A Guide to Medication and Aging.

Achieving optimal therapeutic outcomes. Modern medications have contributed significantly to increased longevity, improved health, and enhanced quality of life for older people. Today's medicines effectively treat diseases that were untreatable just a few years ago, relieving pain and suffering and preventing life-threatening complications of many diseases and conditions common in the older population. However, for older adults, medications -- both prescription and over-the-counter (nonprescription) -can be a two-edged sword. When not used appropriately, effectively, safely, and correctly, medications can have devastating effects. Additionally, the physiological changes that occur with aging-described by Beers in this issue of Generations-make older adults more vulnerable than younger people to the full array of medication-related problems. Nevertheless, research has shown that many medication-related problems are predictable and therefore preventable (Hanlon et al., 1997). Consumers and caregivers can play a key role in helping to identify actual or potential problems, which can lead to the eventual avoidance of costly and unwanted adverse medication effects. Medication-related problems may be due to many factors: a wrong or unnecessary drug being prescribed, improper medication dosage, an adverse drug reaction, or failure to take a drug correctly. The manifestations of these problems often directly affect daily functioning and may include confusion, depression, delirium, insomnia, urinary retention, incontinence, weakness, lethargy, loss of appetite, falls, and changes in speech and cognition. When these symptoms appear, they should be considered red flags, indicating that a medication-related problem may be occurring. Most discussions regarding the problems associated with medication use among older adults have focused on polypharmacy, or the concurrent use of multiple medications. Research indicates that, on average, the more medications a patient takes, the greater the risk of experiencing a medication-related problem (Cipolle, Strand, and Morley, 1998). For many older people, multiple medication use is the norm. The many chronic conditions that afflict older adults-heart disease, diabetes, Parkinson's disease, arthritis, pulmonary disease, osteoporosis-require the use of different medications. The use of multiple medications in the older population may be partly due to what has been called the prescribing cascade, which occurs when a medication causes an adverse effect that is misinterpreted as a new medical condition. This new medical condition is then treated with another medication that may itself cause adverse effects. New adverse effects may then be treated with additional medications. Polypharmacy, per se, is only part of the problem. Rather, the focus must be on the appropriateness, effectiveness, and safety of prescription and over-the-counter medications in individual patients. Healthcare professionals, consumers, and caregivers must ask the following questions about each medication: Is this medication really needed? Is the medication the most appropriate for the medical condition being treated? Will the medication be problematic in combination with other medical conditions that are occurring at the same time? Is the medication being prescribed at the right dose? Does the medication interact with other medications? Will the medication be taken correctly based on specific patient circumstances? When consumers, caregivers, and healthcare professionals function as a team, medication-- related problems can be avoided and optimal therapeutic outcomes and improved daily functioning can be achieved. This article describes the major types of medication-related problems and what can be done to reduce their incidence, with information on the proper use and administration of medications and how to simplify medication regimens. The article also presents ways of improving communication between healthcare providers and consumers and caregivers so that the latter two groups can play a more active role in decisions regarding medication use. …