For many older Americans, their relationship with the most important drugs in their medicine cabinets can be described as "Can't live with 'em, can't live without 'em."
Can't live without 'em, because modern medications are the most effective -- and cost-effective -- treatment we have for most of the chronic diseases (diabetes, hypertension, heart failure, arthritis) that afflict a majority of older people. Without the right drugs, these conditions can quickly become complicated, acute or even deadly, and there is no viable substitute.
Can't live with 'em, because some of the very drugs older patients rely on have the potential to be dangerous, even causing emergency hospitalization. New research from the Centers for Disease Control and Prevention (CDC) shows that about 100,000 people over age 65 are hospitalized on an emergency basis each year, not for a fall or a car accident, but for a dangerous reaction caused by medicine prescribed by their own doctors. Two-thirds of these adverse drug events (ADEs) are unintentional overdoses.
This is the double-edged sword of modern medicine. ADEs hit the elderly disproportionately harder, cost more than $175 billion dollars annually, and can even kill.
Special medication concerns for the elderly
These tragic outcomes are often preventable, yet for years we barely considered the subject. We have my close friend (he died in 2009), colleague, former student and former board president of the American Federation for Aging Research, Mark Beers, M.D., to thank for much of the early progress.
A pioneer, Beers's breakthrough was his premise, namely that elders do not respond to medications, or the same doses of medications, as do younger people and can suffer great harm as a result. In 1991, he published the "Beers Criteria," a roster of drugs with the greatest potential to hurt older patients and one of the most important research outcomes in geriatric medicine. (Twenty years later, the American Geriatrics Society is at work on the third update.)
Yet even use of the Beers Criteria did not end ADEs, and the ER trips continue. If Mark were alive, I know he would be pleased by major new developments that have extended some of his early findings.
Recently, CDC researchers made the startling discovery that just four medications (taken alone or in combination) were to blame for two-thirds of drug-related emergency hospitalizations of older persons. All were common, widely prescribed drugs. (Medications from the Beers Criteria accounted for only slightly more than 1 percent of the emergency admissions.)
The first offender in the CDC research is warfarin, or Coumadin, a blood thinner given for atrial fibrillation to reduce clotting and the associated risk of stroke, which accounted for one out of three hospitalizations. Next comes insulin (by injection, for diabetes) at 13 percent, then oral anti-platelet agents (including aspirin, used for ischemic heart disease) at 13 percent and oral hypoglycemic agents (diabetes pills) at 10 percent of hospitalizations.
For many older adults, these are drugs that they can't live long without. Yet all four are known to have a narrow therapeutic index, the zone between a safe and effective dose and a toxic one.
The same authors had previously identified similar risks with a fifth drug, digoxin. Digoxin has a narrow therapeutic index, but is widely prescribed as the most effective option for patients with congestive heart failure who have not been helped by diuretic and ACE inhibitor treatment.
And, as is often true, the older the patient, the more severe the problem: Nearly half of those hospitalized were age 80 or older.
New guidance on taking your medicine, carefully
Beers Criteria have a successor in the STOPP criteria, or Screening Tool of Older Persons' Potentially inappropriate Prescriptions. Formulated by two geriatricians at the University of Cork in Ireland, STOPP predicted adverse reactions implicated in hospitalizations almost twice as often as Beers. They focus on their own list of drugs, and add the warning that the dangers of the most commonly prescribed "potentially inappropriate medications (PIMs)" for older adults depend on the circumstances. The STOPP criteria include proton pump inhibitors (for uncomplicated ulcers), aspirin (if no history of heart disease), NSAIDs, benzodiazepines (powerful sedatives), diuretics and duplicate prescriptions (a surprisingly big problem). Some of these are over-the-counter drugs, which a doctor may not even know a patient has taken.
STOPP criteria are useful, but also highlight a medical catch-22. Despite the known risks, some of these medications simply cannot be stopped. There is always some risk, and sometimes the benefit outweighs that risk. Should a patient sit back and die of heart failure rather than risk an ADE from digoxin? Should an elderly woman's chronic pain go unrelieved because her medications might increase her risk of falling?
The solution: medication monitoring
The essential (and often missing) piece of the puzzle is medication monitoring. It starts with the realization that only a minority of ADEs can be prevented at the moment the physician writes the prescription. Thereafter, the physician, the patient and everyone else involved in that older patient's life must remain vigilant as long as the patient takes any medication, whether over-the-counter or prescription.
The medication portfolio should be reviewed regularly, at least four times a year, preferably with the help of a well-maintained electronic medical record. But if that's not available, it can be just as effective to bring a paper bag containing all medications to each appointment. Medication monitoring is particularly important during care transitions, such as leaving the hospital or moving to a nursing home.
