Some of these may sound familiar. Are you ...

• taking more than one prescription drug?
• getting prescriptions from more than one doctor or pharmacy?
• taking one or several over-the-counter drugs with prescriptions?
• having trouble keeping track of all your medications?
• having liver or kidney problems?
• confused, disoriented or “spacey” some of the time?

You may take prescriptions for bladder management or to keep spasms under control. Then there are the antibiotics for the urinary tract infections and possibly something for pain. There are always risks with medications, and the risks rise as you age with your SCI and as the number of medications you take increases.

Why Are Older People at Risk?
Because of normal changes in the body that occur with age, drugs often act differently with older people.
As the body ages, the percent of water and muscle usually decreases, while the percent of fat increases. These changes can affect how long it takes for a drug to be absorbed into the body, how much is absorbed, and how long it stays. Also with age, kidney and liver function often slow down. These two organs are responsible for breaking down and removing most drugs from the body. As their function slows, undesirable drug reactions increase.
Medications tend to have a stronger effect as you age, increasing the risk of over-
medication. The risk increases as the number of medications increases. When five different drugs are taken, the risk of a bad reaction goes up to 50 percent. With eight or more drugs, the risk is about 100 percent. Bad reactions can range from medical complications to confusion and disorientation. They can cause you to be misdiagnosed with such conditions as dementia, Alzheimer’s or senility.
The use of medications, both prescription and over-the-counter, often reduces the level of endorphins­ those drugs your body produces to deal with pain and help you feel good. As a result, medications designed to help handle pain and anxiety don’t work as well, causing you to need more drugs. Other common complications for SCI survivors to note: incontinence, loss of appetite, balance problems, blurry vision and bowel accidents. In addition, lack of, or impaired sensation may make it difficult to recognize undesirable drug reactions.

How Are They at Risk?
Because older people tend to develop more long-term illnesses­arthritis, high blood pressure, heart problems, diabetes, digestive problems­it is common for them to be seeing different doctors and different pharmacists. These doctors and pharmacists are often unaware of each other or the different medications each is prescribing.
However, as you age, the risk of medical problems from drugs increases with the number of drugs you take. Older adults average three prescriptions a day, 15 different prescriptions per year, and consume 70 percent of all over-the-counter drugs.

What Is Medication Misuse?
About 25 percent of older people’s hospital admissions are due to incorrect usage of prescription drugs. Older adults are far more likely than younger people to respond unpredictably to drugs, and because of this, most prescription drugs are not even tested on older adults. Medication misuse is almost always the result of either failing to closely follow directions or not clearly understanding the medication and how to use it. Misuse also occurs by being unaware of how different drugs can interact. Medications prescribed to people with SCI often deal with pain or spasticity, or bowel or bladder function, making the consequences of misuse especially troublesome or dangerous. The risks are even greater when drugs for anxiety or depression are involved.
Even over-the-counter drugs such as vitamins, laxatives, cold remedies, pain relievers and antacids used in combination with prescription drugs or alcohol may lead to serious problems.

Some examples of misuse are:

• Not taking medication prescribed for you
• Taking medication at the wrong time
• Taking the wrong amount of medication
• Stopping the medication too soon
• Mixing drugs which may react dangerously with each other
• Taking medications prescribed for someone else
• Consuming alcohol or food which may affect the medication
  

Don’t Be Afraid to Ask Questions
Recent studies show that older people are far less likely than younger people to ask doctors or pharmacists questions about medications. They are even less likely to ask if they’re with someone else, such as a daughter or son. Asking questions helps you to know:

• Whether to take medication with or without food or water
• How different drugs may affect you when they are taken together
• What side effects to be aware of and look out for
• The adverse effects of mixing alcohol and medications
  

How Do I Reduce My Risk?
Drugs, whether they are prescription or even over-the-counter, are powerful medicines whose purpose is to affect how your body works. Safe use demands that you know what you’re taking, why you’re taking it, what it’s supposed to do and what the dangers are. Using medications improperly­too much, too little, or in combination with other drugs or alcohol­puts you at risk. In order to cut down your risks, as well as insure maximum positive results from whatever medications you may use, here are some basic rules to follow:

Ask Questions: Know what you're taking, what it's for, and what it's supposed to do. Be sure you understand the directions: ask the doctor or pharmacist if you don't! Always take the correct amount­on schedule, and for as long as prescribed. For example: you need to finish a prescription of antibiotics, even after you’ve begun to feel better.

Talk to Your Doctor: Inform your doctor of all other drugs­prescription and over-the-counter­you’re presently taking. Always inform your doctor of past problems with specific drugs. Ask about side effects of new medicines, or foods or beverages to avoid, as well as how to store your medications. Ask your doctor how and when to report any unusual reactions.

Get Organized: If you’re taking several medications, ask about pill containers or other methods of keeping track of the various medications, doses and times. Keep a daily record of drugs you’re taking­name of the drug, doctor, dosage and times. Ask for easy-to-open containers if necessary. Discard old medicines. Don’t try to be your own doctor by using leftover pills that have worked in the past.

Be Smart, Be Safe: Take only those drugs prescribed to you­don’t use a friend’s drug, even if your friend has symptoms similar to yours. If possible, always use the same pharmacy when filling your prescriptions. On your next visit to your doctor, take all your medications with you­both prescription and over-the-counter­so you and your doctor can review what you’re taking.

Remember:
Any drug­prescription or over-the-counter­strong enough to cure problems is also strong enough to cause harm if not used properly. Prescription drugs are precisely controlled because they are capable of doing harm. If you’re taking more than one drug, which is often the case with SCI, then chances of misuse are much higher. So,
...Ask questions
...Stay informed
...Be safe

This is one of more than 20 educational brochures developed by Craig Hospital while it was a federally-funded Rehabilitation Research & Training Center on Aging with Spinal Cord Injury. The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

For a hard copy of a METS brochure, click on your selection above and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.