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Wednesday, June 19, 2013
The Risks in Using Multiple Medications
Medications that Pose a Risk and Why
Special Considerations: Drugs Affecting the Central Nervous System
General Advice for the Elderly Population
Elderly patients take about three times as many medications as younger patients do.1 They are also the greatest consumers of prescribed and nonprescribed medications.2 There has been a gradual increase in prescription drug use in the United States. According to the Medicare, the average number of prescriptions per year, including refills, is currently 28.5 per senior (up from 19.6 in 1992). The average cost per prescription has also jumped from $28.50 in 1992 to $42.30 in 2000, an increase of 48%. Since the elderly have less participation in drug trials, there is insufficient information on the side effects and adverse reactions of drugs on the elderly. As a result, older patients have to rely on general guidelines with information extrapolated from other age groups to make decisions regarding prescription drug use.1
Prescription medications can improve the symptoms of a disorder and improve the quality of life. However, they also have the potential to cause dangerous side effects. A good guideline followed by physicians who prescribe medications to the elderly is to "start low and go slow," meaning the elderly should take new medications at a slower rate and start at about half the adult dose. As our bodies change with age, so does the need for a different dosage, interval and duration of treatment. The longer an individual is on a drug, the greater the likelihood of an adverse reaction. The effects of a harmful drug reaction can appear as an isolated symptom (drowsiness) or as a group of symptoms (depression and confusion). In the elderly, toxic reactions can occur even at low drug dosages. Therefore, the elderly should approach the use of prescription medication with caution and report any unusual or new symptoms to their health care provider. It is important to consult a health care provider before changing any prescription medication dosage.
Medications of Risk
Long acting agents
Flurazepam (Dalmane )
|Confusion, sedation and falls.|
|Antidepressants (used to treat depression),
|Confusion, sedation, hypotension, falls, and urinary retention.|
|Antipsychotic Agents (used to treat mental disorders)
|Confusion, sedation, hypotension, falls, urinary retention, Parkinsonism (involuntary shaking and twitching), tardive dyskinesia (TD).|
|Antihistamines (used to treat sinus problems and allergies)
|Confusion, sedation, hypotension, falls, and urinary retention (inability to empty bladder), sleep disturbance.|
|Antiemetics (used to relieve nausea)
|Confusion, sedation, hypotension, falls, urinary retention, Parkinsonism (involuntary tremors and rigidity), involuntary movement (tardive dyskinesia)|
|Analgesics (used to relieve pain)
|Constipation, confusion, & sedation.|
|Antiparkinsonian (used to treat Parkinsons disease)
|Confusion, dizziness, hypotension, increase in cardiovascular toxicity.|
|Cardiovascular drugs (used to treat heart and blood vessels)
|Nausea, vomiting, anorexia, weight loss.Bleeding tendencies (requires close monitoring)|
|Antispasmodic drugs (used to prevent or relieve spasms)
Hyoscyamine (Levsin, Levsinex)
|Dry mouth, constipation, urinary retention, delirium.|
|Urinary Incontinence drugs
|Dry mouth, constipation, urinary retention, delirium, confusion|
|Psychoactive drugs have an effect on the brain and are among the most frequent medications given to the elderly. Elderly patients generally require lower doses of psychoactive drugs, in some cases one-fourth to one-half the dose of a younger patient.3||Examples of Psychoactive Drugs:|
Psychoactive drugs are not the only type of medication that can produce dangerous side effects. Drugs that relieve pain (analgesics), drugs that act on the heart and blood vessels (cardiovascular drugs), drugs that relieve nausea (anti-emetics), and drugs that relieve allergies (antihistamines) also have the potential to produce negative side effects by acting on the brain.
Social, economical, psychological, and medical reasons also play a part in overmedication or polypharmacy.
Desire to help - Health care providers want to lessen the suffering of their patients and they often prescribe drugs to do so. Although not all symptoms, conditions or behavior should be treated with drug therapy, there are conditions, such as depression, which occurs with increasing frequency in the elderly and should be treated. However, non-pharmacological approaches should be tried first, and in conjunction with medications, since they work for many common conditions like high blood pressure, diabetes mellitus, heart disease, and urinary incontinence.
Belief drugs will produce desired results - This belief is embedded in traditional medical training. Often, the medications are given credit for treating symptoms when, with time, the symptoms of many ailments would have resolved on their own.
|Underestimating the side effects of a drug - The side effects of psychoactive drugs are gradual and hard to detect early on in the treatment process. Psychoactive drugs have also been strongly linked to the risks of falling. This is a serious side effect since falls are the leading cause of fatal and nonfatal injury in people 75 years and older.||Psychoactive drugs have also been linked to the risks of falling and hip fractures.|
Behavioral changes - Centrally acting or psychoactive drugs themselves occasionally lead to behavioral problems and confusion.
Patient Demand - Some patients and family members are reluctant to discontinue medication use. This is especially true for some elderly patients because their medication becomes a symbol of care. 2 As a result, there is a belief in the effectiveness of a drug ('more is better'), though it may have the potential to produce side effects.
Lack of Training in Non-pharmacological Approaches to Treatment - It is much easier to write a prescription for an ailment then to explore alternative approaches.
Influence of media and the drug manufacturers - Busy health care providers often rely on pharmaceutical company advertising and distributed literature for information about prescription medication. Drug manufacturers often highlight the benefits while downplaying the potential dangers of a drug. In addition, the media often encourages the public to contact their physician for new prescription medications.
|Alternatives To Using Hypnotics:
|Alternatives To Using Laxatives:
|Alternatives To Using Urinary Incontinence Drugs:
|Over The Counter (OTC) Medications|
Inform your health provider about all OTC products. Avoid such products if central nervous system side effects and other herb/drug interactions are possible.
Consult the Web sites Herbalgram, Food and Drug Administration, or Alternative Medicine Alert (800-688-2421) for information.
Know the following important things about your medication:
Never share your prescription medications or take medications prescribed for someone else.
Keep all medication out of the reach of (grand) children.
Maintain the continuity of care by having a primary physician, usually a family physician or general internist. Also get all of your prescription medication from one pharmacy.
Have a medication set, or medi-set, (a box which holds prescription medication with the days of the week written on each compartment) to help you remember your medication. Have caregivers supervise your medications if you start to experience memory problems.
Last Reviewed: Dec 15, 2000
Arvind Modawal, MD, MPH, MRCGP
Professor of Family & Community Medicine, Geriatrics and Palliative Care
College of Medicine
University of Cincinnati