Seniors Should Be "Stingy" with Medication, No More Than 5 Drugs at a Time
With the rapid growth of China's elderly population, seniors have become the largest consumer group in the pharmaceutical market. Statistics show that seniors account for 23%—40% of prescription drug consumption and 40%—50% of over-the-counter drug consumption. However, the safety of medication use in the elderly should also be taken seriously.
According to literature, the risk of adverse drug reactions in people over 60 is 2.5 times higher than in the general adult population. Experts point out that because medication use in the elderly differs from that in adults, special attention must be paid to dosage and administration.
Everyone will be exposed to drugs throughout their lives, and this likelihood increases with age. Drugs are generally classified as pediatric or adult types. The physiological functions of the elderly are constantly declining, which is completely different from young people, yet there are no drugs specifically designed for the elderly.
Currently, the elderly take medication based on the vague concept of "adult" dosage. From this perspective, medication use for the elderly is different from that for the young. So, what are the characteristics of medication use for the elderly? What kinds of misconceptions might arise?
Mixed Medication is Dangerous
Grandpa Zhang suffers from diabetes, hypertension, hyperlipidemia, coronary heart disease, and other conditions, requiring him to take multiple medications. Recently, the elderly man often felt dizzy and frequently fell. An examination revealed that it was the combined side effects of these medications that caused the dizziness. Such elderly patients are common in clinical practice, most of whom have cardiovascular and cerebrovascular diseases with three or more conditions and are often taking medications for prevention and health maintenance during stable periods.
There are many reasons for repeated medication use. The main problems are: first, patients have multiple diseases with many clinical symptoms and complex causes. Eager for a cure, they often visit multiple hospitals or different departments, leading to prescriptions with the same or similar drugs, and the patient, not understanding this, ends up taking duplicate medications. Second, many synthetic drugs are available for treating common diseases. The main ingredients in synthetic drugs for the same or similar diseases are largely the same, but the drug names are different. Patients buy these drugs on their own and, without carefully reading the package inserts, take several drugs with different names but similar ingredients, which is a prominent phenomenon of repeated medication use.
Drugs are a "double-edged sword"; there are almost no drugs without adverse reactions. Doctors have strict standards for dosage and duration when using drugs. Physicians design treatment plans based on the patient's condition, so the drugs used by each patient are not exactly the same.
The greatest harm of repeated medication is an increase in adverse drug reactions, which can be life-threatening in severe cases. Therefore, during the medication process, patients should communicate fully with their doctor or pharmacist, follow the principle of "less is more" under medical guidance, and try to avoid the harm caused by repeated medication.
Medication for the Elderly Should Follow "Age Up, Dose Down"
We often see the phrase "reduce dose for children" on drug package inserts, but many people do not realize that the same principle of "dose reduction" applies to the elderly.
Nowadays, there are many children's specific drugs on the market, and dosages can be calculated based on age and weight. However, it is rare to find "drugs specifically for the elderly." The functions of various organs in the elderly gradually decline, and due to differences in living environment and physical constitution, there are large individual variations in drug dosage and low tolerance. Therefore, when using general drugs, one should start with the smallest dose and gradually increase it to find a dose that can control the condition while avoiding adverse reactions and is more suitable for the individual.
The dosage for most elderly people is almost the same as for young and middle-aged adults, which can easily cause problems. Even for treating a simple cold, it is clearly unscientific for a 30-year-old man weighing 75 kg and a 70-something-year-old man weighing only 45 kg to take the same dosage.
According to the "Chinese Pharmacopoeia," for people over 60, the dosage should be 3/4 of the adult dose, and the dose should not be increased without professional advice. For those over 80, only 1/2 of the adult dose should be given.
