Many Drugs Not Well-Suited for the Elderly

By Michael Lasalandra | Beth Israel Deaconess Medical Center Correspondent
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As people age, they are likely to require more and more medications for a variety of ailments. But if those multiple medications are prescribed by a number of doctors, patients can run into trouble. Some drugs don’t interact well with others. Some simply are not ideal for senior citizens.

“Older people tend to go to a lot of specialists,” says Dr. Suzanne Salamon, Associate Chief for Clinical Programs for Beth Israel Deaconess Medical Center’s Gerontology Division. “Each one may add another pill. Once they are taking a lot of pills, even if they are taking small doses, they can interact. On top of that, there are a lot of medications that are potentially dangerous for older people.”

In fact, an estimated 177,500 Emergency Department visits for adverse drug events by patients aged 65 and older occurred annually in 2004 and 2005 in the United States alone, according to Journal Watch.

For this reason, some institutions, including BIDMC, combat the problem by using a computer program that red flags prescriptions written for medications listed in what is known as the Beers criteria–a list of medications that are generally considered inappropriate when given to elderly patients because these drugs may pose more risk than benefits. For a variety of reasons, these medications tend to cause side effects in the elderly due to the physiologic changes of aging. The criteria were created through a consensus of a panel of experts.

“If anybody orders one of these medications here, a big red alert pops up,” says Dr. Salamon. “The computer knows if the patient is over age 65 and sets off a red flag.”

There are many medications on the list, but among those that are of most concern are tranquilizers, pain medications, muscle relaxants, cold medicines and drugs for bladder control, she says.

Tranquilizers, such as Valium (generic diazepam) or Xanax (generic alprazolam) or Ativan (generic lorazepam), have a variety of problems associated with them when used by the elderly, she notes. “They can make people very sleepy, can affect the short-term memory and are associated with risk of falling,” she says.

Pain medications–even nonsteroidal anti-inflammatories (NSAIDS) such as Aleve or Advil–can also cause problems, according to Dr. Salamon.

“We have to be very careful about pain meds,” she says. “There are lots of side effects. NSAIDS can be fabulous for pain, but in large doses can affect the kidneys or cause stomach bleeding or increase blood pressure. They are okay to use but we have to monitor that none of these things is occurring.”

Cold pills with antihistamines should be avoided by the elderly as they can make people sleepy, increasing the risk of falling, says Dr. Salamon. In addition, they can affect the bladder and impede the ability to urinate, she notes.

Bladder control medications, such as Detrol and Ditropan, can cause side effects such as dry mouth, confusion and sleepiness. “They can make life easier, but you have to balance it,” she says. “It is best to start at low doses.”

Muscle relaxants such as Robaxin or Flexeril “are very sedating and can increase the risk of falls,” Dr. Salamon notes.

The important thing to remember is to start nearly any new drug at a low dose, she says. “The kidneys and liver shrink as we age,” she says. “The same dose that is good for a 30-year-old is too much for an 86-year-old.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

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