Part One of Medication Use in the Elderly

The following represents the first in a two-part series on medication use in the elderly. As medical director of a local nursing home, I feel it is my responsibility to address important topics with regards to geriatric medicine.
As our elderly population grows dramatically and our reliance upon prescription medication spirals upwards, polypharmacy takes center stage. Though not necessarily affecting you directly, we all have parents or grandparents who it certainly may affect. Studies show that most patients older than 65 years of age are on five or more medications. Can we, as providers, modify patient medication lists while at the same time decrease adverse risks and drug to drug interactions while improving compliance? The answer is a resounding yes! I have developed my own process for the evaluation of patients and their medications, my so-called ABCD’s of polypharmacy and compliance. Every single one of my office visits or trips to the nursing home applies these principles, thereby assisting in the ultimate elimination of unnecessary medicine.
A: ASK – the most obvious step in decreasing unnecessary medication use can be achieved by simply asking patients what medications they are taking, both by prescription and though over-the-counter/herbals supplementation. This needs to be done at every visit! A provider needs to ask themselves why a particular medication is being used. Is medication X being used to treat side effects from medication Y? Is medication Y still needed at all or was it originally used for a short-term condition? A perfect example might be a patient who took prilosec for a gastric ulcer. They took phenergan for associated nausea and antivert for dizziness and now take three medications six month later for an ailment requiring only four weeks of treatment. We must always ask ourselves if medications can be weaned or discontinued entirely.
B: BEERS - The Beers criteria is a well-defined list of potentially inappropriate medications for patients over the age of 65. The list has been consistently updated since its inception in 1991 to keep up with the ever-changing pharmaceutical armamentarium. Meds are listed as either high or low risk depending on their inherent danger to the elderly patient. The list includes common medications like darvocet, iron (325 mg/day), doxazosin (cardura) and cimetidine (tagamet), which are all considered lower risk. Higher risk medications include cyclobenzaprine (flexeril), oxybutynin (ditropan), amitriptyline (Elavil), alprazolam (xanax), antihistamines like benadryl, demerol and nonsteroidal anti-inflammatories like ibuprofen/Motrin. The list is lengthy and often surprising. I always make attempts to discontinue or change medications that are on the Beers list, a practice common in the nursing home setting and one which is gradually becoming standard of care.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.