Drug therapy in the older adult 15
residual drowsiness. Keep in mind that
ingestion of alcohol may exaggerate such
depressant effects, even if the sleeping aid
was taken the previous evening.
Nonprescription drug toxicity
When aspirin, aspirin-containing analgesics
and other nonprescription NSAIDs (ibu-
profen, naproxen) are used in moderation,
toxicity is minimal. However, prolonged
ingestion may cause GI irritation—even
ulcers—and gradual blood loss resulting
in severe anaemia. Prescription NSAIDs
may cause similar problems, especially
with older adults. Although anaemia from
chronic aspirin consumption can affect all
age groups, older adults may be less able
to compensate because of their already
reduced iron stores.
Laxatives may cause diarrhoea in older
adults who are extremely sensitive to such
drugs as bisacodyl. Chronic oral use of min-
eral oil as a lubricating laxative may result
in lipid pneumonia from aspiration of small
residual oil droplets in the person’s mouth.
Individual non-adherence
Poor adherence can be a problemwith indi-
viduals of any age. A significant number of
hospitalisations result fromnon-adherence
with themedical regimen. However, in older
adults, specific factors linked to ageing—
such as diminished visual acuity, hearing
loss, forgetfulness, the common need for
multiple drug therapy and various socio-
economic factors—can combine to make
adherence a special problem. Approxi-
mately one-third of older adults fail to
comply with their prescribed drug therapy.
They may fail to take prescribed doses or
to follow the correct schedule, or they may
take medications prescribed for previous
disorders, discontinue medications prema-
turely or use as-needed medications indis-
criminately. Older adults who havemultiple
prescriptions for the same medication may
inadvertently take an overdose.
Review each individual’s medication
regimen with them. Make sure the person
understands the amount of medication to
take and the time and frequency of doses.
Also explain how the person should take
each medication—that is, with food or
water or by itself.
Give the person whatever help you can
to avoid drug therapy problems. Suggest
that they use drug calendars, pill ‘sort-
ers’ or other aids to help in compliance,
and refer the person to the prescriber or
pharmacist if further information is needed.
