【高齢者と薬】年を取ると薬って効きにくいの？副作用も気になります。
高齢者が薬を使用する場合、若年者と比較し、薬の副作用が起こりやすいことはご存じですか。その結果、高齢者は薬が効きにくいと誤解している方もいらっしゃるようですが、むしろその逆で、効きやすくなってしまった結果、問題が起こることがあります。
この記事では、高齢者と薬をテーマに効果的な薬の使用と、管理についてまとめています。
目次
加齢により薬は効きにくくなるか・効きすぎるのか
高齢になると、若いころと比較し、薬の効き方がかわってきます。
その理由は、身体の中で、薬を分解（代謝分解）する能力が遅れるからです。高齢になると肝臓や腎臓と言った、「代謝」「分解」「排泄」といった機能をつかさどる臓器も、働きが低下しています。
すると、薬の代謝分解が遅れ、薬の効き目が、必要とする以上に長引いてしまったり、薬が体内に残ってしまいます。
その結果、薬が効きすぎてしまうのです。
薬を服用すると、胃や小腸と言った臓器から吸収された後に、血液に乗って全身を回ります。そうすることで、目的となる臓器に薬が運ばれます。
この流れは、分布と呼ばれており、分布することで、薬の効き目が生じます。その後、「代謝」「分解」「排泄」と言った身体の機能を使い、時間をかけ薬の効き目を消して、体外へ排出させます。
他にも、薬の効きを左右する原因には次のようなものがあります。
■使用する薬の量が増えてしまう
本当に必要な薬や量であれば、当然薬を使用しなくてはなりません。しかし、長年いくつもの病院にかかっている場合や、長期的に同じ薬を処方されていると、摂取してる薬の内容が見直されていなかったり、効果が似通っている薬が処方されていることもあります。現在使用している薬を、漏れなく、正確に把握しておきましょう。
■薬に効きを求めてしまう
すでに病院から内服薬等をもらっているにも関わらず、症状がつらいからと、サプリメントや市販薬を併用して摂取してしまうケースも存在します。医師は本当に必要な薬を判断し、処方しているはずですから、同様の効果が期待できる処方薬・サプリメント・市販薬を併用しないようにします。また、ある若い方に向けた薬の処方の仕方、高齢の方に向けた処方というように、年齢に適した処方が存在します。薬の効きも、年齢により変わってくることも覚えておきましょう。
■自己判断で薬をやめてしまう
自己判断で薬をやめてしまうことで、新たな症状を引き起こしたり、本来期待していた薬の効き目がでないことがあります。薬はその1剤で効果を発揮するものもあれば、2剤以上で併用することでその効果が期待できるものもあります。
食べ物と関係する、相互作用とは？
お薬を2種類以上使うことで、摂取したお薬が互いに影響しあい、お薬の効き目を変えることを相互作用と呼びます。ものによっては、薬の効果が強くなってしまい、効き目が強くなり副作用に繋がるリスクが高まるケースがあります。それとは逆のパターンとしては、薬の効果が弱くなり、薬の効果がないと感じられ、不安になってしまいます。
この相互作用が起きるのは、薬、食べ物、サプリメント、喫煙が原因となります。
次にあげる注意すべき飲み合わせを覚えておきましょう。
相互作用について注意したい飲み合わせ
・カルシウム拮抗剤（血圧を下げる薬）【降圧剤】×グレープフルーツの摂取
・クラビットなど、一部の抗生物質×牛乳、ミネラルウォーターの摂取
・ワルファリン(血栓を防ぐ薬【抗血栓薬】)×納豆の摂取
・テオフィリン(気管支を拡げる薬【気管支拡張剤】)×喫煙、カフェインを含む飲料を摂取
・チザニジン(筋肉の緊張をほぐす薬【筋弛緩剤】)×喫煙
・カロナール、一部の制酸剤、（解熱鎮痛剤）×アルコールの摂取
・一部のパーキンソン病治療薬×アルコールの摂取
これらの組み合わせは、時間をずらせば問題ないというものではありません。
例えば、カルシウム拮抗剤とグレープフルーツの影響は、摂取後24時間程度に及ぶということが分かっています。グレープフルーツと服用すると問題のある相互作用の影響を受ける
時間は、その薬によって異なると言われています。長ければ2～4日程度持続するものがあり、注意が必要です。
効果的に薬と付き合うには
効果的に薬と付き合うにはどうしたらよいのでしょうか。次に挙げる対策を取ることをおすすめします。
■かかりつけの薬局を1つに絞る
病院やクリニックなど、大きさを問わず、併設されて調剤薬局がある施設は多くあるものです。しかし、同時にいくつもの薬局を利用していると、お薬の問題に気づけないことがあります。例えば2箇所の病院に通っており、それぞれ処方があったとします。本来であれば、併用してはいけない薬であるはずなのに、気づかずに処方されてしまっていたり、同じ効果の薬をいくつも飲んでいたと言う例も少なくありません。かかりつけ医と同じように、かかりつけの薬局も、1つに絞ることをおすすめします。
■お薬手帳を活用する
「お薬手帳」は処方薬局で、処方毎にだされる、処方薬内容を簡単にまとめたシールを貼っておくことのできる手帳です。処方薬局で無料でもらうことができるので、かかりつけの薬局に相談しましょう。
処方薬をもらう場合や、病院にかかる場合には常に持っていくようにします。お薬手帳があれば、医療施設や薬局であなたが現在どのような薬を内服しているかが一目でわかります。
■飲み忘れないような工夫をする
お薬カレンダーやお薬ボックスを活用しましょう。
カレンダーにポケットがついているものであれば、目につくため忘れ工夫ができます。同時にスマートフォンでお薬リマインダーも活用することで、時間になるとアラームで知らせてくれます。
また、お薬の内服確認はヘルパーさんにも行ってもらうことができますので、サービスを利用しているかたは、ケアマネさんに相談しましょう。
■かかりつけ薬剤師をもつ
かかりつけ薬剤師がいると、薬局が開いていない時間にも、薬の相談をすることができます。また在宅医療もサポートしてもらえます。他には、どれだけの薬が手元に残ってるか、残薬をチェックしてもらえることや、処方内容にあわせ、処方医に電話で相談もしてくれます。普段利用されている処方箋薬局で、かかりつけ薬剤師の制度が導入されているか確認してみましょう。かかりつけ薬剤師の制度を利用する場合、60~100円の負担がかかります。（3割負担の場合）
まとめ
お薬は、正しい量を正しい飲み方で内服しない場合、薬の効果がないばかりか、身体に悪い影響を及ぼすことがあります。特に高齢者は、加齢による身体の変化から、薬の効果が強くでたり、薬が身体に残りやすいという特徴があるので、より注意が必要になります。お薬手帳を持ち、かかりつけ薬局やかかりつけ薬剤師を決め、利用することをおすすめします。また一人でお薬の管理をすることが、困難、不安である場合には、介護サービスを利用するのも手です。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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