This vigilance is a matter of life and death. Most ADEs, if caught early, will be less harmful. Because this monitoring is so important, patients and families (as well as caregivers, pharmacists, nurses and anyone else in a position to notice changes or problems) should speak up any time there is a new symptom, particularly soon after starting a new drug. They should ask, and be told, what possible side effects of any new drug look like.
Sadly, medication monitoring is an area in which research has been scanty and few guidelines exist. According to a recent analysis in the Journal of the American Geriatrics Society, fewer than 5 percent of internal medicine or geriatrics textbook chapters discuss medication monitoring.
The bottom line is, the more drugs a person takes, and the longer one stays on them, the more likely it is that an ADE will occur. Today, 40 percent of people over age 65 take between five and nine different prescription drugs. We can't live without most of these drugs, so we must get better at monitoring them.
For more by Richard W. Besdine, M.D., click here.
For more on aging gracefully, click here.
I take two expensive medicines and 4 generics. I get the two for half price in the donut hole, but if you figure the cost of my premium for drugs, then that makes it save less.
I wouldn't turn down the Medicare A. I don't think you have to take Medicare B, but it is $100 a month which is not bad. I don't think A costs anything. Those two take care of a lot of your health care. You can find a lot out on medicare.gov. I take medigap and the prescription plan too and I pay too much but you can get them for a lot less.
ACA or the Health Care Reform will save a lot of the costs as time goes on. It is doing a lot of good now.
I don't like the mandates either. If they want those to have it that don't want it, then they should pay for it or give them a heck of a deal.
Everyone I know with diabetes is thin. Diabetes is caused by your pancreas not recognizing your insulin. Diabetes has became an epidemic.
I take a daily baby aspirin, cinnamon, tumeric and fish oil, plus inositrol right along with my meds.
Some people with healthy lifestyles die or get cancer, diabetes or other health problems and not all live to be old.
Keep in mind that we were told that smoking wasn't harmful for years. We even had smoking rooms at school. Smoking is a filthy, stinking and dangerous thing to do. But smoking isn't the only thing that can cause cancer. They spray trash bags with something to keep them from sticking that causes cancer. Wood fireplaces are as bad as smoking, so are candles and breathing strong cleaners like amonia, etc.
Type 2 is caused by insulin tolerance, which is caused by continuous high insulin levels - which is caused by consuming carbs and sweets, period. I know lots of people with advanced cases, and they are all obese. When you see people who's eyes look strange and unfocused, walking with canes? That's type 2 diabetes, and everyone I've ever seen was morbidly obese. Type 2 is an epidemic - the same as obesity, because they are one and the same. Type 2 and obesity have both doubled in the last 30 years, and it's diet. I was born in 1950, didn't have McDs until I was 20, never ate french fries, we didn't drink soda - and no artificial sweeteners. They cause obesity, diet soda makes you obese. Google "artificial sweeteners" and read if you don't believe me.
What is not a factor is genetics. Type 2 and obesity have both doubled in a generation, but those obese kids have the same genes as their thinner parents - who were lucky to be born before most junk food. If you went to a supermarket when I was a kid, the middle aisles would be gone. There was no prepared food, no chips, nothing came in boxes. That stuff is all processed carbs - that is what causes obesity and diabetes.
We all know that high blood pressure is bad. But no one seems to talk about blood pressure medication and it's effects on the elderly.
I have taken my mother to the emergency room three times in the last two years for falls. The results were quite colorful, 58 stitches to date (on her face) but not near as bad as what "could have been" (broken hips in elderly women are nearly a death sentence).
I expressed concerns repeatedly to her family doctor about her blood pressure and pulse being "too low".
Last month I had to take her to the emergency room again, when her blood pressure fell to 90 over 50 with a pulse of 38. The doctors at the hospital told me it was due to her high blood pressure medication.
OK, I understand that high blood pressure increases the risk of heart attack or stroke, but is that risk HIGHER than the risk of falls caused by low blood pressure and passing out? Seems to me that sometimes the best "treatment".........is none at all.
Any doctors care to respond?
The same thing happened with my husband. His vitals were about the same as your mothers. The doctor said a slow heart beat meant you are healthy like an athlete. DH said that he was no athlete and had to hold on to the wall to walk. Come to find out the doctor had changed his bp medicine and didn't tell him to cancel the other bp he had been taking.
Sometimes another medicine also causes your bp to be high and if you quit taking that medicine and if you are taking bp meds then you could pass out. That happened to a friend of mine.
I am taking a diuretic and just found out that it lowers your blood pressure too.
My husband's mother died at 42 of a stroke and his father died at 62 of cancer. I did a life expectancy test and according to it, he should have died several years ago. His brother and sister are older than he is. They all now take an aspirin and generic blood pressure medicine. All three have had to have a bypass before starting the aspirin and bp meds. I give a simple aspirin and the blood pressure meds the credit for them being alive. None have had strokes.
