Medications and polypharmacy

In health 2005, prescription costs of older adults were reported at $1807 per person
per year.1 They now represent more than 10% of Medicare costs. Prescription medicines are
those ordered by a physician or other health care provider within the scope of their license,
and do not include vitamins, herbal medicines, or over-the-counter (OTC) medicines. OTC
medications are any pills, liquids, salves, creams and suplements that are purchased at a
pharmacy, discount, or food store without prescription. Most complementary medicines such
as botanicals and herbs are sold as OTCs.

Prevalence of medication use for community-residing older adults was discussed in

chapter 18. Polypharmacy (taking several different drugs each day) is common in older
adults, and was included as a nutritional risk factor in the Nutrition Screening Initiative.
Comorbid conditions lead older adults to take more medications, both OTC and prescription,
than younger adults, and theraby increase the potential for drug interactions and side effects.
Disease progression, drug effects, and functional limitations such as poor eyesight or
impaired memory, all increase risks for using a drug incorrectly. The potential for error also
in creases with the number of drugs.

Effect Of Medication Medications may require dietary restrictions and can interfere with
appetite, digestion, and metabolism and general alertness. For example, the blood-thining
drug warfarin requires a stable vitamin K intake (see Table 19.12). The cost of drugs may
also negaratively affect a person’s food budget. Inabillity to eat or for getting to eat lead to
unintentional weight gain. Table 19.13 describes nutritional implications associated with
medications used to treat diseases that are prevalent in older adults.

Table 19.12 Amounts of vitamin K in selected fruits and vegetables (DRI for ages 51 and
older is 120 mcg/day for males, 90 mcg/day for females)

Less than 5 mcg vutamin K :

1 c servings of corn, mushrooms, onion, baked and navy beans, potatoes, applesauce,
cherries, pineapple, strawberries

1 apple , banana, nectarine, peach, pear, orange, tangerine, 5 dried apricots, 5 dates

5 to 10 mcg vitamin K :

1 c canned apricots, fresh raspberries, chickpeas, lima beans, all varieties of squash, stewed
tomatoes, sweet potatoes, fruit coctail, papaya

2 figs

>10 and <50 mcg vitamin K

1 c yellow and green string beans, blueberries, red cabbage, carrots, cauliflowers, celery,
cucumber, with and without peel, iceberg lettuce, roasted peppers, canned plums, grapes (red
or green)

1 kiwi, 2 springs parsley

>50 mcg vitamin K (1 c cooked unless specified):

Beet greens, turnip greens (529-851)

Brocoli (183-220)

Cabbage, any (27-58)

Collards (836-1059)

Kale ( 1062-1147)

Romaine lettuce (57)

Green leaf lettuce (97)

Mustard greens (419)

Okra (64)

Raw green onion (207)

Prunes or dried plums (65)

Rhubarb (71)

Raw spinach (145)

Cooked spinach (1027)