Drug Therapy Considerations in Older Adults

Polymedicine
 use of five or more medications
 simply the use of unnecessary medications

Factors That Contribute to Polymedicine

 Multiple disease states
 Time constraints on health professionals
 Multiple health care providers
 Use of nonprescription medications
 Patient-driven prescribing

Evidence of Polymedicine
 Medications with no apparent current indication
 Use of duplicate medications
 Use of interacting medications
 Medications that are contraindicated in concurrent diseases or conditions
 Inappropriately high or low medicine dosages
 Pharmacotherapy of adverse drug reactions

Factors That Contribute to Nonadherence

 Taking several medications with different schedules (e.g., combination of daily, twice
daily, three times daily plus medications to be taken with or without meals)
 High-cost medications
 Delays in ordering medication refills
 Inability to travel to the pharmacy to pick up refills
 Confusing or difficult directions or changes in directions
 Perceived or actual adverse effects
 Lack of understanding about a medication’s intended effect or unclear expectations
about outcomes

Strategies For Patients to Improve Compliance

 Use medication calendars, pillboxes, or similar reminder systems.
 Store medications in a location that will serve as a reminder system
 When traveling, keep medications with a cosmetic or toiletry kit, or some other item that
is used on a daily basis.
 If visually impaired, set up a large-type calendar system and place an easily
distinguishable marking on each different medication.
 Ask the pharmacist or prescriber if there are dosage forms available that can be taken
only once or twice a day to reduce the likelihood of a confusing drug regimen.

Altered Drug Action with Aging

Absorption
 slower rate of gastric emptying
 decrease in intestinal motility
  reduction in intestinal blood perfusion
 diminished intestinal mucosal surface area.
 the extent of absorption may be increased in the elderly for drugs that undergo extensive
first-pass metabolism in the liver.
 swallowing difficulties, poor nutritional status, erratic meal patterns, and interactions with
other prescription and nonprescription medications.

Distribution
 drug is absorbed and enters the blood circulation, it distributes to various organs and
tissues throughout the body

Metabolism
 detoxify compounds is to transform or metabolize them, which most often inactivates
them and allows them to be excreted from the body more readily
 nutritional status, diet, genetics, gender, alcohol intake, smoking, environmental factors,
and the concomitant use of other medications
 decrease in liver mass, a decrease in blood flow to the liver, and a reduction in the
intrinsic activity of drug-metabolizing enzymes

Excretion
 kidney function declines with advancing age
 diminished blood flow to the kidneys
 decrease in kidney mass
 reduction in the size and number of functioning nephrons

Four Principles to enhance therapeutic outcomes

 Avoid unsafe medications.
 Recognize when medications worsen activities associated with daily functioning.
 Use evidence-based medicine to determine first-line agents.
 Tailor drug therapy to the individual, considering concomitant disease states and
medications.