Falls are bad, but strokes are bad, too. It is a dilemma.
I took benadryl before I started taking prescription medicines and haven't stopped taking it. I take one at bedtime, it helps me sleep and may prevent interactions with my meds. Some medical articals say that the benadryl is not good for your mind, but other allergy meds I have taken keep me awake even if I take them early in the morning.
I take 3 medicines at different times of the day that don’t fit in the regular pill boxes. I use a small spiral notebook to keep track of when I take them.
I prefer herbs and vitamins over prescriptions, but sometimes you have to take prescriptions.
I don't always take as much as they prescribe, especially at first. Many medicines are too strong especially for the elderly. For instance if it says take two at one time, I take one. If it says take every 6 hours for pain, I spread the hours out so I don't take them that often. I take them every 8 hours.
I do know what you mean about having meds prescribed for times of the day other than MORN, NOON, EVE, as the pill boxes provide for. That takes some extra concentration and some other means, such as writing down the dose and the time you took them, to ensure a dose isn't forgotten or accidentally doubled.
I'm 66 and am fortunate enough to take no meds at all other than an occasional OTC decongestant, but as an experienced caregiver, I can vouch for the helpfulness or even necessity of a drug container such as you describe.
Here is a link to a picture of that type of pill holder. The picture is at the bottom of the page. It has the days on the tray plus on each of the 7 separate pill holders.
Mine is white and I bought it locally. I have dropped my tray and the pill boxes fell out. The tray has the days of the week but the 7 pill boxes do not have the days on them. I had to sort the boxes, putting the empty pill boxes under the days I knew I had taken the meds already. It was a mess. I would get the days on the tray and on each box.
http://mannagoods.com/
I actually bought the pill box for my husband and he wouldn't use it. It was awful when I started taking medicine to keep it all straight and use it daily. I also have a bigger pill box I bought at the vitamin/herb store. It isn't labeled and has one large lid. It has adjustible partitions and will hold the whole prescription bottle. It is good for the pills you don't take every day and vitamins/herbs.
People frequently move from doctor to doctor, and wind up with sacks of duplicated medicines, stuff that interacts with other previously given medicines, and confusing instruction protocols that nobody can understand.
It's not uncommon for elderly people to have trouble reading instructions, or forgetting they have already taken a dose earlier, or to be taking 3 generic versions of the same drug under different names. I've run into many patients that identify their medicines as if they were crayons :- "The little yellow ones" etc.
Sometimes keeping things as simple as possible is a better thing to do than trying for an optimal regime.
I didn't think I could learn my pills but now I know them by their looks.
In my early thirties, I was diagnosed with arthritis in my fingers, many knuckles. My family practitioner at the time told me not to start any medication, but to start doing hand warm ups and easing into things in the morning. Also, I need to keep my hands warm.
Nearly twenty years later, and I am still thankful he didn't prescribe some pill with thirty side effects to ease my pain.
Aging isn't a disease.
It means you haven't died too young.
I'm going to stay positive as long as I can.
I don't mind getting old. You get to take naps and the kids start cooking the holiday dinners. You just have to have notes to jog your memory.
Seniors don't need pillboxes with dates and times on them.
They aren't chemistry kits.
A good example is people with diabetic proximal muscle wasting. They need to switch to insulin, and do heavy progressive resistance exercise. The ones that listen to me get 20 good years extra, sometimes even being able to reduce their treatment back to just diet.
The ones that don't often wind up in wheelchairs, get all sorts of complications and suffer terribly.
As for those *genuinely interested, there is a wide variety of scientific literature available for consideration, and one should consult an MD and/or state licensed ND knowledgeable in their particular issue who may employ both natural and pharmaceutical medicine in their practice.
One more time, if you are unable to access viable scientific literature then consult a professional who does so. Now you and your pharma sales partner take your little show onto some other post.
Your ancient thinking prohibits you from engaging the current, and you instead argue from position of a status quo- dependency on pharmaceuticals. Your nit picking status quo pharma promotions, entirely (and purposely) miss The Point of my Post which was there are alternatives to such thinking. Please do not be afraid of education, you will find it's quite alright to emerge from the nineteenth century.
One big problem lies with the doctors themselves, who rush patients through their appointment so quickly they don't take the time to review ALL the meds they're taking before prescribing another. I've found doctors to be reluctant to d/c meds once they're started, even though a thorough medication review ought to be done at least once a year, and in many cases, some drugs need to be discontinued because of others than have been added, or because the symptoms that caused the prescribing of a particular drug have subsided, or another drug has been added that performs the same function.