Drugs and aging can be a deadly combinationBy Misti Crane The Columbus Dispatch
The medication your doctor suggested when you were 55 could be the very pill he wants you to ditch at 70.
Aging bodies metabolize medication differently, meaning that some drugs we tolerate when we’re younger can be bigger threats to our kidneys and liver when we’re older. Furthermore, prescriptions and over-the-counter treatments that carry risks such as dizziness can be more dangerous to older patients who are more prone to falling.
And then there’s the challenge of volume. About half of patients older than 75 take at least five prescription medications, and a similar percentage are taking something over-the-counter routinely, said Dr. Tanya Gure, the chief of geriatrics at Ohio State University’s Wexner Medical Center.
The more pills you take, the higher the likelihood they’ll interact with one another or stack up to a bigger side-effect burden than they would on their own.
Older people also tend to have central nervous systems that don’t work as well and face a higher risk of low blood pressure and low blood sugar, said Dr. Greg Wise, the chief medical officer at MediGold, Mount Carmel Health System’s Medicare Advantage plan. On top of that, liver and kidney function isn’t what it used to be, he said.
The American Geriatrics Society maintains and recently updated a list of medications that should be avoided or seriously evaluated in older patients. The list, called the Beers Criteria, helps guide doctors and pharmacists to protect patients and can be found at www.americangeriatrics.org.
Sleeping pills, anxiety pills and anti-inflammatory drugs are among the common medications that pose greater risk as we age. In most cases, doctors recommend other ways to cope with problems such as arthritis pain — exercise, for example.
“There are generally options, but there are some very difficult decisions to make,” Wise said. “ It’s a careful transition, and it’s not exactly black and white.”
Ann Collins, one of Wise’s patients, had been taking the same antidepressant since her 20s when he suggested she stop last year. The medication she took can cause dizziness and heart problems, both of which are of greater concern among senior citizens.
Collins, who is 70, said her depression had been under control for decades and she was apprehensive about a change.
“He said, ‘I cannot in good conscience let you take it any further,’??” Collins said. “I said, ‘ Well, we’ve got some problems because this stuff isn’t easy to get off of.’??”
She tapered off her original medication and tried another that didn’t do her any good.
“Every day I was crying, and my husband was miserable, and my sisters were miserable,” said Collins, who lives in Groveport.
She tried a third medication, Paxil, which has worked.
Decisions to stop a medication at a certain age aren’t always clear-cut and should be made in partnership with patients, said Dr. Marian Schuda, the medical director of OhioHealth’s Gerlach Center for Senior Health.
“You have to be very open and compassionate with people. People take medicine to feel better or to try to stay healthy. ... The question is, do you need the drug?” said Schuda, who routinely does medication audits with older patients, including looking at supplements and over-the-counter pills.
“Most people have a drug we can eliminate, and lots of people need better drugs than they’re getting.”
One of the most-common concerns, and one that surprises many seniors, is the use of non-steroidal anti-inflammatory drugs, such as Advil, Aleve and Motrin. They can cause stomach bleeding.
“I spend a lot of time talking to people about the fact that, for most pain, acetaminophen works as well in most studies and it’s safer,” Schuda said.
Acetaminophen (the active ingredient in Tylenol) carries a risk of liver damage, which must be considered in people with existing liver problems. But in most cases, low doses don’t pose problems, Schuda said.
She said she has a lot of conversations about over-the-counter sleeping aids as well. They are risky, and there aren’t many good options, so Schuda said she often suggests changes such as eliminating naps to encourage better rest at night.
Another problem is testing. Older adults often are left out of research that leads to a drug’s approval, and doctors should be mindful of that, Gure said. Dosing recommendations for a healthy middle-age man might be toxic to a frail 85-year-old woman.
Guidelines such as those offered by the Geriatrics Society shouldn’t be seen as dictatorial, she said, but as a good tool to help clinicians, patients and family members talk about what course is best.
“Prescribing medications is a very complex process,” Gure said.