Prevention of Medication-Related Problems in Elderly Patients With Comorbidities

Introduction:

Many conditions may occur at the same time as a person approaches old age. This is known as comorbidity. As a result, different medications that come under different classes have to be taken by an individual which is known as polypharmacy. Polypharmacy may end up in many adverse reactions or side-effects which occur due to drug interactions. Hence, older patients with comorbid conditions and long-term usage of medications are at the highest risk for developing medication-related problems. Doctors, healthcare assistants, pharmacists, patients, and caretakers have the responsibility to prevent and address medication-related problems.

What Are the Common Comorbid Conditions in Elderly Patients?

Any combination of cardiovascular disease, respiratory disease, diabetes, hypertension, etc. may occur simultaneously in an older patient. However, some of the common conditions which occur with others are;

1. Diabetes: Heart disease, obesity, hypertension, disorders of lipid metabolism, cancer, etc. are common comorbid conditions to diabetes, especially, type 2 diabetes.

2. Heart Disease: Heart diseases such as coronary artery diseases, valvular heart diseases, arrhythmias, etc. may occur simultaneously with diabetes, depression, chronic obstructive pulmonary disorder (COPD), etc.

3. Chronic Obstructive Pulmonary Disorder (COPD): COPD is a group of lung disorders that causes inflammation of the lungs and blockage of airflow from the lungs causing difficulty breathing. Heart diseases, lung cancer, sleep disorders, osteoporosis, diabetes, etc. are common comorbidities of COPD.

4. Parkinson’s Disease: It is an age-related neurodegenerative condition that affects a person’s movement, muscles, ability to smell, speak, etc. Studies revealed that depression, diabetes, hypertension, and heart disease are common in patients with Parkinson’s disease.

5. Alzheimer’s Disease: It is a progressive disorder that affects memory and other functions of the brain. Heart disease, stroke, hypertension, diabetes, etc. can occur with Alzheimer’s disease.

6. Osteoporosis: Also called porous bone, osteoporosis is a condition where bones become weak and brittle. The probability of osteoporosis is more in patients with inflammatory bowel disease, celiac disease, rheumatoid arthritis, and multiple myeloma.

7. Cancer: Heart failure, COPD, diabetes, hypertension, obesity, dementia, and many other conditions may occur in association with cancer which may drastically decrease the quality of life.

What Are the Causes of Medication-Related Problems in Elderly Patients?

• Drug Interactions: The interaction of a drug can be with other drugs, food, nutrients, and diseases. In drug-drug interaction, one drug may either inhibit or enhance the metabolism of another drug.

• Inadequate Monitoring of Drugs: Drug monitoring involves documentation of prescribed drugs and their indications, inquiring about past medical history, history of drug allergy, and so on.

• Overdose of Drugs: Overdose of medications is the most common cause of medication-related problems in older adults. The initial dose of many drugs has to be low in the elderly as compared to other patients. The liver and kidney health of the patient also has to be considered before determining the dose.

• Under Dosage of Drugs: It occurs when the dose of the drug prescribed is lower than what is to be required. Studies found that usage of dosage of drugs can also cause drug-related problems in the elderly.

• Untreated Condition: When the patient hides a condition or if a physician fails to inquire about certain symptoms, that condition may go undiagnosed or cause a wrong diagnosis. In this case, the physician may prescribe another drug which may be of no use or sometimes may predispose to other side effects

• Drug Usage Without Prescription: Due to social stigma or other factors some patients may not feel like disclosing all the symptoms they are experiencing. This may prompt them to self-prescription which can contribute to severe complications.

• Adverse Reactions of Drugs: Adverse reactions can happen either due to dose-related or non-dose-related. Dose-related adverse reactions are common and predictable while non-dose-related may occur due to factors such as liver or kidney dysfunction, old age, hereditary, etc.

What Are the Symptoms of Medication-Related Problems?

The adverse reactions of drugs may occur in different systems in the body.

1. Digestive System: The gastrointestinal or side effects in the digestive system include nausea, vomiting, diarrhea, constipation, hemorrhoids, flatulence, etc.

2. Respiratory System: Asthma, pneumonia, chest pain, breathing difficulties, sputum in blood, etc. can occur as adverse reactions to several medications.

3. Skin: Itching, rashes, hives, blisters, redness, bumps, etc. are the common skin reactions of certain medications.

4. Psychiatric Side-Effects: The most common psychiatric side-effects of medications are mania, anxiety, depression, hallucinations, etc.

Other side effects of medications are:

• Insomnia or trouble sleeping.

• High blood pressure.

• Dizziness and drowsiness.

• Xerostomia or dry mouth.

• Sweating.

• Mood disorders.

Adverse reactions to certain medications can even end up in hospitalization. The use of warfarin is considered one of the most drug-related hospitalizations.

How to Manage and Prevent Medication-Related Problems in the Elderly?

When it comes to managing medication-related problems, doctors, other healthcare professionals, and patients have responsibility. For doctors, it is important to take a detailed medical and family history of patients. Previous surgeries undergone by patients, diseases, medications, or any drug allergies have to be inquired about. Vitamins and dietary supplements taken by the patients are also to be inquired about. At the same time, it is essential for the patients to answer the doctor's questions precisely and to present their previous medical history documents and prescription sheets if they have any. Poor communication between doctor and patient Before prescribing medications for severe illnesses, doctors must ask patients to undergo relevant diagnostic tests based on the symptoms. If any symptoms develop after the intake of medication, that has to be reported to the doctor.

Patients must ask about each prescribed medication to physicians and pharmacists. Medications have to be taken consistently and should be taken to the full course. Discontinuing medications may lead to severe complications. For example, the discontinuation of antihypertensive drugs by hypertensive patients may lead to hypertensive crises which require emergency treatment. To avoid these problems, pill organizers or medication reminder alarms can be used by patients to stick to the regime. The overall health of the patient also has to be monitored because dysfunction in the kidney or liver may affect the metabolism of drugs which can cause toxicity.

Conclusion

Comorbid diseases and associated medication-relation problems are common in elderly patients. Drug interactions, inadequate monitoring, overdose or underdose of drugs, usage of drugs without prescriptions, untreated conditions, etc. are considered the common causes of medication-related problems. To prevent this, doctors should inquire about the whole medical and drug history of patients and patients should disclose all their medical histories and current symptoms. Poor communication may result in misdiagnosis and wrong prescriptions that may deteriorate a patient's health even more.