The likelihood of adverse drug reactions increases as the number of medications increases. Taking more drugs also means that keeping track of each becomes more difficult. Imagine having to keep track of six different medications, each of which has a different schedule, as presented in Table 4.2.

Medication adherence (taking medications cor­rectly) becomes less likely the more drugs people take and the more complicated the regimens are. Combined with sensory, physical, and cognitive changes in older adults, medication adherence is a significant problem in this age group (Bosworth, Oddone, & Weinberger, 2005; Shea, 2006). The oldest old are especially at risk; the most common problem is that they simply forget to take the medi­cation. (We consider ways to help people remember to take their medications in Chapter 7.) Yet adher­ence is crucial to treatment success. Christensen

Round pink tablet Oval white pill

Small yellow pill

Take 2 each night with plenty of water

Take one per week

and Johnson (2002) present an interactive model that describes the context of patient adherence. This model is shown in Figure 4.8.

The best approach, of course, is to keep the num­ber of medications to a minimum (Shea, 2006). If the use of drugs is determined to be essential, then periodic reevaluations should be conducted and the medication discontinued when possible. In addition, the lowest effective dosage should be used. In general, medication use by older adults should get the same careful consideration as by any other age group.

Concept Checks

1. How many medications does the average older adult take?

2. What changes occur with age in the ways in which medications work?

3. What side effect and drug interaction concerns do older adults face?