Understanding Medication Use in Older Adults

Therapeutic drug monitoring (TDM) is a crucial practice in healthcare, especially for older adults, as age significantly impacts how medications work in the body. Here’s a breakdown of these age-related changes:

Absorption:

• Slower Gastrointestinal (GI) Motility: The digestive system naturally slows down with age. This can delay or reduce medication absorption from the gut, potentially leading to lower drug concentrations and reduced effectiveness.
• Increased Stomach pH: Stomach acidity decreases with age, which can affect the absorption of certain medications, particularly those that require an acidic environment for proper breakdown and absorption.

Metabolism:

• Decreased Liver Function: Liver function naturally declines with age, leading to slower metabolism of medications. This can increase the concentration of drugs in the bloodstream and potentially lead to side effects.
• Reduced Enzyme Activity: The body’s ability to break down drugs through enzymes also decreases with age. This can further impact how quickly medications are metabolized and eliminated from the body.

Excretion:

• Decreased Kidney Function: Kidney function diminishes with age, reducing the body’s ability to eliminate medications through urine. This can lead to a buildup of drugs in the body, potentially causing increased risk of side effects and toxicity.

Overall Impact:

These age-related changes can significantly affect how medications work in older adults. They may experience:

• Increased risk of side effects due to higher drug concentrations.
• Reduced effectiveness of medications due to slower absorption or metabolism.

Therefore, TDM is especially important for older adults to ensure medications are at safe and effective levels. By monitoring drug levels in the bloodstream, healthcare professionals can adjust dosages as needed to optimize treatment and minimize risks.

Salt Substitutes and Hyperkalemia in Older Adults

Salt substitutes can be dangerous for older adults taking certain medications because they often contain potassium chloride (KCl) as a replacement for sodium. Here’s the connection:

• Hyperkalemia: This is a condition where there is too much potassium in the blood. It can lead to heart rhythm problems, muscle weakness, and even death in severe cases.
• Medications: Several medications, including:
  • Diuretics: These medications help the body eliminate fluids and can also increase potassium levels.
  • Angiotensin-converting enzyme (ACE) inhibitors: These medications relax blood vessels and can also elevate potassium levels.
  • Angiotensin receptor blockers (ARBs): These medications work similarly to ACE inhibitors and can also cause potassium levels to rise.

Combining salt substitutes with these medications can significantly increase the risk of hyperkalemia in older adults. Healthcare professionals should be aware of a patient’s medication regimen and advise them on the cautious use of salt substitutes.

Preventing Medication Nonadherence in Older Adults

Medication nonadherence, where patients don’t take their medications as prescribed, is a major concern in older adults. Here are some strategies to prevent and evaluate it:

Prevention:

• Simplify medication regimens: Reduce the number of medications whenever possible and consider using single-dose packaging or pill organizers for easier management.
• Address medication affordability: Help patients explore cost-saving options like generics or patient assistance programs.
• Improve medication understanding: Provide clear and concise instructions on how and when to take medications. Encourage patients to ask questions and address any concerns they might have.
• Involve family members or caregivers: Include them in medication management discussions and provide support for adherence.

Evaluation:

• Regular medication reviews: Schedule appointments to monitor adherence, identify any issues (e.g., side effects, difficulty remembering to take medications), and make adjustments as needed.
• Use of medication adherence tools: Consider using pill reminders, medication trackers, or adherence packaging to help patients stay on track.
• Open communication: Encourage patients to openly discuss any challenges they face with taking their medications, such as difficulty swallowing pills, experiencing side effects, or confusion about dosage instructions.

By implementing these strategies, healthcare professionals can help older adults better adhere to their medication regimens, leading to improved health outcomes and reduced risk of complications.