Multiple drug use in the elderly

Multiple Drug Use in the Elderly 

Multiple drug use is an important problem for the elderly due to health problems. There are studies showing that 95% of people over the age of 65 use at least one drug per week, with or without a prescription, for various reasons, 40% use five or more drugs, and 15% use ten or more drugs.

The use of over-the-counter drugs, in particular, brings with it serious side effects. Commonly over-the-counter medications include pain relievers, constipation medications, and supplements.



In elderly individuals, as a result of interaction with cardiovascular drugs, blood pressure drugs, blood thinners, psychiatric drugs, etc., it can sometimes cause life-threatening health problems.

Studies show that drug use is higher in women, and the rate of over-the-counter drug use increases as the education level decreases.

Physiological features affecting drug use in the elderly: 

• With aging, body fat mass decreases, body fluid decreases, and changes occur in the binding of drugs to proteins.
• There are changes in the structure, contraction strength and tone of the gastrointestinal tract.
• Renal blood flow decreases, excretion decreases, the possibility of accumulation of drugs in serum increases.
• The affinity of the receptors for drugs that act by binding to the receptors may decrease.

Points to be considered in the use of drugs in the elderly: 

• When evaluating health problems over the age of 65, the patient’s drug use history should be taken well, and there should be no missing medication.
• It should be kept in mind that health problems may be related to the use of multiple drugs.
• When prescribing a drug, the necessity of the drug should be clarified and its interaction with other drugs should be considered.
• Drug doses should be adjusted in a low and easily administered way, the patient’s sleep pattern may affect the choice of drug.
• It may be necessary to start the drug at a low dose and gradually increase the dose according to the effectiveness.
• Patient compliance should be taken into account when choosing medication.
• Medication side effects must be taken into account. In the elderly, drug side effects may be more severe than in other ages.
• The patient or his relatives should be informed about the drug. If possible, a written instruction for use should be given.
• The metabolism, distribution, absorption and excretion of drugs may affect your drug choice.
• Drugs that have an effect on more than one organ should not be preferred.
• Whenever possible, it should minimize the use of multiple drugs.
• When prescribing new drugs, it is useful to start one at a time as much as possible.
• Drugs should be reviewed at regular intervals, preferably every 6 months, and one should not insist on drugs with doubtful efficacy.
• Medicine boxes can be recommended to patients using multiple drugs, where they can monitor their daily or weekly drug intake levels.
• Medicines such as cardiovascular drugs, blood pressure drugs, blood thinners should be followed regularly with blood tests or blood pressure measurements.
• In order to prevent the side effects of a drug, it may be more appropriate to adjust the dose of the drug that causes side effects instead of starting a new drug.
• When choosing drugs in the elderly, it is more beneficial to choose drugs that can be good for more than one disease in terms of reducing the development of side effects.
• Compliance with treatment should be well monitored in the elderly. Factors such as delayed effects of drugs, complex treatment protocols, poor explanation of the drug and its side effects, not being convinced of the need for treatment, and poor patient-physician relationship may reduce compliance with treatment. It is important for compliance with timely controls and accessibility of the healthcare team.