Chan KM

It is sometimes evitable for the elderly to be taking medicine.  There are some gender differences in the way elderly takes medicine.  Elderly men tend to be more stoic and tend not to see a doctor until they are quite sick, and once they are well, they also have a tendency to default their follow up.  Women, on the other hand, tend to seek consultation earlier and they tend to be more ‘obedient’ in following the orders of the doctor with respect to taking their medications.  Hence, I am not surprised that your dad is one of those who ‘always disobey doctor’s prescribed medications’.

However, I feel that the key to getting those who are not so compliant into taking their medications is patient education.  Half-truths are as damaging as ignorance, or may be even worst.  People have the tendency to think that traditional Chinese medicine (TCM) is not medicine.  In fact, medicines are basically chemical agents that are meant to improve the person’s health, either by enhancing the health or treating the disease.  Western medicine are man-made or man-modified chemical agents, while some TCM are naturally occurring chemical agents.  Both can be beneficial to the person if taken for the correct indications and at the correct dose, and both can be equally damaging if abused.

Similarly, all these chemical agents are absorbed in the gut and all will pass through the liver, detoxified and excreted either through the liver (via bile) or through the kidneys (via urine).  So, both also have the potential to damage the liver and the kidney if taken at the wrong dose or for the wrong indications.  In Western medicine, through various studies, we actually know that certain combinations of medicine are beneficial for the person; for example, the use of ACE inhibitors in a diabetic patient with high blood pressure can protect their kidneys from damage due to their diabetes.  I am sure it is the same for TCM where they have their own system of combining herbs for the treatment and protection of the body.  The point is, therefore, that they should obtain their TCM from a suitably qualified TCM Practitioner, just as they would get their Western medicine from a suitably qualified doctor.  Since we do not know exactly the chemical content of naturally occurring herbs, it is always prudent not to take it with Western medicine.  But knowing our local elderly, you know that some of them will do so regardless of what you tell them.  Therefore, if they must, take their TCM at least 2 hours apart from their Western medicine.  TCM should not be taken at all if the person is taking certain Western medicine – example, oral anticoagulants like Warfarin.  This is because depending on the type of TCM, they could either enhance the effect of Warfarin and cause bleeding, or reduce the effect of Warfarin and render it ineffective as a blood thinner.

Other ways of ensuring compliance of taking medicine include simplifying the regime.  Some regimes are so complicated that it is confusing to the elderly.  For example, a certain medicine to be taken before food once a day except two days of the week that it is taken twice a day.  Using a pill box to organize the pills helps.  The elderly also should have an understanding of what they are taking, rather than just swallow a whole lot of medicine without knowing what they are for.

If you detect a genuine difficulty in compliance to medicine because the person just cannot remember in spite of all the above aids given, it could be that the person is suffering from dementia and this warrants an assessment.

When a person takes a medicine and develops a rash or hives which are widespread and itchy, then this person may be allergic to the medicine taken.  He has a drug allergy and not skin allergy.  Sometimes, the offending agent may not be so obvious.  It may be some air borne dust, insect bite, food or even heat, friction, sunlight and exercise.  The skin reacts to these stimuli by releasing certain chemicals that cause swelling, itch, redness and warmth.  In the elderly, a common cause of itchy skin is actually xeroderma or dry skin.

The different types of skin allergy are eczema, allergic contact dermatitis, urticaria and angioedema.  Skin allergy may be a symptom of other medical conditions like asthma, skin infections and blood disorders.

If skin allergy is left untreated, the patient may have a poor quality of life because of the itch, which varies in intensity.  Their sleep may be disturbed.  The scratching will damage the skin and increases the risk of skin infection.  The underlying medical condition like asthma and blood disorder may not be discovered.