Yes, the Holidays are upon us! Assuming…from the start, at baseline, that the drugs a person takes at home are dangerous…can we assume that? It can be especially difficult during the holidays to stay on track managing your medications, when you are taking numerous medications (the average senior is on 10-14 daily medications). Here are some tips that might help! Also, assuming that once at home it is either the consumer, or someone who lives with them that is going to administer the drugs in the home setting most of the time …and this person will have control over the administration (or self-administration) of those meds.
The Problem
Almost ¼ of older Americans are sent to an acute care hospital or nursing home as a direct result of problems with medication. The costs of adverse drug reactions yearly, an estimate on the low side since many of these are missed, it is estimated to be 100,000 causalities and $177 billion dollars yearly. This includes not enough medication, wrong medication, unnecessary medication, wrong timing of administration, drug-drug interactions, drug-food interactions, etc.
- 41,000 hospitalizations/year for NSAID induced ulcers (Health Affairs 1990)
- 16,000 car crashes/year from antipsychotics (Am. Journal of Epidemiology, 1992)
- Drug induced Parkinson’s, induced in 63,000 (CMAJ 1982)
- 32,000 hip fractures/year leading to 1,500 deaths (NEJM 1987; A.J. Epi 1991)
Some Factors
Patient
Physiological…the old and the sick…a different perspective.
–Smaller bodies, different body composition: Body weight increases from 40-60, fat accumulates, some drugs are stored in fat, benzos, hanging around longer. Weight decreases from 60 to 70, percentage water increases, now drug per pound of body weight or per pound of body water increases.
–Decrease in liver function: Cannot detoxify as well, as rapidly or as completely.
–Decreased ability of the kidneys to clear drugs: By age 65, the filtering ability of the kidneys is decreased by 30%.
-Increased sensitivity to many drugs: Drugs acting on CSA (sleeping pills, tranquilizers, narcotics), drugs with cholinergic properties (antidepressants, antipsychotics, antihistamines, donnatal, atropine, anti-Parkinson’s drugs, norpace.)
Anticholinergic Effects – Older adults are especially sensitive to the harmful anticholinergic effects of certain drugs. Drugs in this family should not be used unless absolutely necessary. Mental effects: confusion, delirium, short-term memory problems, disorientation, impaired attention. Physical effects: dry mouth, constipation, difficulty urination, blurred vision, decreased sweating when body temperature rises.
-Decreased ability to maintain blood pressure: Orthostatic hypotension (BP meds, tranquilizers, sleeping pills, antidepressants, antipsychotics, antihistamines, antiarrhythmics) falls.
-Decreased temperature compensation: Anticholinergics particularly, dangerous during heat wave.
-Comorbidities
Other: HOH, memory loss, dementia, failing eyesight, decreased mobility/coordination/strength, unfamiliar with terms used to instruct, lack of understanding, inappropriate/erroneous beliefs about health care/medications (e.g., Darvocet is the drug of choice, I’ve always taken it; I have to have a laxative (or an enema) three times a day; I’ve always done it; I have to have Restoril 30 mg every night; that’s the only way I can sleep, etc.), multiple MD’s, multiple pharmacies.
Medications
-Increased number of medications.
-Inappropriate medications for the elderly.
-Inadequate testing of drugs in older adults before approval. Drugs are tested in young, healthy adults, generally for as few as 3 months. And then prescribed for older adults for long periods of time, years.
Percent of new drugs first introduced in the U.S.
1980 3% 1998 60%
Drug Approval Time
1993 27 Months 2001 14 Months
Percent Drugs Recalled
1993-1996 1.56% 1997-2001 5.35%
According to the FDA, Vioxx may have contributed to almost 28,000 heart attacks in the U.S. between 1993 and 2003.
-Of the best-selling prescriptions, 148 can cause depression, 133 hallucinations or psychoses, 105 constipation, 76 dementia, 276 insomnia and 36 Parkinsonism.
-GAO reports that 51% of new drugs have serious, undetected side effects when they go to market.
-21.3% of the 548 most recently FDA approved medications were subsequently withdrawn from the market, or given a BB warning.
Healthcare Providers
-High risk prescribing
-Inappropriate meds for the elderly
-Questionable combinations
-Inadequate methods for educating
-Little to no follow up
Solutions
- Limit number of drugs used.
- Work to eliminate inappropriate, high-risk drugs from the regimen.
- Develop a system if communication/education for drug use that incorporates follow-up and assessment.
- Make use of large, easily read charts for administration.
- Work with the patient/family to develop procedures/aids for safe medication use.
- Encourage patient/family to become involved in and responsible for their care.
- Teach them to question any medication offered by a health care provider. They should know what it is, what it’s used for, and how and when to take it.
- Develop a system to ensure communication among multiple health care providers.
- Provide a chart, etc. Listing all medications/nutrients/OTC that the resident uses.
We hope this newsletter has been informative and if you know anyone who could use it, please share this with them, and may your holidays be enjoyed safely. Happy Holidays from all of us at Senior Care of Sacramento!
