6 meds to handle with care
Older adults taking five or more medications per week, plus an aging body system, equals problems for home and senior living caregivers.
Polypharmacy can leave residents uniquely vulnerable to side effects and adverse events. That leaves caregivers worried and frustrated because there is little they can do. However, in the daily care of your clients, you can be aware of those drugs that are most likely to lead to potential health issues and be ready.
About 44% of men and 57% of women aged 65 or more years take five or more drugs a week, and about 12% of seniors take 10 or more medications a week. As seniors' internal systems slow down, drugs stay in the body longer, building up to toxic levels more easily and putting more strain on the stomach, liver and kidneys. Commonly used drugs often also tax the heart and affect the brain, especially in the elderly.
As a result, more and more seniors are landing in the emergency department due to drug reactions. One out of every 250 Americans visits the ED each year because of such reactions. Seniors accounted for 35% of ED visits in 2013 and 2014 for drug interactions, according to research from the Centers for Disease Control and Prevention published in the journal JAMA in November 2016.
Staff members and administrators at senior living communities and long-term care facilities may not be able to slow down the rate of prescriptions, but if you accompany a resident to the doctor's office, you can raise the issue of polypharmacy or ask about de-prescribing with the physician then. You also can mention it to the family, but make sure you are working within your company's guidelines.
Many older adults routinely take blood thinners, diabetes medications and opioid painkillers. These three classes of drugs were responsible for 60% of all ED visits that seniors made for adverse drug reactions, according to that JAMA report. If you have residents who are taking two or more of these medications, be on the lookout for potential side effects or behavioral changes they may be experiencing.
The American Geriatrics Society has created a list called the Beers Criteria of over-the-counter and prescription medications that, for the most part, should be avoided by anyone over the age of 65. The list was last updated in 2015, and it's a great resource. Overall, the Beers Criteria list identifies more than 30 medications or drug classes that are potentially inappropriate. Here are six of the most common drug classes taken by seniors so you can be more aware:
1. NSAIDs: Non-steroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin (doses of more than 325 mg/daily) are among the most popular OTC medications seniors take. They can increase the risk of stomach ulcers, however, and also can affect the kidneys. People aged 75 or more years who use blood thinners or oral steroids are at especially high risk. Seniors should try acetaminophen (Tylenol) instead. If a resident must take an NSAID, it should not be taken for long-term use. Seniors should consider taking it with a stomach-acid reducing medicine, such Prilosec (omeprazole) or Prevacid (lansoprazole), both proton-pump inhibitors.
2. Antihistamines: First-generation antihistamines such as diphenhydramine (Benadryl) can cause confusion, blurred vision, constipation, dry mouth and trouble urinating. Second- and third- generation antihistamines such as such as loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec) and desloratadine (Clarinex) are considered safe alternatives.
3. Sleeping pills: Most OTC sleep aids such as doxylamine (Unisom) and Tylenol PM (acetaminophen/diphenhydramine) actually contain antihistamines that cause drowsiness. They often can last a long time, however, increasing the risk for falls and confusion. The same goes for prescription sleeping drugs like eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien). They are only meant to be taken for a short period of time (a couple of weeks at the most).
4. Benzodiazepines: Older adults are especially sensitive to these anti-anxiety drugs, such as lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax) and diazepam (Valium). They may increase risk of cognitive impairment, delirium, falls, fractures and even car accidents. They should be used by residents only in severe distress.
5. Opioids: These powerful pain medications should be avoided in seniors with a history of falls or fractures because they can cause unsteady walking, confusion, seizures and even hallucinations. Be especially cautious of meperidine (Demerol) and pentazocine (Talwin). Elderly adults taking opioid painkillers have four times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking OTC pain medication, according to a 2015 paper from the National Safety Council.
6. Muscle relaxants: Drugs such as cyclobenzaprine (Flexeril), methocarbamol (Robaxin) and carisoprodol (Soma) can leave a senior groggy and confused as well as increase the risk of falls. They also can cause constipation, dry mouth and urination problems. Worse, they have questionable efficacy.
Suzanne Robotti is the founder and president of MedShadow, an independent nonprofit organization that informs the public about the side effects, long-term effects, risks and benefits of medicine, both prescription and over-the-counter. She has been honored for her community service by The President's Council on Service and Civic Participation. Follow Robotti on Twitter: @MedShadow_Su.
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