Medications for Older Adults: Safe Use, Side Effects & Management

How Does Aging Affect the Way Medications Work?

As you age, your body undergoes natural changes that significantly impact how medications are absorbed, distributed, metabolized, and eliminated. Kidney function declines by approximately 50% by age 80, the liver's drug-processing capacity decreases, and your brain becomes more sensitive to many medications. These changes mean drugs stay in your body longer and have stronger effects.

Medications remain the most important treatment option for many health conditions in older adults. There are numerous effective medications available to prevent and treat diseases common in aging populations. However, understanding how your body changes with age is crucial for safe and effective medication use.

The way your body handles medications—absorbing them, distributing them to tissues, breaking them down, and eliminating them—changes as you age. Different organs also become more sensitive to medication effects. It's important to remember that these changes vary considerably from person to person, which is why medication doses and choices need to be individualized.

Kidney Function Declines with Age

The kidneys are responsible for eliminating most medications from your body through urine. The decline in kidney function is perhaps the most significant age-related change affecting medication effects. This decline begins gradually in your 30s and 40s and continues throughout life.

By age 80, the kidneys typically have approximately half of their original capacity. This is a normal part of aging and means that medications eliminated through the kidneys leave the body more slowly. As a result, drugs remain in your system longer, and their concentration in your blood becomes higher. This can lead to various side effects if doses aren't adjusted appropriately.

Examples of medications significantly affected by reduced kidney function include:

• Heart and blood pressure medications: Many need dose adjustments based on kidney function
• Certain diuretics (water pills): Can accumulate and cause electrolyte imbalances
• Diabetes medications: Some can cause low blood sugar if not adjusted
• Antibiotics: Several types require dose modifications
• Opioid pain medications: Like morphine and related drugs
• Anti-inflammatory drugs (NSAIDs): Can further harm kidney function

Often, treatment can be adapted by using a lower dose. However, sometimes a medication must be stopped entirely to avoid potential side effects. Your doctor may order kidney function tests to help determine appropriate dosing.

Body Composition Changes

With age, the proportion of water in your body decreases while the proportion of fat increases. This shift has important implications for how medications are distributed throughout your body.

Fat-soluble medications can spread into a larger portion of your body and may remain and act for a longer time. This particularly affects medications that work on the nervous system and can explain why older adults may feel drowsy or "hungover" the day after taking certain sedatives and sleep medications.

Water-soluble medications, on the other hand, may reach higher concentrations in the blood because there is less water to dilute them. This can make their effects stronger and potentially increase the risk of side effects.

Liver Function May Decrease

Some medications must be broken down in the liver before they can be eliminated from the body. The liver's ability to break down certain drugs can decrease with age. This means some medications may remain in the body longer, their effects may last longer, and their concentration in the body may become higher, potentially leading to stronger effects.

This is particularly relevant for:

• Most psychiatric medications
• Some pain medications containing morphine or similar substances
• Many heart rhythm medications
• Certain blood thinners

The Brain and Nervous System Become More Sensitive

As you age, your brain becomes more sensitive to many medications that affect the nervous system. This increased sensitivity makes side effects like fatigue, dizziness, confusion, and unsteadiness more likely, which in turn increases the risk of falls.

Examples of medications that require extra caution in older adults due to brain sensitivity include:

• Various psychiatric medications
• Sleep aids and sedatives
• Strong pain medications
• Antihistamines (found in many cold and allergy products)
• Muscle relaxants

Blood Pressure Regulation Becomes Less Effective

Your body's ability to maintain proper blood pressure is affected by aging. The reflex that regulates blood pressure when you stand up from sitting or lying down becomes less responsive. Additionally, levels of certain blood pressure-raising hormones decrease, and blood vessels in the legs lose some of their elasticity.

These changes can make you more sensitive to medications with blood pressure-lowering effects, which may cause dizziness or unsteadiness, especially when standing up quickly. This is particularly important because many common medications can lower blood pressure as a primary effect or side effect.

The Stomach and Intestines Are Affected

Aging also affects your stomach and intestinal tract. The protective lining of the stomach becomes less effective at defending against acidic stomach contents. This increases the risk that medications that can irritate the stomach lining may cause ulcers or bleeding.

This is particularly concerning with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. The risk of gastrointestinal bleeding from these medications increases significantly with age.

Why Do Older Adults Often Take Many Medications?

