The Role of Compounding Pharmacies in Geriatric Medicine

Mahshid Moghei, PhD Medically reviewed by Mahshid M. on | Written by Philip Lindeman MD-PhD

Senior Woman Reviewing Food Supplements for Personalized Health Care

Key Takeaways

  • Compounding pharmacies create custom medications for older adults.

  • Individualized dosing reduces drug interaction risks.

  • Compounding offers easier dosage options for those who struggle with pills.

  • Compounded medications can eliminate unnecessary ingredients.

  • Compounding pharmacies help ensure access to necessary treatments despite shortages.

In Act 2 of Hamlet, Rosencrantz quips, "…an old man is twice a child." I often reflect on this line when prescribing medications for older adults, as many considerations overlap between my youngest and oldest patients. This post focuses on the latter group and the challenges we face in treating them.

The older adult population is rapidly increasing, a trend driven by advancements in healthcare and longer life expectancies. As this demographic grows, healthcare systems are faced with the growing complexities of addressing their needs. Older adults frequently have multiple chronic conditions, such as heart disease, diabetes, and arthritis, which often result in polypharmacy—the use of various medications. This increases the risk of drug interactions, side effects, and non-adherence. Age-related physical and cognitive decline can make standard treatment methods, like swallowing pills or following strict regimens, difficult to manage. Adding to these challenges are sensitivities to medication ingredients, drug shortages, and the need for customized dosages to account for slower metabolic rates. Consequently, healthcare providers must adopt more personalized, interdisciplinary approaches to senior care, ensuring that treatments remain safe and effective for aging individuals.

The Unique Challenges Faced by Seniors Regarding Standard Medications

As people age, their metabolism slows, making it more difficult for their bodies to process medications efficiently. Coupled with the prevalence of multiple chronic health conditions, this means that standard drug dosages may not be appropriate for seniors. Over-medication can lead to harmful side effects, while under-medication may render treatment ineffective. Precise dosing is critical in senior care to ensure the desired therapeutic effect without increasing the risk of complications.

Many older adults also struggle with swallowing pills due to conditions like dysphagia (difficulty swallowing) or dry mouth, both common in the geriatric population. These issues can make it difficult for seniors to take their medications consistently, potentially leading to missed doses and compromised treatment outcomes.

The Risks of Polypharmacy

Polypharmacy refers to the practice of taking multiple medications simultaneously, a common occurrence among seniors managing several chronic conditions such as diabetes, heart disease, and arthritis. While often necessary, polypharmacy increases the risk of adverse drug interactions, side effects, and medication errors, which can lead to serious health complications like falls, confusion, or hospitalization. Additionally, managing multiple medications can overwhelm older adults, contributing to non-adherence or improper dosing. Seniors are especially vulnerable to the cumulative effects of medications due to slower metabolism and declining organ function, further complicating treatment. Given these risks, it is crucial for healthcare providers to carefully monitor and adjust medication regimens. Compounding pharmacies can also play a role by consolidating medications and simplifying treatment plans, helping to reduce unnecessary complexities.

Medication Sensitivities Among Older Adults

As we age, we often become more sensitive to the fillers, dyes, and preservatives commonly found in commercial medications. While generally harmless, these additives can trigger allergic reactions, digestive issues, or skin irritations in older adults with weakened immune systems or heightened sensitivities. For seniors managing multiple health conditions, such reactions can complicate treatment and reduce the effectiveness of essential medications.

Compounding Pharmacies for Older Adult Medicine

Compounding pharmacies create custom medications that are precisely dosed and formulated to meet the specific needs of older adult patients. Unlike standard commercial medications, compounded prescriptions can be tailored to account for age-related changes in metabolism, making treatments both more effective and safer. These pharmacies also offer alternative dosage forms, such as liquids, creams, or patches, which are easier for older adults to administer, especially for those who have difficulty swallowing pills. Additionally, compounding pharmacies can remove unnecessary ingredients, such as preservatives or allergens, that might trigger adverse reactions in sensitive older patients. By providing personalized treatments, compounding pharmacies improve medication adherence, minimize side effects, and enhance the overall quality of healthcare for seniors.

Compounding pharmacies address many of the aforementioned issues by creating custom doses tailored to each patient's metabolic rate and medical profile. For example, they can reduce the strength of heart medications to better align with an older adult's decreased metabolic capacity or adjust doses for patients taking multiple medications to prevent drug interactions. By offering these personalized solutions, compounding pharmacies help manage chronic conditions more effectively and safely in older adults.

Addressing Medication Shortages and Discontinuations

Medication shortages and discontinuations pose significant challenges for older adults with chronic conditions. Many older medications are phased out or become unavailable due to manufacturing issues or decreased demand, leaving patients without essential treatments. In such cases, compounding pharmacies play a crucial role by replicating these medications and providing customized formulations tailored to individual patient needs.

For instance, consider an older adult who had been successfully managing her chronic pain with a now-discontinued analgesic. After consulting with her healthcare provider, a compounding pharmacy formulated a customized version of the medication, allowing her to maintain effective pain management and improve her quality of life. This example underscores the importance of compounding pharmacies in addressing medication gaps and ensuring continuity of care for vulnerable populations.

Managing Chronic Conditions with Tailored Therapies

Managing chronic conditions such as arthritis, hypertension, or dementia requires long-term medication strategies tailored to a patient’s evolving needs. As older adults experience changes in their health status, compounding pharmacies play a vital role in adjusting formulations to provide optimal care. For instance, a patient with arthritis may benefit from a customized topical pain relief cream that combines multiple analgesics for enhanced effectiveness. Similarly, a patient with hypertension might require a specific dosage of a heart medication that is not commercially available. Cognitive support therapies can also be tailored to address varying degrees of dementia, ensuring that patients receive the most appropriate treatment. This individualized approach not only improves medication adherence and efficacy but also significantly enhances the quality of life for older adults managing chronic conditions.

If you are caring for a loved one who is aging and struggling with medication management, consult their healthcare provider about the potential benefits of involving a compounding pharmacy. Additionally, some issues may be addressed through an online pharmacy. Your healthcare provider can help guide you through this process.

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Sources

  1. Krause JE. The Art, Science, and Technology of Pharmaceutical Compounding, Third Edition. Am J Pharm Educ. 2009 May 27;73(3):39. PMCID: PMC2703278 .

  2. Hughes CM. Medication non-adherence in the elderly: how big is the problem?. Drugs Aging. 2004;21(12):793-811. doi: 10.2165/00002512-200421120-00004. PMID: 15488173.

  3. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. doi: 10.1517/14740338.2013.827660. PMID: 24073682.

  4. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6-14. doi: 10.1046/j.1365-2125.2003.02007.x. PMID: 14678335.


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The content on this page is for informational and educational purposes only and does not constitute professional medical advice. Patients should not use the information presented on this page for diagnosing a health-related issue or disease. Before taking any medication or supplements, patients should always consult a physician or qualified healthcare professional for medical advice or information about whether a drug is safe, appropriate or effective.