Medications Matter

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Older adults tend to have multiple illnesses and therefore take more drugs, but polypharmacy (taking multiple medications) increases the risk of a poor outcome. The more medications a person takes, the higher the risk becomes of adverse drug reactions, nonadherence, financial burden, drug-drug interactions, and worse outcomes. From 1999 to 2011, estimates of the prevalence of polypharmacy rose from eight to 15 percent. One of the causes of this problem is that medications started in late middle age need to be closely monitored as the patient ages and those medications, at some point, may become inappropriate for an older patient. The problem of polypharmacy may be compounded by older patients who take over-the-counter medications and dietary supplements. Many times a patient may not consider these non-prescription items to be medication and may not tell their doctor about them.

In addition, medication usage is often dictated by controlled studies, many of which use younger study participants. The results of these studies may not translate well to older individuals. Let’s start with drugs with anticholinergic properties, which are often prescribed for older people. Anticholinergic drugs block nerve impulses in the central and peripheral nervous systems. This class of drugs includes antihistamines, antiparkinsonian agents, muscle relaxants, antidepressants, antipsychotics, antiarrhythmics, and others. Side effects from these drugs may include decreased coordination, dementia, dry mouth, blurred vision, increased heart rate, urinary retention, confusion, and many other effects. Benzodiazepines (Xanax, Valium) are among the most commonly prescribed psychoactive medications in developed countries and are used to treat anxiety, insomnia, and agitation. They have a potential for abuse and withdrawal, and their continued use, especially in older people, is associated with cognitive decline, impaired driving, falls, and hip fractures. The American Geriatrics Society recommends against using them and non-benzodiazepine hypnotics (Ambien) as first-line treatment for insomnia, agitation, and delirium in older individuals, yet the rate of their use is rising.

Statins (Lipitor, Zocor, etc.) are among the most commonly prescribed drugs overall and their use is rising. They are used for primary prevention of heart disease (preventing disease in those without it) and secondary prevention (preventing worsening disease in those with it). Many of the statin studies have used volunteers under age 60, yet their use has been extrapolated to use in those 80 and over. Myopathy (muscle pain) is a common side effect of statins plus they interact with many other medications including amlodipine, amiodarone, and diltiazem. Their use in primary prevention of heart disease in older people is now in question and their use in these patients should be closely monitored. Lastly, the use of proton pump inhibitors (PPIs i.e. Nexium, Protonix) has increased greatly, despite estimates that 25 to 70 percent of these prescriptions have no appropriate indication. Patients discharged from hospitals very often are prescribed a PPI for no clear reason. Although they are effective at treating GERD and dyspepsia, they have significant side effects including C Diff infections, pneumonia, hip fracture, kidney disease, dementia, and B12 deficiency.

To sum up, medications that may be appropriate for a 55-year-old may be inappropriate for an 85-year-old and medication use in older individuals needs to be closely scrutinized.

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