In Italy, 2 out of 3 elderly people take at least 5 drugs with different active ingredients every day and 1 out of 4 elderly people (over 3.5 million people) uses even 10. It is ‘polytherapy’, a growing phenomenon, related to aging (today in Italy there are over 14 million over-65s) and the coexistence of several chronic diseases which affects 75% of over-60s and almost all of the over 80s. But this ‘daily ritual’ is far from easy and can lead to problems of adherence to treatment, confusion between the different medicines to be taken, as well as the risk of adverse events or reduced efficacy of the therapy due to interactions between drugs or between them and the nutrients taken in with the diet.
The spotlight on the theme is turned on by Italia Longeva, the national association for aging and active longevity of the Ministry of Health which, together with the Italian Society of Gerontology and Geriatrics (SIGG), has created the video tutorial ‘Old people and medicines: 10 rules for the correct recruitment’, presented in the context of the 67th SIGG National Congress underway in Rome, underlining the central role of geriatricians for the correct management of polytherapy in the elderly.
The video, declined in the form of a decalogue for use in medical practices and for dissemination by geriatricians, is aimed at patients and caregivers to help them in the daily management of therapies and inform them about the use of equivalent medicines that allow for treatment with same efficacy, quality and safety as the original medicines, but with the advantage of being cheaper. The latter aspect is far from negligible, especially for the most fragile segments of the population and with less financial resources.
In 2021, Italians spent over 1 billion euros on sharing in the purchase of ‘branded’ medicines. The tutorial is also a tool for healthcare professionals to educate and empower patients to play an active role in the management and periodic review of therapies, sharing any doubts, difficulties, changes in habits or changes in health status with the doctor and the pharmacist.
“Information improves care: sharing with the elderly patient, and with the whole family, the aims of the therapy and the indications for the correct use of the prescribed drugs is a decisive factor in avoiding the do-it-yourself and creating better health outcomes” says Roberto Bernabei, President of Italia Longeva. The task of us doctors is also to reassure patients about the novelties and therapeutic alternatives which may concern, for example, equivalent medicines, identical in all respects to ‘branded’ medicines yet still little used. For this we have created a tutorial with a few simple rules that we invite you to follow. Polytherapy if you know it, you can do it”.
“For example, it is good to keep an updated list of medications in use, making sure that the doctor is always aware of all the therapies taken. To avoid administration errors, it may be useful to involve a caregiver and help yourself with pre-measured dispensers and mobile apps”, explains Graziano Onder, Professor of Geriatric Sciences, Catholic University of the Sacred Heart. “Periodic discussions with the doctor are also important to evaluate any changes to the therapy: sometimes it can be enough to vary the diet or increase physical exercise to reduce the number of drugs. The golden rule is always that of not interrupting or independently reducing the prescribed treatment”.
“It is advisable to follow the doctor’s instructions also to avoid possible interactions between drugs and between drugs and food, bearing in mind that some foods can increase or reduce the effectiveness of an active ingredient contained in the medicine”, says Francesco Landi, President of the Company Institute of Gerontology and Geriatrics (SIGG). “For those who assist a frail elderly person, in any care setting and in particular at home, the administration of medicines is an extremely important and highly responsible act: doing it correctly is equivalent to guaranteeing greater effectiveness of the therapeutic intervention, minimizing the risks for the patient”.
The decalogue “The elderly and drugs: 10 rules for correct use”
- Keep an up-to-date list of all your medications: both those prescribed by the general practitioner and by the specialist, including supplements and over-the-counter drugs, i.e. those that can be purchased in pharmacies without a medical prescription
- Be aware of the treatment you are doing: make sure you understand what disease or ailment a drug is being taken for, how it should be taken, what interactions or side effects it may cause. If there are any doubts or difficulties, always remember to communicate them to your doctor or pharmacist
- Inform your doctor about all medications you takeincluding supplements and herbal products that could interfere with the proper functioning of some medicines or with some foods
- Check periodically with your doctor about the treatment you are takingto evaluate changes in therapy or if some drugs in use can be replaced with a correct lifestyle, for example with diet or exercise
- Ask your doctor or pharmacist if it is possible to replace a medicine you are using with an equivalent medicine which has the same concentration of active ingredient, the same effectiveness and the same quality of the drug known by the brand name, and in addition has the advantage of costing less
- Get help in managing the therapy: involve a family member or caregiver as support in remembering the times and methods of taking medicines, especially if you have memory difficulties and risk administration errors
- Avoid DIY: take medicines only on doctor’s advice and do not interrupt or independently modify the dosage of the prescribed therapies
- Be supported by tools which can facilitate the correct intake of medicines: apps and reminders on mobile phones, or pillboxes organized with daily or weekly doses
- Pay attention to possible interactions between drugs and food because some foods can change the effectiveness of an active ingredient contained in the medicine. Always follow the instructions received on how to take it (on an empty stomach, before/after meals)
- Inform your doctor if your health changes due to external factors (e.g. a change in blood pressure caused by heat/cold), which can affect the drugs in use