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(21.08.2025) The right dosage saves lives: Why medication needs to be adjusted particularly carefully for older people. An expert explains.

When older people take medication, special care is required. The art of the right dosage often determines well-being and quality of life - sometimes even life and death. Prof. Dr. Martin Hug, Head of Pharmacy at the Medical Center - University of Freiburg: "The organs of older people work differently, and this must be taken into account in drug therapy," emphasizes Hug.

Medication works differently in old age

With increasing age, the functions of the liver and kidneys change - two organs that are largely responsible for the breakdown and excretion of active ingredients. Hug explains: "Many medications remain in the body for longer in older people. If the dosage is not adjusted, this can lead to dangerous side effects." This is particularly critical with medication for high blood pressure, diabetes or pain. However, sensitivity to certain active ingredients can also increase or decrease with age. This can be the case with anticoagulants, antidiabetics and certain psychotropic drugs, for example.

Polypharmacy: when many medications become a risk

Many senior citizens take five or more medications every day. This increases the risk of interactions enormously. "Taking different medications at the same time can lead to active ingredients reinforcing or weakening each other," warns Hug. It is therefore essential to regularly review and adjust all medication.

The importance of the right dosage

Standard dosages, which are common for younger adults, are often unsuitable for older people. "We have to adjust the dosage individually - not only according to age, but also according to kidney function, weight and concomitant illnesses," says Hug. He recommends checking kidney function every time the medication is adjusted or changed significantly. This is particularly important if kidney problems have already been diagnosed in the past.

Lists such as PRISCUS help to avoid risks

To avoid dangerous side effects or interactions, there are aids such as the PRISCUS list. It lists medications that are particularly risky for older people and suggests better tolerated alternatives. Hug emphasizes: "Such lists are an important guide, but they are no substitute for individual medical and pharmaceutical advice."

The following side effects, among others, can be triggered by medications that are often prescribed to older people:

• Falls
  Sleeping pills and tranquillizers, drugs that lower blood pressure, drugs for dementia, Parkinson's drugs
• Confusion
  Sleeping pills and tranquillizers, medication for depression, neuroleptics, Parkinson's medication, painkillers (opioids), medication for urinary incontinence
• Dry mouth
  Drugs for depression, neuroleptics, drugs for urinary incontinence, some Parkinson's drugs
• Dizziness and drowsiness
  Sleeping pills and tranquillizers, antihypertensive medication, dementia medication, Parkinson's medication
• Nausea, abdominal pain, constipation
  Painkillers (opioids), medication for depression, Parkinson's medication, iron supplements
• Problems urinating
  Medication for depression, neuroleptics, medication for urinary incontinence, Parkinson's medication
• Incontinence
  Sleeping pills and tranquillizers, antihypertensive medication, Parkinson's medication, medication for dementia
• Sleep disorders
  Drugs for depression, some Parkinson's drugs, some antihypertensive drugs

Interdisciplinary cooperation is crucial

Safe drug therapy for older people works best as a team. At the Medical Center - University of Freiburg, physicians, nursing care and pharmacists work closely together to minimize risks. "We can only prevent side effects and hospital stays if we work together to meet the needs of patients," summarizes Hug.

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