In general, because of multiple and chronic diseases, older patients often take multiple prescription and over-the-counter drugs. Persons over sixty-five may take seven or more prescription drugs in addition to some over-the-counter drugs (Stewart & Cooper, 1994). However, such multiple-drug therapy predisposes the elderly to an increased risk of unintended, adverse drug reactions (ADRs). The overall incidence of ADRs in this age group is two to three times that found in young adults. Although the results of studies vary, about 20 percent of all adverse drug reactions occur in the elderly (Korrapati, Loi, & Vestal, 1992); they may result from drug overuse, from drug misuse, from slowed drug metabolism, or from slow elimination of the drug in the urine. These bad side-effects may be caused or increased by age-related chronic diseases, by intake of alcohol, and/or by incompatibilities between the foods and the medicines which the elderly person takes. Furthermore, ADRs are more severe than among young adults. At increased risk are women, persons living alone, persons suffering from multiple diseases, persons taking multiple drugs (especially prescribed by multiple physicians who do not each know what the other physicians have prescribed), persons with poor nutritional habits, and persons with less sharp sense perceptions or mental clarity. Some of the age-related physiological causes for increased levels of medicines remaining in the bloodstream and examples of increased sensitivity of nerve cells to drugs have already been discussed. The elderly who drink regularly, even if they are not alcoholic, place themselves at increased risk for bad interactions between alcohol and their medicines. This risk would be greater still if an elderly person combined alcohol, prescription medicines, and illegal drugs. Thus, since both the kidneys and the liver are often slower at eliminating substances from the body in old age, medicines should generally be taken at lower initial doses by older patients.
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