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Medication management: how medication review improves lives and reduces waste

02 October 2024
Volume 29 · Issue 10

Abstract

Ageing is associated with an increased risk of adverse drug reactions. This calls for great care and diligent follow up when prescribing medication to older patients. Yet, this is seldom the case and the proportion of older people taking five or more medications has quadrupled from 12% to 49% in the last 20 years. Certain medications are riskier than others. Those with anticholinergic effects are of particular concern. Adverse effects of anticholinergics include dry mouth, nausea, dizziness, fatigue, vomiting, constipation, abdominal pain, urinary retention, blurred vision, tachycardia and neurologic impairment, such as confusion and agitation. Anticholinergic medication can cause daytime drowsiness and cognitive decline, while increasing the risk of fall and can lead to increased mortality. Although anticholinergic medication should be avoided in older people whenever possible, their use has almost doubled in the last 20 years, and those who are most vulnerable to its adverse effects had the greatest increase in use. This article examines why older people are at increased risk of adverse drug reactions and how medication review can enable older persons to take medications regularly, improve quality of life and minimise medication waste.

Many people think that medicines are prescribed with great care by experienced staff; this is not always the case. The World Health Organization (WHO) estimates that ‘more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly’ (WHO, 2022). Medicines can harm as well as heal. The greater the number of medicines prescribed, the greater the risk of adverse drug reactions (ADRs) and incorrect medicine consumption. This article outlines why older people are at greater risk of adverse drug reactions, how to work with the older person to review medicines and the benefits of medication reviews.

Adverse drug reactions are ‘unintended, harmful events attributed to the use of medicines’ (Coleman and Pontefract, 2016). Ageing affects the body's ability to absorb and excrete medicines and increases the risk of harmful effects. Each organ and system in a young person's body has a substantial reserve capacity available to deal with high-demand or high-stress situations. As people age, this reserve capacity diminishes (Milanović et al, 2013). Aerobic capacity, the body's ability deliver oxygen to the muscles, decreases by 30% from the age of 40-65 years and muscle mass reduces by 30-50% between the age of 30 and 80 years.

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