How many medications do you take? How about your mother? Your grandmother?
Chances are your elderly loved ones take a lot more medicine than you do. Chances also are they may be taking some medications they should not.
A study published recently in the Journal of the American Geriatrics Society evaluated data involving more than 175,000 older adults enrolled in HMOs. Researchers found that almost a third of those older adults had received at least one of 33 medications deemed potentially inappropriate by medical experts.
“This study and others raise an important red flag,” said Dr. Mark Stratton , who holds the Herbert & Dorothy Langsam Endowed Chair in Geriatric Pharmacy at the University of Oklahoma College of Pharmacy. “It’s estimated that the population over 65 represent about 14 percent of the U.S. population. Yet, they take one-third of the prescription medications sold in this country and 40 percent of the over-the-counter medication market. These are huge numbers.”
It’s not only how many medications we take as we get older, but how our bodies react to those medications that can spell trouble.
“Changes in the brain, changes in other organ systems as we age affect how drugs are handled,” explained Stratton. “Then when we throw diseases on top of the aging process that compounds it even more, making older adults more sensitive to not only the desired effects, but also ultimately more sensitive to the adverse effects associated with medications. And the more illnesses an older person has, the more likely he or she is to have an altered response to a medication.”
According to Stratton ensuring the elderly do not receive inappropriate medications requires diligence on the part of doctors, pharmacists, older patients and their families.
Enter the Beers list. Developed in the early 90s, the list included prescription drugs considered inappropriate for use by nursing home residents. It was later revised to include all elderly people. (The Beers list can be viewed online at: http://www.dcri.duke.edu/ccge/curtis/beers.html . However, Stratton stressed if you or someone you know is taking a medication on this list, consult with a physician before making any changes.)
Stratton was a member of a national panel of experts convened in recent years to update the criteria for inappropriate medications for older adults again. Those efforts produced a new up-to-date list of inappropriate medications for older adults, including over-the-counter drugs, which can also be problematic.
“If the patient or pharmacist is willing and has access to this list, he or she can take an important first step toward avoiding potential problems with these medications,” said Stratton.
Even among commonly prescribed medications, there are certain drugs or classes of drugs that tend to be especially troublesome for older people. These include some medications used to treat high blood pressure. “For example, we know among high blood pressure medications, there are medications we should use and others we shouldn’t use for older people,” said Stratton.
He added other problematic prescription medications include those for diabetes, blood thinners and medications that work within the brain or so-called psychoactive drugs. “Within that group of psychoactive medications, there’s a class of medications that are used to treat sleep disorders or used to treat anxiety. They’re called benzodiazepines. But within that class of drugs, of which there are many, there are medications that are absolutely never to be used in people over 65. Those include Valium, Librium and Dalmane.”
Stratton pointed out Celebrex, Bextra and other COX-2 inhibitors should not be used in anyone with a history of heart trouble, with elevated cholesterol or elevated blood pressure and possibly should not be used in the elderly in general.
“Ask questions every time a new prescription is written,” urged Stratton. “Talk to your doctor about possible risks and side effects. Then talk to your pharmacist too.”
He pointed out over-the-counter medications can add to the problems too, especially when older people buy them to enhance the effect of other prescription medications.
If an older person is looking for an over-the-counter medication and he or she has multiple medical problems and is already taking multiple medications, Stratton said it’s time to consult the pharmacist. “Take that over-the-counter medication back to the pharmacist and talk with him or her about what’s in it. ‘You know my other health conditions. You know my other medications. Is this going to be safe for me to take?’ Don’t be afraid to ask questions.”
Stratton said the bottom line is there is no medication that is risk-free. “Our goal is to maximize benefit and minimize the risk whenever we can do that.”