Senior Medication Safety
Research has shown that inappropriate prescribing is common in older adults. Meaning that, when patient charts are carefully reviewed, experts often find that seniors are receiving medications that are ineffective, duplicate the effect of another medication, or otherwise lack a basis for being prescribed.
Why does this happen?
Well, doctors often see patients during short visits, which can make it hard to think carefully about prescriptions. The healthcare system, after all, wasn’t designed to provide ideal care to people living a long time with chronic illnesses. Doctors are also humans, not computers so it can be a challenge for them to keep up with all the latest medical knowledge. Plus, they also just sometimes slip up, as we all do.
To reduce the chance of a senior being harmed by inappropriate medications, the answer is not to look for a super doctor. The answer is to regularly have a methodical medication review.
Scheduling such regular medication reviews are becoming more common in well-run primary care clinics. But if your parent’s doctor’s office doesn’t yet offer this service, we’re here to help.
5 Steps to Prepare for a Medication Review
Before going in for your medication review, here are 5 things you can do to lay the foundation for checking a medication list for safety and appropriateness:
1. List all medications your parent is taking, along with the intended purpose of each medication.
If you aren’t sure of why a medication is prescribed, make a note to find out why you are taking this. Pharmacists specifically trained to do this and work closely with your doctor identify any problems.
Over time, medications may need to be adjusted since our bodies continually change. Dosage adjustments may be needed or a medication may need to be discontinued. Also, anytime a medication therapy changes, it is best that your medication therapy is reevaluated to assure that your medication therapy is both safe and appropriate.
2. If the purpose of a medication is to control a symptom, take note of when the symptom was last checked on, and how it’s been doing.
This is especially important for medications prescribed for bothersome symptoms, such as pain, incontinence, or depressed mood.
If the symptom isn’t better, that is often a sign that the treatment plan needs to be reassessed. Let your doctor or pharmacist know!
If the symptom is better, this might be a sign that it’s time to try tapering the medication. Or it might mean the current treatment is just right and should be continued. Which it is will depend on what condition is being treated. High blood pressure, for instance, usually requires indefinite treatment. But for other conditions, it might be quite appropriate to try reducing the medication dose to see if it’s still absolutely necessary. You should let your healthcare provider make medication adjustments, do not do this on your own.
What you don’t want is for a medication to remain at the same dose simply because things are on “auto-pilot.” Keeping a medication at the same dose should be an actively considered choice made by the patient and healthcare provider together, rather than the consequence of inertia.
3. Check to see if any of the medications are on the Beer’s list.
The Beer’s list is a list of medications that are considered inappropriate to be prescribed to seniors. Since falls can be very dangerous for the elderly, the medication on this list can potentially make a person drowsy and increase the risk of falls. The easiest way to do this is to go to a page that lists all medications that are on the Beer’s list like, this one, and check. If you are on one or more of the medications on the list, find out why. It doesn’t necessarily mean that it is inappropriate but you should know the risk and why you are on the medication(s).
For instance, it’s fairly common for seniors to be prescribed medication for overactive bladder, because urinary leaks are common among older adults. But most of these drugs are anticholinergics, which means they affect the brain along with the bladder. Anticholinergics are on the Beer’s list because they can cause confusion in older adults; they’ve also been linked with developing dementia. Fortunately for seniors, it’s often possible to improve bladder issues using non-drug techniques, such as bladder training, pelvic strengthening exercises, or timed toileting. This may not be right for every senior so check with your healthcare provider.
Along with anticholinergic drugs, the Beer’s list medications that are most often prescribed to seniors are sedatives and tranquilizers for sleep or anxiety, anti-psychotics for dementia, and non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen, which are also available over-the-counter) for arthritis.
4. Check for signs of over-treatment, especially for high blood pressure and diabetes.
Did you know that it’s fairly common for seniors to be receiving higher doses of medication than is actually necessary? This can potentially create safety issues, especially when it comes to high blood pressure and diabetes.
Over-treatment of hypertension, for example, can cause an older adult’s blood pressure to be low, especially with standing. (A drop in blood pressure with standing is sometimes called orthostatic hypotension.) This can cause dizziness or light-headedness. It can increase the risk of falls; a study in 2014 found that seniors taking high blood pressure medication had a higher chance of bone-breaking falls.
Similarly, high doses of diabetes medication can cause a senior to experience episodes of hypoglycemia or low blood sugar. Studies have found that insulin, in particular, is linked to hospitalizations and emergency room visits.
To help your parent’s doctor spot over-treatment, you’ll want to familiarize yourself with what the “goal” is for your parent’s treatment.
For blood pressure, this means finding out what your blood pressure range should be. Based on the most recent expert guidelines, the recommended blood pressure target for adults aged 60 or older is less than 150/90. (The recommended goal used to be less than 140/80, but there’s now increasing concern about the risks of blood pressure treatment in seniors.)
For diabetes, you’ll want to find out what is a good range for your random blood sugar, as well as the ideal range for his hemoglobin A1C. You can learn about expert recommendations for diabetes control in seniors here.
5. Check for drug interactions.
You may also be concerned about the possibility of drug interactions, especially if you are taking several prescription medications. Also, nutritional supplements and over-the-counter medications may interact with your prescription medications.
Risky drug interactions are certainly a serious issue in senior health care since many are taking two or more prescriptions.
Functional Health 4U provides medication review. It is recommended that this be done regularly, especially if your medication prescription medications are changed. Also, if you want you are considering nutritional supplements, please check with our pharmacist.