As people grow older, they can develop a litany of health problems and see multiple specialists who prescribe various drugs to treat common conditions such as osteoporosis, high blood pressure, diabetes, heart disease, arthritis and memory loss.
“Drugs may not play well with each other, and problems can snowball for older adults who take five or more medicines,” Little said.
“As a geriatrician who quarterbacks the health care of my patients, I think six medicines usually is too many, and studies have shown mortality is higher among patients who are taking 10 medicines. I love to analyze medicines my patients are taking because reducing the number of drugs often makes them feel so much better. Many times, less is more.”
Every patient is unique with different health goals and challenges that change as a person ages, which is why one-size-fits-all guidelines don’t work, Little adds. She advocates an annual medicine check-up, where patients ask doctors to assess the drugs they are taking, being mindful that vitamins, supplements and over-the-counter medicines count, too.
“Supplements and other nonprescription medications, which are often less rigorously regulated than prescription medications, are a major cause of dangerous drug-drug interaction in elderly patients,” Little said. “I don’t recommend a multi-vitamin or gingko for brain health for everyone. The supplements are for specific people, and I prescribe them like anything else, only for those who need them.”
Here are questions Little asks as she analyzes the medicines her patients take:
How old is my patient? Guidelines on what constitutes good health loosen with age. For instance, a good blood pressure for a younger adult – 120/60 – is much lower than a healthy blood pressure for an older adult – 160/90. And a person who has a blood pressure with a top (systolic) number that’s too low – 130 – could fall or become dizzy, which creates additional health risks. “My prescriptions for patients who are 65 are different than those for patients who are 80,” Little said. “For patients who are 100, I probably wouldn’t prescribe any medicine at all. If they’ve lived to be 100, it’s probably nothing doctors did.”
How long has the patient taken the medicine? Prescriptions are not forever, and should be reviewed periodically to make sure they’re still necessary. “It may have been appropriate for you 10 years ago, but may not be today,” she says. “Under your doctor’s guidance, don’t be afraid to try going off your medicine.” For instance, there is no evidence that shows a 76-year-old patient who has high cholesterol but hasn’t had a heart attack or stroke within the last year would benefit from taking a statin, although he might have been prescribed the statin 16 years ago, when it likely could help.
Is the dosage right? As people grow older their bodies change. A smaller dose of medication might yield the same response as a younger adult. Often times, a half-dose of a psychotropic medication works better in older patients than a full dose, as does a smaller dose of medicine for osteoporosis. “Start low and go slow,” Little says. “You can always give more but you can’t take it out of the body once it’s given.”
What are the drug’s side effects? A medicine might address one problem, but create another. For instance, antidepressants can cause frequent urination, which can lead to incontinence. Statins and blood thinners worsen frailty, which makes patient vulnerable to more medical problems. An anti-diuretic for blood pressure can worsen symptoms of gout, which is a form of arthritis.
How well do medicines play with each other? Drugs given for one illness could make another condition worse. Medicine given for acid reflux can reduce the effectiveness of blood thinners because of the way the medicines are broken down in the liver.
“Some older adults believe taking a pill will make them healthier, which is not always the case, particularly when they’re taking many pills for different health issues. Too many medicines can make older adults feel fatigued, and undermine the quality of their lives,” said Little, who is the author of an editorial on overmedication in the elderly that appeared in a 2016 issue of JAMDA. “We have a lot of evidence that non-medical treatments, such as exercise, yoga and massages, work better in improving a person’s health. But they’re work.”
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.
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