adults.
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Concerns about accessibility to primary health care are raised by the older population, impacting medication access.
4. Polypharmacy:
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Polypharmacy, defined as having five or more medications, is a pervasive challenge among older adults.
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Prevalence rates range from 34 percent in the United States to 82 percent in Sweden, with varying exposure durations.
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Comorbidities contribute to increased medication use, necessitating appropriate prescribing to prevent issues.
5. Inappropriate Medications:
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Inappropriate medications contribute to polypharmacy challenges.
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Studies report varying percentages of inappropriate medications, with one study highlighting 50 percent for cognitively impaired older adults.
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Deprescribing is recommended to reduce inappropriate medications and enhance compliance.
6. Belief About Medications:
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Patients' beliefs about medications impact adherence.
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Studies indicate a high understanding of medication necessity but express concerns about adverse events.
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Addressing beliefs is crucial for assessing and improving medication use problems.
7. Lack of Knowledge and Awareness:
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Lack of knowledge and awareness challenges older adults, leading to confusion and potential errors.
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Reading and understanding instructions highlight poor knowledge levels among the older population.
8. Lack of Deprescribing:
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Deprescribing and reducing inappropriate medications under health care supervision face barriers.
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General practitioners' knowledge gaps and adherence to health care guidelines affect deprescribing.
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Focusing on deprescribing interventions is crucial to addressing medication use challenges among older adults.
What Considerations Are Crucial for Enhancing the Safety and Efficacy of Medicines for Older People?
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Practical problems faced by older individuals with medication intake should be considered during the development, evaluation, prescription, and dispensing of medicines. This is especially critical for unforgiving medicines with direct safety implications.
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The pharmaceutical industry can play a role by considering older individuals' needs and concerns while developing medicines. This involves addressing challenges related to information leaflets, packaging design, and improving the usability of pill bottles and containers.
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Design challenges include accounting for decreased handgrip strength and manual dexterity, developing accessible and child-resistant closures, improving the quality of pill bottles and blister packs, and ensuring visual identification of medicines to prevent confusion.
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Pharmaceutical development should focus on providing medicines in appropriate dosages to minimize the need for pill splitting. When splitting pills is unavoidable, ensuring equal parts effortlessly is essential. Additionally, considering ease of holding and swallowing is crucial due to older individuals' poorer fine motor skills and swallowing difficulties.
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Regulatory agencies should consider the suitability of medicines for use by older individuals during the evaluation process. This emphasizes the need for comprehensive assessments considering older populations' practical challenges.
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Healthcare providers, including pharmacists, should proactively inquire about practical problems, as individuals may occasionally report them. Selecting medicines with appropriate presentation and formulation, considering dosage, form, and user-friendly packaging, can contribute to addressing these issues for older patients.
What Are Other Concerns Seen Among the Elderly?
Understanding drug interactions is crucial, especially for older adults. These interactions can occur between medicines, medical conditions, foods, and alcohol. Drug-interactions may lead to unwanted effects or altered effectiveness. Conditions like high blood pressure can make certain drugs harmful, and drug-food interactions can impact absorption. Mixing alcohol with medication can cause unexpected reactions.
Side effects are unplanned symptoms or feelings from medicines. While most are temporary, some can be serious. Seniors should track their side effects and inform the doctor, that help the doctors assess medication responses. Communicating with healthcare professionals about all medications, including over-the-counter (OTC) drugs and dietary supplements, is essential. Regular medical check-ups ensure proper medication evaluation, and discussing changes in lifestyle or diet is crucial. It is beneficial to keep a written medical history record and share it with healthcare providers for comprehensive care. Discussing difficulties swallowing tablets or maintaining a complex medicine schedule can lead to alternative solutions, making adherence easier. Asking healthcare professionals to provide a written medicine schedule and keeping a record of all medications can enhance communication and promote medication safety.
Conclusion:
Oral medication problems in the elderly present multifaceted challenges, including issues with polypharmacy, adverse drug reactions, and oral health impacts like dry mouth. The complexity of these concerns necessitates comprehensive approaches such as interdisciplinary medication reviews, risk assessments, and tools for evaluation. Initiatives like Comprehensive Geriatric Assessment prove effective in reducing unnecessary prescriptions. Monthly regimen evaluations, preference for single agents, and careful dosage considerations are vital to mitigate risks. Addressing oral medication challenges is pivotal for improving outcomes and enhancing the overall quality of life for elderly individuals, emphasizing the importance of regular medication reviews in this population.
