Did you ever come across people who are healthy and active, but all of a sudden, crashed to the floor? If yes, you will notice this often happened to older adults, and they usually do not have idea why they had fainted. In this article, I hope to share with you some common medication problems we are facing in old age. If you are getting older, you can easily be at risk of over-prescribing medicines.
Professor Sarah Hilmer, a geriatric pharmacologist from Royal North Shore Hospital in Sydney, says over-prescribing medications for older people are one of the major factors that caused them to pass out. Hilmer explains medicines work differently in our bodies as we age.
As we get older, our bodies generally have less muscle and more fat. We also shrink in size with liver and kidneys don’t work so well, as such we often don’t need the same dose as we did when we were younger. Another possible factor is the medication might not be right for us at all.
Medications for Blood Pressure
Based on studies, people tend to combine medications to lower their blood pressure and cholesterol. They do so to reduce risk of deaths from heart disease. But the problem is people still continue to prescribe high doses of medication even after their blood pressure is within acceptable range.
Can you imagine, if this were to happen to older adults?
This will lead to confusion, falls, dizzy spells, severe kidney health problems due to over-treatment from medications. This is exactly when medicines do more harm than good, as we often heard. You may read drugs that lower blood sugar are involved in many medication-related hospitalizations.
For people with diabetes, their doctor will likely be more aggresive to treat their high blood pressure in order to reduce the risk of heart diseases and stroke. On the contrary, the Cochrane Review had found that lowering blood pressure too much will have serious health impact for people with diabetes.
The chief researcher of a Swedish study, Dr. Mattias Brunström revealed that diabetics who do not have high blood pressure, will have 15 percent higher chance of death due to taking blood pressure-lowering medications. The risk of death is attributed to heart disease and stroke, in this case.
Drugs to Lower Cholesterol
Statin is now considered as the most prescribed drugs in the world for cholesterol lowering. People over the age of 60 tend to take it for disease prevention. However, Professor Sarah Hilmer advises older adults to stop taking statin if they have not had a heart attack or stroke before. She noted from her studies the benefits of statins are unclear in older adults and the side effects on health are high.
A large 2015 Finnish study showed the more statins people took, they risk lowering the insulin sensitivity and insulin secretion. The study had also found that people with Alzheimer’s do experience improvement in cognitive function after stopped taking statin.
Studies have shown older adults who have no current signs of cholesterol-laden plaque build-up in their blood vessels derive little or no long-term disease prevention benefits by taking statin. People do experience muscle aches and weakness as well as risk themselves of new-onset diabetes due to taking statins.
You may want to read “Some Older Patients Are Treated Not Wisely, but Too Much”.
Insulin for Diabetes
In a large 2015 US study, Dr. Jeremy Sussman (an internal medicine specialist), found that older patients with diabetes rarely had their insulin dosages adjusted. When people take more insulin than necessary, they risk getting hypoglycemia.
Hypoglycemia is a condition when you have too little glucose circulating in your bloodstreams. This often leads to confusion and other cognitive impairments, falls, coma and even death.
Since it takes decades for blindness or kidney failure to occur due to poorly controlled diabetes, you must weigh the benefits of taking insulin versus the very real risk of a hypoglycemia attack.
Very often, doctors don’t follow up to ensure you are well tolerance with your prescribed medicines. Or they continue to refill your old medication prescriptions without considering those drugs are still or ever necessary.
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Opioids for pain
If someone you know is overusing opioids to control their pain, you may highlight to them that opioids work very well for acute (short-lasting pain) and pain caused by cancer. However, there is minimal evidence Opioids are effective for long-term, chronic pain.
The harm of using opioids is high as they not only cause side effects such as constipation and impaired memory, those who use opioids will later become tolerance to it and needed more and more in order to feel the same relief.
“If you are going to try an opioid for pain relief, you should on a low dose for a defined period with a defined treatment goal,” says Professor Sarah Hilmer.
Instead of taking another pill to lessen the experience of pain, recent studies have shown more people have become aware the benefits to adopt cognitive behavioural therapy as part of their pain reduction treatment routine.
Sedatives for insomnia
“It’s important for people to understand that for every medicine or test there is a risk and a benefit. Most of the time the benefits far outweigh the risks. However, for medicines there is always a risk of side effects, and the risks can multiply when you take multiple medicines.
Your doctor may not know what you are taking, you as the person taking the medicines really have the best visibility. We encourage people to keep a list, and have a periodic review to make sure the medicines not doubling up,” says Dr. Robyn Lindner of Choosing Wisely Australia.
Studies have also found anti-insomnia sedative drugs such as Zolpidem (Ambien/Stilnox) and other similar drugs (i.e. Eszopiclone/Lunesta, Zaleplon/Sonata) do have a role in car collisions. Car collisions noticeably happened after women and elderly aged 80 and over took the drugs at night. These anti-insomnia sedative drugs have been linked to increases in falls.
In February 2008 the Australian Therapeutic Goods Administration attached a boxed warning to zolpidem (Stilnox), stating it “may be associated with potentially dangerous complex sleep-related behaviours that may include sleep-walking, sleep-driving …”
How do you know how many pills is too many?
“The number of pills you take is directly correlated with your likelihood of having an adverse drug reaction,” says Dr. Cara Tannenbaum, a geriatrician and pharmacy professor. This is because drugs are not tested in combination with each other.
Dr. Cara Tannenbaum advises us to beware of the prescribing cascade, i.e. you get a second pill because you thought you have a new symptom due to a rash or nausea and not realizing it was a side effect from one medication. You may learn the 5 Medication Safety Tips for Seniors.
I would suggest you to never stop taking a medication or change your dosage without medical guidance. One thing you ought to do is to discuss the risks versus the benefits of every medicine with your doctors and pharmacists, and ask them whether your prescriptions are still right for you as you grow older.
If you are concerned about possible dangerous drug interactions, you may ask a pharmacist or use this online drug interaction checker for help. You may read what is a proper way to store your medications.
Sometimes, a simpler and safer option for leading a healthier life is simply to make some slight lifestyles changes like eating healthier foods or exercising more!
Tan Kok Hui
Nutrition Made Simple, Life Made Rich