Due to decreased tolerance in the elderly, adverse reactions or poisoning can easily occur, so medication should start with a small dose. Elderly individuals who are older, lighter in weight, or in poorer health should have their doses reduced accordingly. Furthermore, the elderly often suffer from multiple diseases at the same time. When taking medication, they should first take drugs for acute and severe conditions, and after the condition stabilizes, take other drugs to treat other conditions. Do not take multiple drugs at once. It should be noted that a consistently small dose is not always the case; it can be a starting small dose or a small maintenance dose, which mainly depends on the type of drug.
No More Than 5 Drugs at a Time
Surveys show that currently, elderly people take at least 3-5 drugs daily, and some take as many as 7-9. It seems that most of an elderly person's time is spent waiting to take medication every few hours. However, doctors point out that because most elderly people lack a basic understanding of drug properties and pharmacological knowledge, and there is insufficient understanding of the physiological characteristics of the elderly, blind medication often has the opposite effect.
With increasing age, the structure and function of the body's various systems, organs, and tissues change. For example, the cardiac index decreases by about 0.8% per year, renal blood flow decreases by 1.9% per year, hepatic blood flow decreases by 1.5% per year, and cerebral blood flow decreases by 0.4% per year. In their 70s, elderly people lack an average of 20%-30% of gastric acid, and total body water decreases by 10%-15%. This decline in the structure and function of organs and tissues, especially the decline of heart and kidney function, directly affects the absorption, distribution, metabolism, and clearance of drugs. Another statistic shows that when using 1-5 drugs, the incidence of adverse reactions is 3.4%, and when using 6 or more drugs, the incidence is 4.7%. This shows that taking a large number of drugs at the same time or long-term, non-standard medication can cause great harm to the elderly.
The elderly should not take more than 5 drugs at the same time. It is necessary to clarify treatment goals, focus on the main problem, and select primary drugs for treatment. Any drugs with uncertain efficacy, poor tolerance, or not taken as prescribed can be considered for discontinuation to reduce the number of medications. If the condition is critical and multiple drugs are needed, the "5-drug principle" should still be followed after the condition stabilizes. Adhering to the doctor's prescription is key
Elderly patients with chronic diseases must follow their doctor's prescription and must not be "on-again, off-again" with treatment—taking medication only when they feel unwell and stopping as soon as they feel slightly better. This intermittent medication can cause the condition to relapse and not be effectively controlled. For example, metoprolol, used to treat angina and hypertension, has strict time and dosage requirements. Especially for patients with coronary heart disease, the drug cannot be stopped abruptly, as it can induce angina, myocardial infarction, or ventricular tachycardia. For long-term users of this drug, the dosage should be tapered during withdrawal, taking at least 3 days, and generally 2 weeks. Taking medication as prescribed is an important guarantee for improving efficacy and avoiding accidents.
In general, a doctor's prescription has already taken into account the patient's actual condition and is specific. However, when patients see multiple doctors and use multiple prescriptions, there may be duplicate medication or potential drug interactions in the prescriptions. In this case, you should consult the pharmacist before paying for the medication and ask them to review the prescription for safety and reasonableness to ensure medication safety. After getting the medication, patients should also carefully read the package insert and consult their doctor or pharmacist if they have any questions.
Mastering the best time to take medication can not only improve drug efficacy but also reduce adverse reactions. The elderly often suffer from forgetfulness and may forget to take their medication or take it at the wrong time. To prevent this, the elderly should use their medication with the assistance and supervision of family and friends.
In addition, the elderly should choose simple and effective routes of administration. First, oral administration is a simple and safe method and should be used as much as possible. Second, acute conditions can be treated with injection, sublingual administration, or nebulization. Everything should be based on the characteristics of the elderly, with appropriate selection of dosage forms and packaging, and necessary guidance or supervision provided when needed.
Self-"Treatment" is Not Advisable
Some elderly people, suffering from chronic diseases, believe that "a long illness makes a doctor," so whenever they feel unwell, they always rely on their years of "experience" to self-treat. Taking medication indiscriminately or increasing the dosage without a diagnosis is especially dangerous for the elderly who are in poor health or suffer from multiple chronic diseases. While self-treatment indicates some health awareness, the physical condition of the elderly is special. Onset is often sudden, the condition progresses rapidly, and the consequences are unpredictable. Therefore, elderly friends should not blindly and casually engage in self-"treatment."
