DRUG ABUSE IN THE ELDERLY

by Robert S. Stall MD, Geriatrician

I. The Statistics

A. Currently, approximately one out of eight (12%) people are 65 and over; by the year 2030, approximately one out of five (20%) will be in this age bracket.

B. People 65 and over have more illness, consume more drugs, and are more sensitive to adverse drug reactions than other age groups.

as of 8/5/05 C. In the USA, about two thirds of persons >= 65 years use prescription and over-the-counter (OTC) drugs; this age group accounts for about one third of all prescription drug use. Women use more drugs than men, especially psychoactive and antiarthritic drugs. At any time, an average elderly person uses four to five prescription drugs and two OTC drugs and fills 12 to 17 prescriptions a year. The frail elderly use the most drugs. Drug use is greater in hospitals and nursing homes than in the community; typically, a nursing home resident uses seven or eight drugs.

(from Merck Manual of Geriatrics 2005 http://www.merck.com/mrkshared/mmg/sec1/ch6/ch6a.jsp)

as of 8/5/05 D. Medication statistics with references https://www.rxmanager.com/rxmanager/statistics/1,2966,,00.html

as of 8/5/05 E. American Heart Association medication statistics http://www.americanheart.org/presenter.jhtml?identifier=107 

II. The Problems

A. Adverse Drug Reactions

  1. Cost of medications
  2. Large # of medications ("polypharmacy")

B. Drug Interactions

  1. Drug-drug
  2. Drug-disease
  3. Food-drug interactions

C. Patient-Related Factors

  1. Decline in kidney and liver function with age
  2. Body composition changes (greater relative fat content, decreased relative free body water)
  3. Patient non-compliance

III. Common Signs and Symptoms

A. Anxiety

B. Confusion

C. Constipation

D. Depression

E. Falling

F. Fatigue

G. Incontinence

H. Malnutrition

I. Memory loss

J. Poor appetite

K. Restlessness

L. Weight Loss

IV. The Solutions--General Strategies

A. The Doctor

  1. "Start low, go slow"
  2. "When in doubt, leave it out"
  3. SCRUTINIZE AND RESCRUTINIZE MEDICATIONS...
    1. ...AT OFFICE VISITS
    2. ...UPON HOSPITAL ADMISSION
    3. ...AT HOSPITAL DISCHARGE
    4. ...UPON ADMISSION TO A NURSING HOME
    5. ...AT ALL NURSING HOME VISITS
  4. Look for UNDIAGNOSED DISEASE AND CONDITIONS THAT ARE COMMON IN THE ELDERLY (Treat Diseases and Conditions, (e.g., Thyroid Disease, B12 Deficiency, Malnutrition, Social Isolation), Not Symptoms)
  5. Patient education

B. The Nurse

  1. Patient education
  2. Coordination of care
  3. Nursing approaches to care

C. The Pharmacist

  1. Patient education
  2. Drug interaction/compliance surveillance

D. The Patient

  1. Keep an eye on yourself!
  2. Involve your family and friends
  3. Keep an eye on your doctor!
  4. Ask questions until you get a good answer

E. Regulatory Approach

  1. JCAHO
    1. "Drug Utilization Evaluation (DUE)" Monitoring
    2. "Adverse Drug Reaction (ADR)" Monitoring
  2. Federal/DOH

    a. Mandated Psychotropic Dose Reduction Trials (Nursing Facility Regulations)

    as of 8/5/05
    b. Potentially Inappropriate Medications for the Elderly According (Revised Beers Criteria) 2003
    http://www.dcri.duke.edu/ccge/curtis/beers.html

V. The Solutions--Other Strategies

        A. Medication questions "Hotline"

        B. "Brown bag" programs

        C. Computerized medication profile analysis

        D. Formal research

        as of 8/5/05
       
E.  "Grassroots Geriatrics" (Self-assessment / health fairs) http://grassrootsgeriatrics.org/

VI. References

as of 8/5/05
Medication Related Problems in Older Adults
from the American Society of Consultant Pharmacists 2005 http://www.ascp.com/public/pr/mrps.shtml

Return to:
Geriatrics for Patients, Caregivers and Health Professionals by Robert S. Stall, MD


Your thoughts please!

I hope some of these concepts prove useful. I would love to know if they do. Please send me your comments and success stories!

Robert S. Stall MD, 68 Stonington Lane Apt 6, Getzville, NY  14068
Phone: (716) 636-7531 FAX: (888) 387-1238
E-Mail: drstall@buffalo.edu
WWW: geridoc.net

Translate this page into other languages:

翻译这页对汉语 - Chinese
Traduisez cette page aux français - French
Übersetzen Sie diese Seite zum Deutsche - German
Tradurre questa pagina ad italiano - Italian
日本語へこのページを翻訳しなさい - Japanese
한국 언어에 이 페이지를 번역하십시요 - Korean
Traduza esta página aos português - Portuguese
Traduzca esta pagina al español - Spanish
This page Copyright 1996 - 2005 Robert S. Stall, MD / Stall Geriatrics
What Should You Expect At Your Age?  A Lot!
Originally written 5/10/94; posted 5/25/96; last update 8/5/05.