Advising the Elderly on Multiple Medication Use

JANUARY 01, 2008
Yvette C. Terrie, BSPharm, RPh

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

Results from a survey conducted by the National Council for Patient Education reported that only 37% of patients who use nonprescription drugs consult the pharmacist to ensure proper selection and use.1 In addition, many patients taking prescription drugs also concurrently use nonprescription drugs without first consulting their physicians or pharmacists. These individuals may not be aware of possible therapeutic duplications, contraindications, or drug interactions when some nonprescription and prescription drugs are used concurrently.

The elderly become more susceptible to problems with drug therapy because aging alters both pharmacokinetics and pharmacodynamics, which impacts the selection, dosage, and dosing interval of many pharmacologic agents.2,3 Pharmacists are pivotal in identifying possible drug interactions, contraindications, and incidences of polypharmacy.

Many Conditions, Various Medications

Individuals aged 65 and older account for more than 12% of the population in the United States, and this percentage is expected to double by the year 2030.4 Because many seniors have multiple chronic medical conditions, they are most likely to take various medications, including both prescription and nonprescription drugs; therefore, the probability of adverse effects increases, including potential drug interactions and contraindications.

It is estimated that the elderly account for 40% of the nonprescription drugs (including nutritional supplements) sold in the United States.4,5 On average, individuals aged 65 and older take an estimated 1.8 nonprescription products daily. Nonprescription drug use among the elderly is most prevalent in the Midwest among Caucasians and women.2 Results from 1 study show that women aged 65 and older take more nonprescription drugs than men, using an average of 3.8 nonprescription drugs.2 Analgesics, laxatives, and nutritional supplements are the most commonly used nonprescription drugs by the elderly.2

Examples of the most commonly known nonprescription drugs responsible for interactions among the elderly include nonsteroidal anti-inflammatory drugs, antihistamines, and antacids.2 The use of these drugs, such as nasal and oral decongestants, may exacerbate some preexisting medical conditions. Also, some in the elderly population appear to be more sensitive to certain classes of drugs, such as anticholinergic drugs.2

Other medication problems affecting the elderly include dosing considerations due to hepatic or renal impairments, which may require a dosing decrease or increase in dosing intervals.2,3 Some seniors also may have difficulty swallowing certain dosage forms or have issues with dexterity due to conditions such as arthritis. Pharmacists can assist patients by making recommendations, such as a liquid or chewable dosage form, if applicable, or easy-to-open containers to suit their individual needs.

Benefits of Counseling

Although counseling every patient about nonprescription drug use is not a realistic option in the daily duties of a pharmacist, when a patient does seek advice regarding a nonprescription product, pharmacists should seize every opportunity to ensure that the patient is thoroughly counseled on its proper use, as well as determine the appropriateness of therapy. Pharmacists also should find out if the request for a nonprescription product is to treat a side effect of another medication.2 Particularly among the elderly, when a patient is receiving a prescription medication, pharmacists should inform him or her about possible drug interactions and contraindications with any applicable nonprescription drugs when warranted.

Patients also should be reminded to always consult their primary health care provider before taking any nonprescription drugs—including nutritional supplements and herbal medications—and when in doubt, to ask their health care provider. In addition, seniors are more likely to see several health care providers due to multiple medical conditions, so it is imperative that they provide each of them with an updated, comprehensive list of their medications. This list should include prescription and nonprescription drugs, as well as nutritional and herbal supplements, and be brought to each doctor's visit. Furthermore, encouraging the use of a single pharmacy also can minimize possible drug interactions and medication duplications. See Table for additional reminders.

As more and more of the elderly population become proactive about their health, it is important to empower them with necessary information about their drug therapy so that they make smart choices to improve their quality of life.



  1. National Council of Patient Information and Education. Uses and Attitudes About Taking Over the Counter Medicines: Findings of a 2003 National Opinion Survey.
  2. Isetts, B, Brown, L. Patient Assessment and Consultation. In: Berardi R, Kroon L, Newton G, et al, eds. Handbook of Nonprescription Drugs. 15th Edition. Washington, DC: American Pharmacists Association; 2006:29-30.
  3. Basics of Geriatric Care: Clinical Pharmacology. In: Beers, M, ed. The Merck Manual of Geriatrics. Rahway, NJ: Merck Publishing; 2000:Chapter 6.
  4. Lam, A, Bradley, G. Use of Self Prescribed Nonprescription Medications and Dietary Supplements Among Assisted Living Facility Residents. Medscape Web site.
  5. Conroy, M. Polypharmacy: Pandora's Medicine Chest? Geriatric Times. 2000.

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