Older adults often have multiple health problems which require treatment with medicines. Medicines include tablets, capsules, mixtures, ear and eye drops, nasal sprays, creams and ointments, skin patches, suppositories and inhalers.
Assessment of the risks and benefits of medication is very important, especially as a person ages. This is because:
- All medicines have potential side effects, and these can increase with the more medicines you take
- If medicines are not taken as they are prescribed or are combined, an individual can react differently to how they were originally intended
- Long-term use of medication such as sleeping pills can increase health risks and risk of falling
- Older adults respond to medicines differently. Age causes metabolism to slow down, causing medicines to stay in the body for longer, and making people more sensitive to the effects of medicines.
Did you know? Two thirds of people aged 75 and older take at least 5 medicines per day.
Multiple medications and side effects
All medicines have side effects. Long-term use of some medications such as sleeping pills can increase health risks. Taking multiple medications increases the likelihood of adverse effects and interactions. Older adults who take 5 or more medications each day are at an increased risk of falling.
Common medication side effects that can increase falls risk include:
- Dizziness, light-headedness or fainting
- Feeling unsteady
- Blurred or double vision
- Memory problems
It is important that older adults keep an up-to-date list of their medicines, and get their medicines checked by their doctor or pharmacist regularly. A complete medicine list should also be taken to all medical appointments and hospital visits. Medicines should only be used until their use-by-date and should never be shared with other people.
Managing medicines appropriately can be a simple and easy way to reduce side effects. The following management strategies may help older adults to manage their medicines:
- Dose administration aids: A dose administration aid such as a Webster-pack or pill box is a simple way to manage medicines. The aid is set up by a pharmacist for a small fee. The aids include details of all the medicines inside, as well as when and how often each medicine needs to be taken. The information is laid out clearly and is easy to follow. These aids are also very useful for travelling.
- Medicine Lists: NPS Medicine Lists are available free of charge in various formats, and are a useful way to track medicines. It is a good idea for older adults to have multiple copies of the list (i.e. a copy with a family member, a copy at home, and a copy with them at all times for medical appointments or in case of an emergency). Older adults can also ask their pharmacist for an information sheet on their medicines to take to health appointments.
- MedsCheck: A MedsCheck involves an in-pharmacy review of an individual’s medicines. Older adults who take multiple medicines, or take medicines to help them sleep, should be advised to visit their GP or pharmacist for a medication check or review.
- Home Medicine Reviews: GP’s may be able to provide a referral for a free home medicines review. This involves a consultant pharmacist visiting the older adult’s home to conduct a medicine check, discuss any concerns, and report back to the GP.
- Medicines must be stored and disposed of safely and appropriately.
A Medications Risk Assessment Form for older adults to fill in and take to their GP to discuss if they require a medication review can be found on page 80 of the Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Community Care 2009.
Gradual and supervised reduction of psychoactive medications
Psychoactive medications, also known as psychotropic and centrally acting medications, are those that affect mood, behaviour, mental activity and perception. These medications are taken by 22% of older adults, and are associated with an increased risk of falling. Stopping these medications can reduce falls risk by 66%. It is therefore very important to consider this increased falls risk when working with older adults.
Benzodiazepines (Sleeping tablets)
Benzodiazepines are a common psychoactive medication which are commonly used as sleeping tablets to treat insomnia. They can affect older adult’s ability to think clearly, walk and move around, maintain their balance, and control their bladder.
Sleeping tablets can be helpful in the short term to assist sleeplessness for periods of less than 2 weeks. However, there is little evidence that taking sleeping pills helps to treat insomnia in the long term. Despite this, almost 1 in 5 older adults take these tablets for longer than 4.5 years.
Sleeping tablets can be addictive, and the risk of developing a dependency increases the longer they are taken for. Discussing the benefits of stopping sleeping tablets (e.g. improved memory, daytime alertness, increased quality of sleep and reduced risk of falls) may help to encourage older adults to consider a reduction plan for their sleeping tablets. Older adults who wish to stop taking sleeping tablets should do so gradually, on a GP’s recommendation and under supervision. Going ‘cold turkey’ or stopping sleeping tablets immediately and altogether can cause severe withdrawal symptoms. It is important to involve older adults in all decisions regarding their withdrawal from sleeping tablets, and ensure that they are aware of the benefits of withdrawing and the withdrawal symptoms they may experience. The NPS Medicine Wise how to sleep right guide provides information for older adults about sleeping habits and what they can do to improve sleep.