By Maureen Wendt, President/CEO
The Dale Association, Inc.
September is “National Healthy Aging Month”. I hope many of you reading this were able to attend the lifesaving event that Assemblyman Mike Norris sponsored in partnership with Team Alice, UB’s Center for Successful Aging and National Council on Aging, and The Dale Association earlier this week. I write this week’s article in honor of National Healthy Aging Month, Team Alice, Assemblyman Norris, UB’s school for Successful Aging and all the rest of the partners who helps spread the word about important medication information that could save your life.
What is Team Alice? Alice was the life of the party, living her best life as an active senior in her own home, driving herself and managing her own finances – until, suddenly, a preventable medical error and overmedication led to her rapid decline in just six weeks. Team Alice is part of UB’s Center for Successful Aging and a partner with the National Council on Aging, working to educate older adults about the dangers of overmedication and to empower seniors to actively participate in their health care decisions. Alice’s daughter, Mary Brennan Taylor, an adjunct assistant professor at the Jacobs School of Medicine and Biomedical Sciences, wants to build awareness and spark change in senior health care after the tragic and preventable death of her 88-year-old mother Alice Brennan in 2009. For more about Team Alice, please check out their video’s on YouTube here.
Do you keep track of your medications? It is wise to keep track of current medications, dosage strength, how often/when taken and any special notes about each medication. As we get older, our bodies react to drugs differently than when we were younger because our bodies and how we process medications change with age. The aging process, along with medical conditions, often impacts the benefits and side effects of medications.
Drugs go on a complex journey through our body from the time we take our medications until they leave our body. The aging process can affect how the medication is absorbed, used in the body, and exits the body. Changes that decrease your body’s ability to break down or remove certain medications from your system may mean that medications can stay in your body longer. So, you may need a lower dose of the medication or a different medication that is safer. In most cases, older adults need lower doses of medications than younger adults. You can start with a low dose of a medication then slowly increase to the target amount to receive the same benefit and avoid side effects. This can be done by working closely with your healthcare provider.
Older adults often have multiple medical conditions that may affect how medications work in the body. Medications used to treat one condition may also make another condition worse. For example, older adults with memory problems may have worsening symptoms caused by medicines used to treat their other conditions. Therefore, it is important that all providers who prescribe medications for you know about all of the medical conditions you have. Also, be sure to let the prescriber know if a medication they gave you worsens any of your conditions.
Medications may be affected by food, beverages, and supplements or medicines that you take at the same time. For example, some antibiotics are not absorbed well when taken with foods, beverages, or medicines that contain calcium, magnesium, or iron (such as antacids, vitamins, or dairy products). Certain foods, such as grapefruit juice, can also change the metabolism of certain medications. This may cause the medicine to build up in the body. You can ask your pharmacist about what foods, beverages or supplements to avoid when you pick up your medications.
A medication interaction is a reaction between two (or more) medications or between a medication and food, beverage, supplement, or herbal product. A medication interaction can make a drug’s effect stronger, weaker, or cause unwanted side effects. An older person may be on multiple medications to treat multiple conditions they have and also use over-the-counter (OTC) medicines, vitamins, other supplements or herbal products. The more medications and other products you are on, the greater the chances of having a medication interaction. Be sure to let your provider and pharmacist know about all prescription and other medicines you use at home, so they can check on interactions for you.
Other factors may affect how the body deals with medications. For example, a medication’s effect can be affected by cigarette smoking, drinking caffeinated or alcoholic beverages, changes in diet, changes in medical conditions, and viral infections.
Common side effects of medicines in older adults can be dizziness and falls, weight loss or weight gain, and changes in memory or our ability to think and process information. These, in turn, can cause older adults to get hurt and may ultimately lessen their ability to function in day-to-day life. Be sure to let your providers know about these other factors and any changes you have.
Many older adults take multiple medications from different prescribers. It is important to provide a list of your current medications, including any over the counter medicines, vitamins, supplements, or herbal products you use, to each provider so they can update their records. This practice can help prevent harmful side effects and decrease unnecessary medications and interactions. Tell your healthcare providers about all of the medicines you are taking, no matter which provider prescribed them to you. Do not forget to include over the counter medications, vitamins, supplements, and herbal products on your medication list.
Discuss over the counter medications, vitamins, supplements, and herbal products, as well as any prescriptions given by other healthcare providers. Then you and your provider can figure out whether one or more drugs can be changed or stopped. Also, if you have experienced an unwanted symptom (such as having had a fall or having memory problems), be sure to tell your healthcare provider – and ask if this could be caused by one of your medicines.
Multiple prescriptions increase the possibility of a “prescribing cascade.” A prescribing cascade is when a side effect of one medication is mistaken for a new medical condition and is then treated with another medication. This can lead to being prescribed more medications than you need and also further increases your risk of having more side effects and continuing the cascade. Therefore, ask your healthcare provider to review all of your medicines with you. And before you get a new medicine, ask if one of the medicines you are already taking might be causing the problem the new medicine is meant to treat.