Multiple chronic conditions become more common with age, often requiring multiple medications. Studies show approximately 40% of adults 65 and older take five or more medications. While all may be necessary, polypharmacy significantly increases the risk of drug interactions, side effects, and medication errors.

There are several reasons why older adults typically use multiple different medications. It is primarily with increasing age that diseases and conditions requiring treatment become more common. Sometimes an additional medication is also needed to prevent side effects from another drug.

It is important to use the medications you need, but also to ensure your medication treatment is working as well as possible. When you see a doctor, it is therefore crucial to tell them about all medications you take, both prescription drugs and those you have purchased over the counter. It is also important to inform your doctor if you experience side effects or for any reason have difficulty taking your medications.

The most common types of medications used by older adults include:

• Cardiovascular medications: For heart disease, high blood pressure, heart failure
• Blood thinners: To prevent blood clots and strokes
• Psychiatric medications: For anxiety, sleep problems, and depression
• Pain medications: From mild analgesics to strong opioids
• Gastrointestinal medications: Acid reducers and laxatives

What Should I Know About Heart and Blood Pressure Medications?

Heart and blood pressure medications are among the most commonly prescribed drugs for older adults. Special considerations include the risk of orthostatic hypotension (dizziness when standing), electrolyte imbalances from diuretics, and the need for careful monitoring of kidney function. Always rise slowly from sitting or lying positions when taking these medications.

There are many different medications for heart and blood vessel diseases. Understanding the specific considerations for each type can help you use them more safely.

Blood Pressure-Lowering Medications

Many different medications can lower blood pressure. These may be specifically prescribed for high blood pressure, angina, or heart failure. However, certain psychiatric medications, Parkinson's disease medications, and prostate medications can also lower blood pressure as a side effect.

With age, your body's ability to regulate blood pressure changes. Therefore, you may experience problems with blood pressure drops if you use medications with blood pressure-lowering effects. This is usually most noticeable when you get up from lying or sitting. You may feel dizzy or unsteady.

Diuretics (Water Pills)

Diuretics are often used for heart failure and sometimes for high blood pressure. In heart failure, fluid can accumulate in the body, causing swollen legs or shortness of breath. Diuretic medications increase the elimination of salt and water through the kidneys.

If the diuretic effect becomes too strong, you may develop fluid deficiency, which can lead to fatigue and constipation. Fluid deficiency can also cause low blood pressure, dizziness, or headache. Some diuretics can also cause potassium imbalances, which may require monitoring through blood tests.

Some medications have such a pronounced diuretic effect that you become very urgent and need to urinate frequently. Sometimes it is possible to wait with a dose to, for example, go out shopping for a while, but you should not change the dosing without first talking to your doctor.

What Are the Risks of Pain Medications in Older Adults?

Different pain medications are appropriate for different types of pain. Paracetamol (acetaminophen) is generally safest for older adults. NSAIDs like ibuprofen carry significant risks including stomach bleeding and kidney damage. Opioid pain medications can cause drowsiness, confusion, constipation, and increase fall risk.

Different pain-relieving medications help with different types of pain. For mild pain conditions, a medication that works where the pain is localized is usually sufficient, primarily paracetamol (acetaminophen). For more severe pain conditions, a stronger pain-relieving medication that works on the nervous system may need to be added—so-called opioids.

Paracetamol (Acetaminophen)

The active ingredient paracetamol is a common pain-relieving medication that can be purchased without a prescription. Paracetamol rarely causes side effects and can be used by most people. However, if you take too high a dose, you can get serious liver damage. Therefore, it is important to never take more than what is stated on the packaging.

There are medications that contain paracetamol together with another pain-relieving substance. Therefore, find out what your medications contain so that you do not accidentally get too high a dose. The maximum daily dose for most adults is 4,000 mg (usually 8 regular-strength tablets), but older adults may need to take less.

Anti-inflammatory Medications (NSAIDs)

Medications with ibuprofen or naproxen are examples of anti-inflammatory pain-relieving medications, so-called NSAIDs or COX inhibitors. Many such preparations can be purchased without a prescription. They are used, among other things, for joint diseases such as rheumatoid arthritis.

As you age, the risk increases that this type of medication will cause ulcers and bleeding in the stomach. With age, the risk also increases that the medications will impair kidney function. They can also trigger or worsen heart failure and counteract the effect of medications used for heart failure.

