Older people tend to take far more medications than younger people. As common health problems such as high blood pressure, diabetes and arthritis begin to strike, the list of treatments needed starts to rise. As a result, most New Zealanders over 70 are taking four or more different prescription drugs, often for long periods of time.
Now, a University of Auckland study involving residents of a retirement village suggests many older people should review the medications they are taking. It is highly likely that some doses will need to be adjusted, some drugs should be stopped altogether and others started.
As we age, the way we respond to prescription drugs begins to change, says the study’s lead author, geriatrician Katherine Bloomfield. Our liver and kidneys may not break down and excrete drugs as quickly and the composition of our body changes, too, with less fluid and more fatty tissue.
“That’s important in terms of how much of the active drug is available to older people,” says Bloomfield. “As you get older, you’re more sensitive to medications and to any adverse side effects and drug interactions.”
As part of wider research looking at older people in retirement villages, a team of specialists assessed 173 residents, all of whom were in reasonably good health. Many of their prescriptions were found to be outdated and 135 were advised to make changes to their drug regime.
The most common medications recommended to be stopped or reduced included statins, prescribed to lower cholesterol, and proton pump inhibitors, used to reduce stomach acid. Blood pressure medications, diuretics, anti-platelet drugs and diabetic medications also needed tweaking.
Bloomfield was surprised by how many of the participants needed to make changes, but the list of drugs involved was fairly predictable. “When I’m treating patients, blood pressure medication is something that always comes up. More than two-thirds of the participants were taking them. They’re amazing drugs that have transformed cardiovascular health, but blood pressure can change naturally over time. And it’s important that we look at standing blood pressure as well as sitting, because if it’s going too low when someone stands up, that’s a risk of falls and fractures. Probably the most common thing I do in my clinical practice is reduce blood pressure medication.”
Among the treatments that participants were advised to start taking or increasing were paracetamol, vitamin D and infusions of bisphosphonates, a class of drug that prevents the loss of bone density.
Even when an older adult’s health seems stable, a review of medications every one or two years is a good idea, says Bloomfield, because things naturally change as a part of ageing.
“If new symptoms develop or there are changes in cognition, mobility and balance, then clearly it needs to be done more frequently,” she adds.
As well as GPs, clinical pharmacists, geriatricians and gerontology nurse specialists have a role in making sure older people don’t continue to take drugs when the risks outweigh any benefits. A set of international guidelines, called Stopp/Start (Screening Tool of Older Persons’ Prescriptions/ Screening Tool to Alert to Right Treatment) is available to help guide appropriate prescribing and these were updated last year.
“It takes time to explore all the ways that medications are affecting an individual,” says Bloomfield. “Everything in older adult medicine impacts on everything else.”
She and her fellow researchers have been investigating the health and wellbeing of people living in purpose-built retirement villages for several years. A 2020 study revealed that more than a third of residents experienced some level of loneliness and almost half experienced daily pain.
Meanwhile, research looking at levels of satisfaction among a group of 578 residents from 33 villages in the Auckland region found older adults with frailty were less satisfied with this way of living.
“We’re seeing more people moving into retirement villages and the advertising is all baby boomers on the bowling green with a glass of champagne but that wasn’t quite the reality we were seeing in a clinical context,” says Bloomfield. “So, we wanted to explore who is living in these villages, what their health and social needs are and what happens to them over time.”
