Older adults often have multiple health conditions which require treatment with medicines. Medicines include tablets, capsules, mixtures, ear and eye drops, nasal sprays, cream and ointments, skin patches, suppositories and inhalers.
Assessment of the risks and benefits of medication is very important, especially as a person ages because:
- All medicines have potential side effects and these may increase the more you take.
- If medicines are not taken as they are supposed to be or are combined, a person can react differently than originally intended.
- Long-term use of medication such as sleeping pills can increase health risks and risk of falls.
Older adults also respond to medicines differently. As we age, our metabolism slows down, medicines stay in the body longer and the body becomes 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. An older adult taking 5 or more medications per day is at greater risk of falling.
Common negative side effects from medications that can lead to falls include:
- Dizziness, light-headedness or fainting
- Feeling unsteady
- Blurred or double vision
- Memory problems
It is important for older adults to keep an up-to-date list of medicines and to get these 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 before the use-by-date and should never be shared amongst peers.
Managing medicines can be a simple and easy way to minimise 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-pak or pill box is a simple way to manage medicines. The aid is set up by a pharmacist for a small fee and includes details of all the medicines inside. They illustrate what day and time each medicine needs to be taken in a way which is easy to read and follow. They are also useful for travelling.
- Medicine Lists: NPS Medicine Lists are available free of charge in a number of formats and are a useful way to track medicines. Encourage older adults to have multiple copies of the list, keep 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 about their medicines to take to health appointments.
- MedsCheck: A MedsCheck provides an in-pharmacy review of a patient’s medicines. If an older adult is on multiple medications or has one of the risk factors mentioned above, you may want to recommend they visit their doctor or pharmacist to consider if they need a medication check or review.
- Home Medicine Reviews: GP’s may be able to provide a referral for a free home medicines review, where a consultant pharmacist will visit the older adult’s home to complete a medicine check, discuss any concerns and report back to the GP.
- Appropriate storage and disposal of medications.
A medications risk assessment form for older adults to fill in and take to their GP to discuss if they are suitable for a medications 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 are those that affect mood, behaviour, mental activity or perception and are also known as psychotropic or centrally acting medications. These medications are taken by 22% of older adults and are associated with an increased risk of falling. Stopping these medications can reduce the risk of falls by 66% and therefore it is important to consider this when working with older adults.
Benzodiazepines (Sleeping tablets)
Benzodiazepines are a common psychoactive medication, commonly used as sleeping tablets. They can affect an older adult’s ability to think clearly, the way they walk, their balance and bladder. Sleeping tablets may be helpful in the short term to assist sleeplessness for less than 2 weeks; however, there is little evidence that taking sleeping pills works to address sleeplessness in the long term. Yet almost 1 in 5 older adults take these tablets for longer than 4.5 years.
Sleeping tablets can be addictive and stopping them becomes more difficult the longer they are taken. If an older adult is taking sleeping tablets, seeking their readiness to change, and considering gradual withdrawal is helpful. Discussing the benefits of stopping sleeping tablets (including improvement in 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.
It is important to involve older adults in all decisions made regarding withdrawal of sleeping tablets and ensuring they are aware of the benefits of withdrawing from sleeping tablets and the withdrawal symptoms they are likely to experience. The NPS Medicine Wise how to sleep right guide allows older adults to learn more about their sleep habits and what can be done to improve sleep.