Opioid Pain Medications

Opioids is a collective name for morphine and morphine-like pain-relieving medications. Older adults are more sensitive than younger people to opioids and can therefore more easily get side effects such as fatigue, drowsiness, dizziness, nausea, and constipation. Opioids can also increase the risk of falls. They can also affect memory and thinking ability, and in some cases cause confusion.

If you are prescribed opioids, your doctor should start with the lowest effective dose and increase gradually if needed. Constipation prevention (stool softeners or laxatives) is often recommended from the start, as this side effect is common and doesn't improve with time.

What Should I Know About Sleep and Anxiety Medications?

Sedatives and sleep medications commonly cause drowsiness and fatigue the next day in older adults. They can also cause dizziness, balance problems, muscle weakness, memory impairment, and confusion. These medications typically remain in the body longer when you are older, prolonging their effects. Sleep aids should be used only when needed and not for more than four weeks at a time.

A common side effect of sedatives and sleep medications is feeling drowsy and tired the next day. You may also become dizzy, have problems with balance, or feel weak in the muscles. This increases the risk of falling and injuring yourself. The medications can also impair memory and cause confusion.

These types of medications usually remain in the body longer when you are older. This means the effect lasts longer than in younger people. Talk to your doctor if you feel tired the day after taking sleep medication. Sometimes you can feel more alert during the day by lowering the dose or switching to another sleep medication.

Sleep medications should only be used when needed and not for more than four weeks at a time. Otherwise, the body can get used to the sleep-inducing effect of the tablets, which means their effectiveness decreases. Over time, you may need more of the medication to achieve the same effect, and stopping the medication can cause rebound insomnia.

What About Medications for Depression and Other Mental Health Conditions?

Antidepressants, particularly SSRIs like sertraline and citalopram, are commonly prescribed for older adults. While generally safer than older antidepressants, they can still cause side effects including digestive issues, fatigue, dizziness, and increased fall risk. Antipsychotic medications should be used with particular caution due to risks including stroke.

There are several different types of medications for mental health conditions. Understanding their specific effects and risks in older adults can help ensure safer use.

Antidepressants

Antidepressant medications are used by many older adults. Most often, the type of antidepressant called SSRI is used, for example, medications containing citalopram, sertralin, or mirtazapine.

The most common side effects of SSRIs include digestive problems, weight changes, fatigue, dizziness, headache, and sleep disturbances. They can also increase the risk of falls. SSRIs can also cause low sodium levels in the blood, particularly in the first few weeks of treatment, which can cause confusion and weakness.

When starting an antidepressant, be patient—it typically takes 2-4 weeks to start feeling the full benefits. If you and your doctor decide to stop an antidepressant, do so gradually to avoid discontinuation symptoms.

Antipsychotic Medications

Antipsychotic medications are also called neuroleptics. Such medications should be used with caution by older adults and only when truly needed. They may be appropriate for, for example, severe psychotic symptoms such as hallucinations, since they can cause significant side effects.

Antipsychotic medications can, among other things, cause blood pressure drops. These medications can also affect muscle movements, which is primarily manifested as stiffness and reduced mobility. They can also cause something called akathisia, a feeling of physical restlessness that makes it difficult to be still. Antipsychotic medications have also been shown to increase the risk of stroke, particularly in people with dementia.

How Can I Use My Medications Correctly?

Safe medication use requires understanding what each medication is for, how to take it correctly, what side effects to watch for, and what to do if you miss a dose. Keep an updated medication list, use pill organizers if helpful, and tell your doctor about any difficulties with packaging or swallowing tablets.

The doctor or nurse who prescribes a new medication should inform you about several key points:

• Why you should take the medication and what effect it is intended to have
• How you should take the medication (with food, at bedtime, etc.)
• How long you should use the medication
• Whether the medication can cause any side effects you should particularly be aware of
• If there is anything special you must think about when using the medication
• What you should do if you forgot to take the medication, or do not remember if you have taken it

You can ask the doctor or nurse to write down the answers.

Keep a Medication List

The doctor needs to know all medications you take. This includes prescription medications, over-the-counter medications, natural remedies, and herbal medicines. Therefore, it is good to have a list of all medications you use. At the pharmacy, you can get a compilation of the medications you have had prescribed and picked up on prescription.

It is important to remember that these lists may contain medications you should no longer take. The doctor may also have changed the dosing of your medications. Keep your list updated and bring it to every healthcare visit.

