Drugs and Aging – How Much Drugs Dosage is Safe?

Something you and your doctor should appreciate is that getting older influences the way you react to drugs. Elderly patients are twice as susceptible to drug reactions as younger adults are. The aging kidneys and liver contribute to the problem. The relative quantity of water in the body decreases and thus is not as available to dilute the medication, and the kidneys are less capable of excreting drugs. The liver is also less able to metabolize drugs.

The dosage of that drug suitable at a younger age is too high a dose in an older person because of the effect of aging on prothrombin response. Another example: less morphine is needed for pain. Many drugs stay in the body longer, so a rule of thumb is lower doses further apart for most drugs and aging (most seniors).

There are special problems for seniors and patients of all ages in hospitals (and especially for seniors in nursing homes). You mustn’t think you’re safe because you’re in a hospital. Far from it. I don’t want to worry you, but you will want to take your Merck Manual and drug PDR and medical dictionary with you. They could save your life. Remember how many patients die in hospitals because of medical errors. Don’t contribute to that frightening statistic.

Be sure you know your diagnosis and whether it’s tentative or firm. And ask what your drugs are. Look them up in the drug PDR. At the very least, the presence of the books at your bedside will alert the health professionals that you’re involved and are watching them. Be sure the titles are visible because the Merck Manual and drug PDR are very familiar to health care workers. They’ll know you’re not getting your information from John Smith’s Handy-Dandy Manual. Some exhausted intern may follow your lead and use drug PDR at the nurses’ station to double-check for adverse interactions between the drugs he or she may be prescribing.

All too often, in hospitals and nursing homes patients receive drugs that are potentially hazardous, that may adversely interact, or that may be contraindicated. The overuse of psychoactive drugs for the elderly in nursing homes is a particular problem. There even more than at home, patients board the merry-go-round of one psychoactive drug following another and another, each causing side effects, so it’s the side effects more than the patients that are being treated.

According to Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, 70 percent of doctors treating Medicare patients failed an examination on their knowledge of prescribing drugs for the elderly (the majority of physicians refused even to take the exam, some stating that they had a lack of interest in the subject); 48 percent of patients taking three or more drugs received drugs that had one or more harmful interactions with other drugs. Each year drug reactions put 659,000 older adults in the hospital, and drugs induce or worsen memory loss in 163,000 seniors annually. Every year adverse drug reactions lead to over 30,000 falls and hip fractures in seniors, many of which are eventually fatal.

Not that I’m against drugs. They’re an important part of my stock-in-trade as a physician. And one reason I’m still around to plunk away on the keyboard of my computer may be because I take a cholesterol-lowering drug and aspirin as part of an overall plan for cardiovascular and general health.

There’s a word physicians use, compliance, that means how well the patient follows directions for taking his or her medications. I’ve learned as a geezer that missing dosages or taking a dose twice is not deliberate and does not show a lack of respect for the physician’s recommendation, rebelliousness, or anything more sinister than challenges with memory.

I frankly need my compartmentalized week’s-supply pillbox. It’s hard to keep several drugs straight. But it’s important. For example, not remembering to take your antihypertensive medication could lead to a rebound, and your blood pressure could shoot up to a dangerous level. If you discontinue a blood pressure drug, as with the statins, taper the dose gradually under your doctor’s direction. If you’re taking Coumadin because you have atrial fibrillation or you’ve had a stroke or a TIA (transient ischemic attack, also called strokelet), don’t stop the medicine without strict medical supervision. You could be risking another stroke or TIA.