When the elderly get sick, one of the characteristics is that it is often long-term and chronic, which can easily lead to "doctor shopping." Unverified secret recipes and single formulas cannot scientifically determine their efficacy. Relying on luck to treat a disease often delays the condition and even leads to drug poisoning, adding illness and harm. It is recommended that once you feel unwell, you should go to the hospital to see a doctor, first to understand the condition, and then prescribe the right medicine.
At the same time, we advise elderly friends, "Do not trust advertisements blindly, and avoid abusing tonics." Frail elderly people can use appropriate supplements to tonify deficiency and benefit qi based on their condition, but if the purpose is just to "supplement" and it is abused blindly, it is likely to have the opposite effect.
Beware of Drug Incompatibilities
For medication use in the elderly, it is necessary to understand some medication principles and issues related to drug incompatibilities.
Central Nervous System Drugs: The central nervous system of the elderly is more prone to dysfunction than other systems. The use of two or more sedative-hypnotic drugs can cause excessive sedation, ataxia, and confusion, which is particularly noticeable in the early morning and at night. Therefore, it is not recommended for the elderly to routinely take sedative-hypnotic drugs.
Cardiovascular Drugs: The elderly are more sensitive to cardiac glycosides, and toxicity can occur even with small doses. Therefore, the incidence and mortality of digoxin poisoning are higher in the elderly than in the young. It is recommended that the elderly generally be given 1/2 or 1/4 of the adult standard dose, with a further reduction in case of renal failure. The dosage should be adjusted during treatment based on clinical manifestations and blood drug concentration monitoring. In addition, because the elderly are sensitive to oral anticoagulants, combining them with antiplatelet drugs increases the risk of bleeding and must be警惕 (be alert to).
Hypoglycemic Drugs: Elderly diabetic patients should use "beta-receptor blockers" with caution, as they can mask the symptoms of hypoglycemia, making it difficult to detect. When elderly diabetic patients take antihypertensive drugs, thiazide diuretics should be avoided to prevent hyperglycemia.
Diuretics: Due to decreased kidney function in the elderly, hypokalemia is easily induced, while improper potassium supplementation can easily lead to hyperkalemia. The hearing and vestibular function damage caused by furosemide and ethacrynic acid can be aggravated when combined with aminoglycoside antibiotics, so their combination is prohibited.
Antibiotics: When the elderly use antibiotics to treat infectious diseases, attention should be paid to the possibility of a superinfection, especially in frail elderly individuals who are more prone to it.
In fact, we should value non-drug therapies. For some conditions, if treatment without drugs is possible, there is no need to rush to use medication. For example, early diabetes can be treated with diet therapy; mild hypertension can be treated by limiting sodium, exercising, and losing weight; constipation in the elderly can be improved by eating more high-fiber foods; for patients with insomnia and dreams, good results can be achieved by avoiding strenuous mental work and smoking/tea at night; for elderly people with emotional depression, treatment can be provided through counseling and psychological guidance; for patients with arthritis, physical therapy often has better effects than medication.
In summary, medication use in the elderly should be cautious. For the elderly who need long-term medication, liver function, kidney function, electrolytes, blood drug concentration, and acid-base balance should be regularly monitored to adjust the dosage and administration time promptly and prevent adverse drug reactions.
Finally, experts unanimously recommend that patients on long-term medication should have regular medical check-ups to detect and prevent damage from drug accumulation in a timely manner. Generally, the general population over 45 should have at least two comprehensive medical check-ups per year. For the elderly with chronic diseases, it is best to have regular physical examinations according to their specific conditions. For patients taking certain drugs for a long time, more specific examinations should be conducted regularly.