Older adults have a high prevalence of multiple chronic medical conditions and therefore tend to take more prescription drugs than younger individuals. While these medications are intended to treat health issues and manage symptoms, they also increase seniors’ risks for adverse drug reactions (ADRs) like unintentional overdoses. This risk increases with the number of medications a person takes.
A study published in The Journals of Gerontology concluded that the median number of prescription medications Americans age 65 and older use is four. However, an estimated 15.1 million seniors (39 percent of this age group) report taking five or more. Polypharmacy, or the use of multiple medications at once, can negatively impact health outcomes, especially for seniors.
Opioids Aren’t the Cause of Most Senior Overdoses
When it comes to overdoses and adverse drug events, one might immediately think that more dangerous drugs like prescription opioids would be to blame. In fact, ongoing research from the Centers for Disease Control and Prevention (CDC) indicates that seniors are more likely to be hospitalized for adverse events related to the use of blood thinners or diabetes medications than they are to be harmed by prescription painkillers.
CDC researchers have discovered that three common drug classes—anticoagulants (blood thinners), diabetes agents and opioid analgesics—were responsible for the majority (59.9 percent) of drug-related hospitalizations among people age 65 and older. According to the study, “Four of the 15 most common drug products implicated in emergency department visits for adverse drug events among older adults were anticoagulants (warfarin, rivaroxaban, dabigatran, and enoxaparin) and five were diabetes agents (insulin, metformin, glipizide, glyburide, and glimepiride).”
Opioid analgesics make the list, but by contrast, they only accounted for 4.6 percent of emergency department visits among adults age 65 to 79 and 3.5 percent among patients age 80 and older.
And therein lies the problem—riskier drugs like narcotics, sedatives and antipsychotics are not given to seniors nearly as often as blood thinners and insulin. Diabetes and heart disease reign supreme as two of the biggest health problems for all Americans, not just the elderly. While lifestyle changes can help, many still require prescription drugs to control these chronic conditions and prevent complications.
Even if an older patient is capable of properly and consistently managing their medications, they may still be overmedicated per their doctor’s orders and susceptible to ADRs. Without regular monitoring and careful management with the help of an attentive physician, these medications can lead to serious complications, such as hemorrhage (bleeding) in patients with heart disease and hypoglycemia (low blood sugar) with moderate to severe neurological effects in patients with diabetes. Nearly 44 percent of all seniors who report to the emergency room for adverse drug events are admitted to the hospital.
How to Prevent Adverse Medication Events
Sadly, these events are expensive and stressful for older adults, but it is important to note that many of them are also entirely avoidable. The CDC offers the following tips to help seniors and their caregivers handle medications more effectively:
- Maintain an up-to-date list of all medications and dosages.
- Make sure ALL doctors have current and complete medication information.
- Use medications exactly as prescribed and directed by a doctor.
- Relay all medication questions to the prescribing doctor or a pharmacist.
- Learn about possible adverse reactions that may occur with the prescribed medications.
- Act quickly on any symptoms that may indicate an adverse drug reaction.
- Be vigilant with any prescribed blood tests.
The Importance of Blood Tests
This last bit of advice is especially important for seniors who are taking blood thinners and older adults with diabetes. These ongoing tests can be a nuisance, but they are crucial.
For example, proper anticoagulant dosing for drugs like warfarin typically includes regular prothrombin time blood tests to check the blood’s ability to clot and determine the effectiveness of the medication a person is taking. Prescribing recommendations for newer, “safer” anticoagulant drugs like Xarelto (rivaroxaban) and Pradaxa (dabigatran) do not include routine blood testing, but authors of the CDC study found that these are the fifth and tenth most implicated medications in adverse drug reaction emergency room visits among seniors. The Mayo Clinic points out that older patients are more likely to have age-related bleeding, clotting, stroke and kidney problems, which may require caution and adjustments in dosages for patients who are taking either of these drugs.
When it comes to any kind of medication management in older adults, there are many different factors that can complicate treatment. One senior’s physical and functional abilities, health status, medication regimen, living situation, social support and financial resources can differ greatly from that of another. Medication guidelines tend to be rather generalized, therefore it is up to physicians to gather all relevant patient information and customize treatment as needed. These patient characteristics can have a particularly pronounced effect on glucose control as well.
A1C blood tests are often used to diagnose diabetes and determine how effectively certain treatment options are managing the disease. One study concluded that age alone can affect A1C levels, as can other health issues like iron deficiency anemia, recent blood transfusions, hemodialysis and erythropoietin therapy. Furthermore, a 2018 update to the American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” acknowledges that stressful events like illness, trauma and surgery may worsen glycemic control and precipitate complications. “Any condition leading to deterioration in glycemic control necessitates more frequent monitoring of blood glucose; ketosis-prone patients also require urine or blood ketone monitoring,” the authors note.
Seeking Specialized Health Care for Seniors
To complicate matters further, older adults also tend to metabolize drugs differently than younger populations, display unusual symptoms of illness and take multiple medications that could potentially interact with one another. Authors of another report published in Therapeutic Advances in Drug Safety note that “ADRs can be difficult to recognize in older people as they often present with nonspecific symptoms, for example falls, fatigue, cognitive decline or constipation, all of which have several aetiologies.”
It is crucial for doctors to receive proper training and education in treating special populations, such as the elderly, to improve health outcomes. While geriatricians (doctors who specialize in treating older adults) are in high demand and short supply these days, finding one to spearhead a senior’s health care can be highly beneficial, especially if they are managing one or more chronic conditions like heart disease or diabetes. These professionals understand the unique physical, emotional, social and financial circumstances that influence many older adults and take these factors into consideration when treating patients.
To find a geriatrics healthcare professional in your area, use the search tool on the Health In Aging website provided by the American Geriatrics Society.
Sources: Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/#); US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014 (https://jamanetwork.com/journals/jama/fullarticle/2585977#joi160124t4); Adverse Drug Events in Adults (https://www.cdc.gov/medicationsafety/adult_adversedrugevents.html); Rivaroxaban (Oral Route) (https://www.mayoclinic.org/drugs-supplements/rivaroxaban-oral-route/side-effects/drg-20075013?p=1); Dabigatran (Oral Route) (https://www.mayoclinic.org/drugs-supplements/dabigatran-oral-route/side-effects/drg-20074611?p=1); Diabetes Management in the Elderly (https://spectrum.diabetesjournals.org/content/31/3/245#ref-20); 6. Glycemic targets: Standards of Medical Care in Diabetes—2018 (https://care.diabetesjournals.org/content/diacare/41/Supplement_1/S55.full.pdf); Predicting risk of adverse drug reactions in older adults (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716390/)