Medication Issues

Responding to Older Adults with Substance Use, Mental Health and Gambling Challenges

On this page:

• How common are medication issues in older adults?
• Signs of medication issues
• How to talk with an older adult about medication issues
• When to get help

Older adults take up to 40 per cent of all medications prescribed in Canada (Holloway, 2001). Most older adults take several types of medication at a time.

Many older people take medications as prescribed. However, some forget to take their medications, or share medications with others. Some may also "self-medicate"-try to treat their medical conditions on their own by taking more or less of a medication than prescribed, or by taking medications not prescribed.

Medications, even when taken as directed, can affect older adults in ways that weren't intended. For example:

• side-effects
• interactions
• dependence and withdrawal
• other problems.

Side-effects

Side-effects such as constipation, dry mouth or itchiness may be unpleasant. Medications can also have dangerous "adverse effects." For example, they can cause unsteadiness and confusion leading to falls; delirium; or worsened depression leading to suicide. Reactions to drugs are often mistaken for signs of aging or of failing health.

Older adults' bodies process drugs more slowly than younger people's. However, most medications are not tested on older adults. Since medications may be stored longer in the older body, they may have effects not seen in younger people.

Interactions

Taking more than one medication at a time can lead to medication interactions. When medications interact, they may not work as well, or the interaction may cause other problems. Older adults need to tell their doctor or pharmacist about all medications they take, whether prescribed, over-the-counter or herbal remedies.

Older adults should not take medications with any amount of alcohol. Some medications don't work well if they are taken with alcohol, so the health problems the medications were taken for won't be treated properly. Other medications have an increased and dangerous effect when taken with alcohol, causing slurred speech, sleepiness, stumbling and falls. Older adults who know this sometimes don't take their medications when they want to drink. However, missing a dose of a prescribed medication can also cause problems.

Dependence and withdrawal

Medications prescribed for anxiety, sleep problems or pain can lead to drug dependence (also called addiction) when used over a long time. When people are dependent on a drug, they feel they need the drug to be able to cope, even when taking it causes problems. If they stop taking the drug, they may experience physical withdrawal. This can make them feel mildly to severely ill and anxious, depending on the drug and the level of dependence.

Older adults who are dependent on a drug may:

• become isolated as they try to hide their drug use
• behave in ways that cause their friends and family to stay away
• neglect personal care.

Other problems

The common pain medications acetaminophen (Tylenol) and acetylsalicylic acid (aspirin) can cause potentially fatal liver damage when taken in higher than recommended doses, and especially when taken with alcohol. Long-term use of Tylenol containing codeine may lead to drug dependence.

Medications used to treat constipation or stomach upset, when taken too often or for too long, can also be harmful.

Use of illicit drugs, such as marijuana, cocaine, heroin and methamphetamine, is becoming more common as baby boomers age. Increase in the use of these drugs among older adults may create a whole new set of issues.

How common are medication issues in older adults?

• An estimated 50 per cent of prescriptions are not taken properly.
• Up to 20 per cent of hospitalizations of people over 50 are due to problems with medications (Coambs et al., 1995).
• Over 150 medications commonly prescribed to older adults can cause problems if taken with alcohol (Seeking Solutions, 2004).

Signs of medication issues

The signs of medication issues are sometimes mistaken for signs of aging. These include:

• slurred speech
• increased confusion, lethargy or sleepiness
• stumbling, falls
• new medical symptoms following the start of a medication.

How to talk with an older adult about medication issues

You can help to identify medication use problems by asking questions such as:

• "How do you keep track of all the medications you're using?" "Do you keep a list?" "Do you use a pill box?"
• "Do you know what each medication is for?"
• "I've heard that sometimes medications interact and don't work as well, or can cause problems. Does your doctor or pharmacist know about everything you are taking, including herbal remedies?"
• "Do you know if drinking alcohol affects your medication?"

When to get help

Let your supervisor know if:

• The older person seems unable to keep track of medications.
• The older person uses more than one doctor to obtain a certain medication.
• You notice changes in the older person's behaviour or health following the start of a new medication.
• You think the older person may be misusing a medication by taking it more or less often than indicated, or by sharing it with others.
• You think an older person's drinking may be causing problems with his or her medication.

In Responding to Older Adults :

1 The Nature of Aging

• Aging myths and facts
• Discussing diversity

2 Substance Use, Mental Health and Gambling Challenges in Older Adults

• Alcohol problems
• Anxiety
• Dementia
• Depression
• Gambling problems
• Medication issues

3 Communication Tools and Techniques

• Extra resources

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