Practical aspects of drug treatment in elderly patients with mobility problems.

Elderly people with impaired mobility frequently experience difficulty with medication administration and compliance. Many medications are dispensed in packages or in containers which are difficult to access by older people with disabilities. Attending a medical centre, activating an inhaler, applying eyedrops or opening medication containers can prove major obstacles to medication compliance for older people with impaired function. Assessment of each patient's ability to physically comply with medication regimens by the physician is therefore recommended. Contact with the care giver or support person should also be made where appropriate. Compliance aids such as some calendar packages for medications, metered dose inhalers (MDIs) or eyedrop aids should be prescribed where indicated. Because of their close contact with many elderly patients when dispensing, pharmacists can also play an important role in ensuring adherence with medication regimens. Some medications may improve mobility as seen in the treatment of Parkinson's disease whereas other medications such as phenothiazines may impair mobility and contribute to falls. Several drug classes including antipsychotics, antidepressants, antihypertensives and benzodiazepines have been recognised as having an association with falls and impaired mobility. Multiple medications have also been found to be a risk factor in falls. Medications should be reviewed regularly and rationalised where possible. If mobility problems or unexplained falls are occurring, medications should be closely scrutinized as they may be responsible. Where possible, domiciliary visits for older people should be undertaken by health professionals as they often provide critical information about a patient's functional status, their medication compliance and their ability to cope at home. Emphasis must be placed on older people maintaining their independence and mobility. This is best achieved through a multidisciplinary approach.