Taking many medicines safely in older age: lists and questions

Many older adults live with more than one health condition and take several medicines, vitamins and supplements, and more than one doctor may be involved in their care. That can be perfectly appropriate, but it also needs careful organising. This article explains why, and what helps, using information from MedlinePlus and the US Food and Drug Administration (FDA).

1. Introduction

MedlinePlus explains that taking several medicines, whether for one condition or for several, increases the chance of side effects and of interactions, which means one medicine changing the way another works ^[1]. Some interactions can be serious. Keeping track of dose times also gets harder, and people may forget which doses they have already taken ^[1].

The FDA adds that the body handles medicines differently with age, so the same medicine may act differently in an older person ^[2]. This is why regular review of medicines is a normal part of care for older adults.

2. Why older adults are more affected

The FDA describes several changes that can alter how medicines work ^[2]:

• Digestion changes, which can alter how quickly a medicine enters the bloodstream.
• Changes in body weight, which can affect how much medicine is needed and how long it stays in the body.
• Slower circulation, which may change how quickly medicines reach the liver and kidneys.
• Liver and kidneys that work more slowly, which changes how medicines are broken down and removed.

MedlinePlus notes that people are at higher risk if they take five or more medicines, if medicines come from more than one prescriber so that nobody sees the full picture, or if they are older adults or have recently been in hospital. It also notes that unneeded medicines may be prescribed when several providers treat the same problem ^[1].

3. Interactions and side effects

The FDA describes four main kinds of interaction ^[2]:

• Between two medicines, which can cause unwanted effects or make one weaker or stronger.
• Between a medicine and a health condition. For example, a nasal decongestant may be a problem for someone with high blood pressure or asthma.
• Between a medicine and food, because food can change how a medicine is absorbed.
• Between a medicine and alcohol, which can cause drowsiness and slow reactions.

Side effects are unplanned symptoms or feelings. Most are not serious, but some are bothersome or serious. The FDA advises tracking them and telling your doctor, and notes that new symptoms or mood changes may come from a medicine rather than from ageing ^[2]. MedlinePlus adds that some medicines raise the risk of falls ^[1].

4. Staying organised

MedlinePlus and the FDA suggest these habits ^{[1, 2, 3]}:

• Keep an up-to-date list of every prescription medicine, over-the-counter product, vitamin, supplement and herbal product, plus eye drops and anything you put on the skin. Keep a copy at home and one in your wallet.
• Give all your doctors a copy and review the list at every visit, asking whether each medicine is still needed.
• Use a pill organiser to stay on schedule, and ask for a written schedule and a simpler routine if possible.
• Use one pharmacy where you can, so the pharmacist can check for interactions across all your medicines. The FDA notes that easy-open caps and large-print labels can be requested ^[2].
• Tell your doctor if you cannot tell pills apart, have trouble remembering doses or have trouble swallowing tablets. Do not crush or chew a tablet without asking first ^[2].
• Bring your medicine list to any hospital stay ^[1].
• Ask your doctor to check how well a regular prescription is working, and talk to your doctor if you want a simpler medicine schedule ^[2]. The FDA also advises telling the doctor about allergies, other specialists you see and habits such as caffeine, alcohol or smoking ^[2].
• If cost is a concern, say so. A lower-cost generic option may be available ^{[2, 3]}.

5. Questions worth asking

MedlinePlus suggests asking about each new medicine ^[3]:

• What is it called and why do I need it?
• How and when should I take it, with or without food, and for how long?
• How long will it take to work, and how will I know it is working?
• Which side effects should I expect, and should I report them?
• How should I store it, and are any lab tests needed to check how it is working?
• Which foods, drinks or activities should I avoid?
• Could it interact with my other medicines, herbal products, food, drink or alcohol?
• What should I do if I miss a dose, and is it safe to stop?
• Is a lower-cost generic option available?

Take a trusted friend or relative to appointments if that helps, and write down the answers. Ask again if you do not understand medical words or instructions ^{[2, 3]}.

6. When to see a doctor

Contact your doctor or pharmacist if you are confused about how to take a medicine, if you notice side effects, if a medicine looks different than expected or if a refill is not the same as usual ^{[1, 3]}. Call your doctor right away about an unwanted side effect ^[2]. Do not stop a medicine on your own, because you may need a different medicine or a changed plan ^{[1, 2, 3]}.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Taking several medicines is common in older age and can be done safely with good habits. A current written list, one pharmacy, honest reporting of side effects and regular reviews with your doctor are the core steps. Your doctor decides which medicines are right for you, and no medicine should be started, changed or stopped without their advice.