Dealing with Difficult Packaging

Tell your doctor if you have difficulty opening or using certain medication packages. Certain diseases such as rheumatism or symptoms after stroke can make it difficult for you to use your hands. It can sometimes also be difficult to know how a package should be handled.

You can ask your doctor or at a pharmacy if the same or an equivalent medication is available in a package that is easier to handle. There are also opening tools available for purchase at pharmacies.

Swallowing Difficulties

Tell your doctor if you have difficulty swallowing tablets and capsules. Sometimes it is possible to switch to smaller tablets, tablets that dissolve in the mouth, or liquid medications.

Some tablets and capsules can be divided or crushed, but this is not the case for all. Some are even directly unsuitable to crush. Certain tablets and capsules are made to dissolve slowly in the stomach and intestines. Such tablets do not work as they should if you divide or crush them. The package insert states how you should take the medication.

Remembering to Take Medications

It can be troublesome to have to take a medication several times a day. Sometimes you can switch to another medication that has a more long-lasting effect, which you only need to take once a day.

A pill organizer can be a good aid if you have several different types of tablets or capsules to take at different times. In the box, you can distribute your medications for different times of the day. The box comes in different variants and usually holds medications for one week at a time. Pill organizers can be purchased at pharmacies.

Some medications may be sensitive to light or moisture and should therefore not be stored in a pill organizer. Such information is usually found on the package or in the package insert. Sometimes it can be good to ask a family member or home health nurse for help filling the pill organizer once a week.

Consider Starter Packages

Many people have large amounts of unused medications at home. The reason may be, for example, that treatment has been discontinued due to side effects or that it did not help. It may also be that the illness you got the medication for has passed.

To reduce the risk of larger quantities of medication being left over, you can get a smaller package the first time you get a new medication. This is usually called a starter package. You can then pick up a larger package if the medication works well.

Taking Care of Your Teeth

There are many medications that can make your mouth dry due to reduced saliva production. This in turn leads to an increased risk of cavities or inflammation of the gums and oral mucosa.

The risk of dry mouth increases if you use several different medications simultaneously. Therefore, it is extra important to take care of your teeth if you use many medications. It is also good to visit a dentist or dental hygienist regularly. If dry mouth is bothersome, there are saliva substitutes and special oral care products that may help.

How Can Family Members Help?

Family members, friends, or caregivers can provide valuable support with medication management. They can help organize medications, accompany patients to medical appointments, help remember and record important information from doctors, and ensure unused medications are properly disposed of.

It can be helpful to get assistance from family members, relatives, friends, or contact persons. They can help keep track of which medications you should take. For example, they can fill pill organizers and ensure that medications you no longer need are returned to a pharmacy for proper disposal.

Family members can also accompany you to the doctor. It can sometimes be difficult to perceive everything the doctor says. Then a family member can ask questions to the doctor and write down what they say. This is particularly helpful when you're receiving important information about new medications or changes to your treatment.

What Is a Medication Review and Should I Request One?

A medication review is a comprehensive evaluation of all your medications by a healthcare provider. It checks whether each medication is still needed, appropriate for your age and conditions, at the correct dose, and not causing harmful interactions. You should be offered a review if you're 75+ and take 5+ medications, but you can request one at any time.

You can together with a doctor make a thorough review of the medications you use. A doctor is responsible for the medication review. Sometimes others can also participate, for example a nurse, pharmacist, or elderly care staff. It is good if you yourself participate in the medication review. A family member can help if needed.

A medication review can prevent you from taking medications you no longer need or medications that are inappropriate for older adults. It can also reduce the risk of taking medications that affect each other, are inappropriate for diseases you have, or cause side effects. After a medication review, you receive an updated list of all medications you use.

Simple Medication Review

In a simple medication review, the doctor reviews which medications you use. They also assess whether the medication treatment is well adapted to your needs and is safe. You should be offered a simple medication review if you are 75 years or older and take five or more medications. You can also get a medication review if you have problems with your medication treatment.

In-depth Medication Review

You can get an in-depth medication review if, after a simple medication review, you still have problems with your medication treatment. In an in-depth medication review, a reassessment is made of each prescribed medication based on how you feel and what needs you have.

The doctor reviews how appropriate the medication is for you and whether the dose you take is appropriate for your age, kidney function, and any other diseases. The doctor also makes an assessment of how the medication fits with your other medications. This comprehensive review can identify medications that can be stopped, doses that should be adjusted, and potential drug interactions.