Studies also show that certain medications are less safe for older people, and it is important that you work with your provider or pharmacist to use medications that are safe for your age. The American Geriatrics Society’s (AGS) Beers Criteria lists medications that may not be safe in older people and can be used as a tool when you talk with your provider or pharmacist about using safe medications.
What is Beers Criteria list? The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults 65 years and older in all except palliative setting. The list was introduced in 1991 to improve the quality of care for older adults. It is named after the geriatrician Mark H. Beers, MD, who worked with a panel of experts to develop a list of potentially inappropriate medications in older adults in the early 1990s
For years, the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults have been a leading source of information about safely prescribing medications for older people. The AGS Beers Criteria® identify medications with risks that may be greater than their benefits for people age 65 and older. The AGS reviews and updates the AGS Beers Criteria® on a regular basis because new medications are created and new research is published that provides information on the safety of existing treatments.
As you get older, your body changes. These changes can increase the chances that you’ll have side effects when you take medications. Older people often have more health problems and take more medications than younger people. Because of this, older adults are more likely to experience harmful interactions between different medications. In fact, one in six adults age 65 or older will likely have one or more harmful reactions to a medication or medications. This is why it’s important to identify and help reduce the use of medications that are associated with more risks than benefits in older people.
Using a time-tested method for developing treatment guidelines, and following the recommendations of the Institute of Medicine, members of the AGS Beers Criteria® expert panel reviewed 6,700 high-quality research studies about certain potentially inappropriate medications prescribed for older adults. Based on the review of this research, the experts updated lists of:
- Medications and types of medications that are “potentially inappropriate” for older people. Healthcare providers should consider avoiding medications on this list when prescribing for adults age 65 and older. These medications generally pose a higher risk of side effects, may not work as well in an older person, and can sometimes be replaced with safer or more effective medications or non-medication remedies.
- Medications that are potentially inappropriate for older adults with certain common health problems. Older adults often have other specific diseases or disorders that some medications may make worse.
- Types of medications that should be used with caution in older adults. Medicines on this list can cause medication-related problems. There is less agreement by the experts about the balance of benefits and harms of these drugs in older adults, and they may be the best choice available for certain older adults. However, healthcare providers and patients need to carefully monitor how these medications are working and keep an eye out for side effects.
- A list of medication combinations that may result in harmful “drug-drug” interactions. Medications for several conditions common in older adults may be inappropriate when prescribed at the same time. In each of the combinations of medication or medication classes listed, the medications interact with each other to put older adults at higher risk of serious side effects.
- Medications that should be avoided or have their dose changed in people with poor kidney function. Because the kidneys help to filter many medications from the body, people with reduced kidney function may react poorly to certain medications.
Alternatives to Potentially Inappropriate Medications on the Beers List
- The AGS understands that older adults, healthcare providers, and other people and organizations involved in health care might benefit from suggestions for alternatives to potentially inappropriate medications. In response, AGS created a list of certain suggested alternative medications and treatment options. This list of alternatives is meant to be used alongside the AGS Beers Criteria® for additional guidance.
To access the complete Beers Criteria and resources, information is available at GeriatricsCareOnline.org.
To lower the chance of medication-related problems:
- Keep a list of all of the medications you take—both non-prescription and prescription. This includes any supplements that you take, such as vitamins. You should also write down the doses, and remember to bring the list with you whenever you see a healthcare professional. This way, he or she will know what medications and supplements you are taking and can check whether these might be causing side effects, or could cause side effects, if taken along with a new medication.
- Ask what side effects your medications can cause, and watch for them. If you think you may be having a bad reaction to a medication, or if you think a medication is not working, tell your healthcare provider as soon as possible. However, don’t stop taking a medication without first checking with a healthcare professional.
- Always ask your healthcare provider or pharmacist if you have any questions about a medication.
- Be sure to report any new symptoms or possible side effects.
- Make a list of all of your medications (including supplements and over-the-counter medications) that you take, along with their doses. Don’t forget to update the list if you start or stop any medications.
- Tell your healthcare provider if you have not been taking your medications regularly.
- Also tell your healthcare provider if you are having any problems getting or using the medication.
When taking medications, it is important to make sure that:
- The correct medication is prescribed for the correct condition
- The medication is right for you, your age, and your conditions
- You take the proper dose for the length of time your healthcare provider prescribes
- Talk with your healthcare provider if a medication you are taking is in the AGS Beers Criteria®. Ask if there might be a safer or more effective alternative. Keep in mind that if a medication you take is on the AGS Beers Criteria®, it still may be a reasonable choice for you. The way you respond to a medication or medications can differ from the way other people respond to it. Medications included in the AGS Beers Criteria® are “potentially inappropriate,” but can be reasonable choices for some older adults.