Managing pain medication can be difficult for anyone, however, older adults may face certain challenges that require extra attention, including:

  • Multiple medications. Medical problems may add up as the years go by, resulting in multiple medications, sometimes from different prescribers. More medications, in turn, can increase the chance of experiencing a drug side effect or having an unwanted drug interaction.2
  • See Non-opioid and Topical Medications for Chronic Pain

  • Physical changes. Age-related physical changes can affect how older adults respond to medication. For example, liver and kidney function dictate how medications break down and leave the body, and these organs may work differently in older adults. As a result, dose adjustment and medication selection are important considerations. Sometimes, routine lab work can tell a doctor how a new medication will work for an older patient.

In addition to these common issues, there are other physical and mental factors that influence appropriately taking pain medication.

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Taking Pain Medications: Physical Limitations and Side-effects

Age-related physical changes can lead to discomfort or incorrect use of pain medication:

  • Constipation. Generally, constipation increases with age, and it is also a common side effect of some pain medications, especially opioids. Drinking more water than usual can help prevent constipation. If opioid-related constipation does not lessen over time, finding a way to balance taking pain medication with proper laxative support may be necessary. Commonly used nonprescription medications for opioid-induced constipation include Colace, Senna-S, and Miralax. Relistor and Movantik are prescription options.
  • See Opioids’ Potential Risks and Side Effects

  • Breathing problems. Some pain medications, especially opioids, cause the respiratory system to slow. Issues related to chronic obstructive pulmonary disease (COPD), asthma, bronchitis, and pneumonia tend to be more common in those age 65 and older and can add to the risk of opioid-related breathing difficulties.
  • Difficulty swallowing. Medically known as dysphasia, difficulty swallowing can make it challenging to take medication in pill or tablet form. Patients should speak to their doctors about swallowing issues. Some medications are available in easier-to-take forms, such as a liquid or a patch.

Communication about any medication-related problems with the doctor or pharmacist is recommended.

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Taking Pain Medications: Challenges with Cognitive Decline

Many older adults experience age-related cognitive decline. Even mild memory problems can cause a person to forget to take his or her medication or accidentally repeat a dose. The result is too little or too much pain medication in a person’s body.

These strategies may be helpful:

  • Reminder devices. If memory issues are not severe, medication reminder devices may be considered. Medication dispensers with timers and watches with alarms can be helpful to both older adults and caregivers in remembering medications. There are also smart phone apps to help people remember to take medication.
  • Outside support. Family members, friends, or caregivers may need to assist with medications in certain situations. Some independent living communities have nurses on staff who can visit patients daily to administer medications.
  • Keeping track. It is best to carry a list of current medications and properly dispose of old, unused medications. A medication list is especially useful when seeing a new doctor or if an unexpected visit to urgent care or the emergency room occurs.

Family members who notice mild cognitive decline beginning to occur are advised to be alert for how medication may be affected if symptoms worsen. Cognitive issues should be shared with a doctor.

References:

  1. Koronkowski M, Eisenhower C, Marcum Z. An Update on Geriatric Medication Safety and Challenges Specific to the Care of Older Adults. The annals of long-term care : the official journal of the American Medical Directors Association. 2016;24(3):37-40.
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