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Older Americans are swimming in a sea of heavily marketed, symptom-specific prescription drugs—medications that act as life-savers, if taken appropriately. But if seniors and their physicians don’t review the drugs frequently, the life-preserver can weigh more than an anchor.
When Chris Ojeih, M.D., first treated Jimmie Holley, the geriatric patient was ingesting more than 20 different medications. He was gobbling pills by the handful for congestive heart failure, kidney failure and diabetes. Ojeih reviewed his medications and quickly reduced the drugs and doses.
“A month ago, the medications were appropriate, but many of them were not anymore,” says Ojeih, professor of family practice at The University of Texas Medical School at Houston who specializes in geriatrics. “He (Holley) was stable enough that he no longer needed them.”
Even though people ages 65 and older make up 12 percent of the U.S. population, they consume 30 percent of the prescription drugs, says the American Geriatrics Society. By the year 2030, it’s projected that 40 percent of all medications consumed in the U.S. will be used by those over 65.
Because older people tend to have long-term, chronic illnesses, they’re consuming more drugs than any other age group, says Mary Rapp, R.N., assistant professor of nursing at The University of Texas School of Nursing at Houston. “It’s just a fact of life. That is the age group who takes the drugs.”
Ads for prescription drugs are everywhere from billboards to Super Bowl commercials. Merck & Co., makers of Vioxx (rofecoxib), spent $500 million in the past five years on advertising before abruptly pulling the anti-inflammatory from the market. In Sept. 2004, data was found to suggest a link to increased risk of heart attack and stroke. Vioxx was taken by tens of millions people worldwide, according to the American Association of Retired Persons (AARP).
No doubt, drugs save and enhance lives. However, medications also can cause problems, especially for seniors. Because of changes in organ function and loss of muscle tissue that cause the drug to be more concentrated in the blood, older people can be more sensitive to drugs, including those available as over-the-counter (OTC) medications. Older people can face dangerous drug interactions and uncomfortable side effects, including depression, confusion, disability, dizziness and ultimately death.
For example, Tagamet (cimetidines), an over-the-counter antacid, has been known to cause confusion in seniors, says Rapp. “Seniors have brain sensitivities to the drug. This is something the physician would know, but not the consumer, and that’s a concern.”
Rapp says for some seniors, Tylenol PM or Benadryl- brand products can put their bladders to sleep. This is especially risky for older men with diabetes who can experience acute urinary retention and have to go to the hospital.
Drug interaction is particularly dangerous. For example, a person who takes a blood-thinner, such as warfarin (Coumadin) should not combine that with aspirin, which can cause the blood to thin more. Vitamin E supplements may prolong clotting time; Vitamin K supplements may promote clotting, which may interfere with a blood-thinner.
Antacids can interfere with the absorption of certain drugs for Parkinson’s diseases, high blood pressure and heart disease and certain antibiotics, according to U.S. Food and Drug Administration.
Holley remembers taking a heart medication that was too tough on his stomach. “I’ve been put on different heart medications that just made me too sick,” says Holley. “I couldn’t take them anymore.” Holley has been hospitalized several times because of heart and medication-related problems.
According to Ojeih, about 30-40 percent of hospital admissions for seniors stem from medication-related problems. “Seniors need to be careful with the drugs,” he says, adding, “They go to the ER because of a reaction between medications or the particular medication has a bad side effect.”
Each year medication-related problems cause more than 250,000 hospital stays for people 65 and older, adding billions to the national healthcare bill, according to the American Society of Consultant Pharmacists.
Adding to the med mix is a tendency for seniors to visit a variety of doctors for their medical needs, instead of orchestrating their needs through one primary care physician. Therefore, the physicians are not fully aware of the patients’ entire menu of prescription and over-the-counter medications. Ojeih says it is vital to talk about prescription and OTC medications with all of your health care providers—doctors, pharmacists, physical therapists and nurses.
At LBJ General Hospital, where he is chief of family practice and geriatrics, Ojeih runs a comprehensive geriatrics program, a one-stop shop for seniors for preventive care, common geriatric screenings, nutritional and social support, polypharmacy, environmental safety and mental health assessments. Ojieh says he reviews his patients’ drugs during every visit they make to him.
Ojeih encourages patients to be their own advocates. "You need to ask your doctor to review your medications each visit. Bring all your meds with you so you don’t forget,” he suggests.
Rapp says seniors can either store copies of prescription labels in a Zip-Loc bag or store all medications in one large container when transferring to a physicians’ office. Also, in an event of an emergency, it is important to have all the meds in one easy location.
Rapp also is a geriatric nurse practitioner for Geriatric Associates of America, a group of geriatric nurse practitioners and physicians who work collaboratively to serve the nursing facility population. She regularly visits facilities in the Houston area. Recently, she helped to establish a medication reduction program. Two primary goals of the program are to reduce the number of medications each senior takes, and reduce the number of times nurses administer meds. The fewer times medications are passed, the less likely for an error, says Rapp.
To help prevent errors, Rapp says, seniors should be their own medicine manager. “To protect yourselves, you should have a core list of drugs handy and make sure that the people prescribing them are certain of what you’re taking.”
Most of Rapps’ patients are able to survey their own medications, but if it gets too difficult, involve children, spouse and other family members when possible. Adult children in particular can help keep track. In the event children assume caregiver duties, they’ll already be acquainted with the medications, physician and pharmacist. Whomever the medicine manager, it is important to speak up, says Rapp. “Don’t be afraid to ask questions.”
Holley listens closely to that advice. “If I go to the ER and they give me medications, I question why and make sure Dr. Ojeih knows about it,” he says. “I’m being healthy and I owe that to Dr. Ojeih. I do what he tells me to do.”
Last Updated: 10-21-2005Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
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Dr. Chris Ojeih is a professor in the Department of Family Practice at the UT Medical School.
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Mary Rapp is assistant professor of nursing at the UT School of Nursing.
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Eating healthy
reverses metabolic syndrome
Dr. Tasnime Akbaraly of University College London and her colleagues were interested if healthy eating could actually turn-the-tide and reverse metabolic syndrome, which is having 3 or more of the following risk factors: excess abdominal fat; high triglycerides, hypertension, low levels of HDL the “good” cholesterol, or type 2 diabetes. Having metabolic syndrome doubles a persons’ risk of heart disease and greatly increases the odds of developing type 2 diabetes.
The researchers studied 339 British civil servants with metabolic syndrome, and how closely the adhered to the Alternative Healthy Eating Index (AHEI) to see if it could help reverse metabolic syndrome. The AHEI is a set of published nutritional guidelines by the Harvard School of Public Health in 2002 that emphasizes whole grains, fruits, vegetables and decreased red meat consumption.
Five years into the study, nearly 50% no longer had metabolic syndrome. People who followed the AHEI guidelines the closest were nearly twice as likely to have reversed their metabolic syndrome. The results of the study were published in Diabetes Care, online July 29, 2010.
Dr. Alice Lichtenstein, an expert on diet and heart health from Tufts University in Boston who was not involved in the study said, "It's not about focusing on individual components of the diet, it's really the whole package, and that becomes important because it means that if one of the components of a healthy diet is to eat more fruits and vegetables, just buying a pill saying that there's a concentrated extract of fruits and vegetables is probably not what's going to help you."
Call and make an appointment with Wellness Coach Sam Hester, CWC, CPT, LWMC, at 713-500-3327. It's confidential and free. For more information on the wellness services provided, visit UT Counseling and WorkLife Services.
