They’re the same meds you’ve been taking for years, but now they’re starting to work differently. Maybe they’re less effective than they used to be. Or maybe they have new side effects. It’s not that the medicines have changed, but that your body has.
“Prescribing medications for people 65 and older can be more challenging, because some drugs can be more toxic or cause more side effects than when you were younger,” says Kirby Lee, professor of clinical pharmacy at the University of California at San Francisco. “As your body ages, it absorbs medications differently. They can be metabolized differently by your liver and excreted differently by your kidneys.”
That’s one part of the problem. Another is that too few doctors are trained to be fully aware of it. Of 1,045,910 doctors of medicine in the United States in 2013 , only about 7,500 specialize in caring for older adults. Since there are 46 million Americans age 65 and older, according to the American Geriatrics Society, that works out to roughly one geriatrician for every 6,100 patients.
Of those 46 million older Americans, many if not most are likely to be seeing more than one doctor – a primary care physician and one or more specialists. As a result, patients can end up with more prescriptions than they should, sometimes with adverse side effects or interactions. “I don’t blame the doctors,” says Chad Worz, president-elect of the American Society of Consultant Pharmacists. “Instead of stopping a drug that causes a certain side effect, doctors often prescribe a[n additional] drug to fix the side effect.”
And there are plenty of potential side effects:
- In older adults, the normal dosage of Zantac (150 mg twice a day) can be more than the kidneys can eliminate quickly, leading to cognitive issues that look like dementia.
- Valium, Ativan, Xanax, Librium, and other tranquilizers prescribed (often overprescribed) for anxiety and sleep disorders can cause confusion and greatly increase the risk of falling.
- Ambien, Sonata, Lunesta, and other prescription sleeping pills are highly addictive and can cause bizarre sleep behaviors, including sleepwalking.
- Blood pressure medications can cause fatigue or lead to falls.
- Some antibiotics have been taken off the market after causing nervous system changes, hallucinations and other problems.
- Benadryl, Tylenol PM, Motrin PM, Nyquil and other antihistamine-based cough- and itch-relieving medicines and muscle relaxants can cause confusion, constipation, dry mouth, blurry vision, or urine retention in older adults. Over time, they can lead to dementia.
- Motrin, Advil, Aleve, aspirin and other nonsteroidal anti-inflammatories are “tough on kidneys,” according to Professor Lee, and long-term use can increase the likelihood of stomach bleeds.
That’s why senior care coordination is so important: Coordinating different treatments for different doctors for different conditions; coordinating different prescription and over the counter medications to avoid side effects; and coordinating everything to fit the patient’s current state of health.
That’s why we make sure your primary care physician, your specialists, your physical therapists, or any other caregivers all have the same, specific information about your current health.
It’s also why, when we accompany clients to doctor visits, we make sure to discuss current health information that we learned from weekly checks with the client and his or her caregivers – including information about changes in medication and any drug side effects or reactions.
Finally, no one medicine fits all. While some people undergo side effects due to the way their bodies change by the time they’re 65 or 70, others don’t. And that’s why Senior Insights plans and manages coordinated care plans based on each client’s specific needs, as determined by our thorough three-part assessment .