Are you taking the wrong medications?

If you have been taking medication for many years, it may be difficult to continue taking the medication as you age. But doctors say many people may be exposed to “inappropriate” drugs that are safe for aging or causing new health problems.

According to a study published in April 2023 in JAMA Web, globally, 37 percent of adults over the age of 65 use inappropriate medications (PIM). Misuse of the wrong medication can lead to more side effects, emergency room visits, and reduced quality of life. How? Risk factors include falls, hallucinations, depression, dizziness, hallucinations, balance problems, dementia, hallucinations, bleeding (internal or external), heart failure, osteoporosis and liver problems.

“If a drug works in your 40s or 50s, it may work in your 60s or 70s, but then the effect may wear off,” says Amber Kalshrishtha. and Associate Professor, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta.

Some are not even doctors. In fact, a 2022 study published in the journal Frontiers in Pharmacology found that 55 percent of nearly 600 Chinese doctors had never heard of an analytical device that could cause PIM in elderly patients. A 2016 study published in the journal PLOS One also found that 58 percent of 400,000 patients aged 65 and older in Germany received PIM prescriptions from pharmacies.

Post-operative complications may also occur. A 2022 study published in the journal Anesthesiology and Analgesia examined substance use among 1,627 adults age 65 and older undergoing elective outpatient surgery: researchers reported that 69% Patients received at least one PIM. It is associated with longer hospital stays after surgery.

In other words, by using PIM, older people can replace one health problem with another. Jason Karlovsh, an ophthalmologist and professor of medicine at the University of Pennsylvania.

PIM Groups

Each year, the Geriatrics Society updates the BEER guidelines, a comprehensive list of medications that may be contraindicated in older adults. This list includes doctors, researchers and other health professionals.

In the new year 2023 there will be five categories: Medicines that are not good for the elderly; Medicines that may not be recommended for people with certain medical conditions, such as heart disease, dementia or Parkinson’s disease. Medications that can cause complications and interactions, as well as medication dosages, should be adjusted based on the individual’s liver function.

More than 200 medications commonly used by older adults are listed in the 2023 PIM Bear Rolls. These include various types of antihistamines (such as diphenhydramine or oral Benadryl), benzodiazepines (such as alprazolam, clonazepam, and diazepam), and blood circulation medications. Medications (eg, prescription digoxin). Clonidine for heart failure and high blood pressure. Some have skin care products. . amitriptyline and paroxetine), certain psychotropic drugs (usually unlicensed sleeping pills), proton pump inhibitors used to treat acid reflux, certain muscle relaxants, nonsteroidal anti-inflammatory drugs, ongoing medications (including ibuprofen and naproxen), and other pain relievers. . , and another.

PIM usage varies around the world. Africa and South America had the highest PIM adoption (47 percent), followed by Europe at 35 percent, and North America at 29 percent.

Adding to the complication of PIM is the complication of polypharmacy, which is defined as the use of five or more medications at the same time and is common in the elderly.

In a 2021 study published in the Archives of Gerontology and Geriatrics, researchers looked at PIMS among 61,000 adults age 65 and older with at least two chronic conditions (eg, high blood pressure, diabetes, or depression). See usage. and used at least five brands of prescription drugs over a seven-year period: They found that 69 percent of them used at least one PIM, and it was more common among women.

As people age and develop various illnesses, they may also experience a “healing leap,” says Dr. Austin Armstrong, MD, an ophthalmologist at MedStar Washington Hospital in Washington, D.C. Work with someone with high blood pressure. For example, and they take medicine. Medicines to lower blood pressure. It should be noted that some antihypertensive drugs can cause leg swelling (drowsiness) as a side effect, so the patient should reduce fluid intake and receive diuretics. Recording to this type of tape usually requires further processing.

“When multiple drugs are taken, they can do more harm than good together, even if they are safe to take individually,” says Kalashrishtha. And when PIM is added later, the potential for side effects increases.

Why do some drugs cause medications anxiety?

There are many reasons why certain drugs become harmful as we age, but the most likely explanation lies in age-related physiological changes.

Metabolism slows down as we age, which is why people gain weight as they age. Most Popular Patients: The elderly are also prone to gastrointestinal motility, loss of body fluids, and changes in liver and kidney function, which affect drug absorption, metabolism, and physiology. They affect emissions. “This represents a dangerous trap in dire circumstances,” Armstrong explained.

On the other hand, changes in vision, hearing and orthopedics can make older people more sensitive to certain side effects of medications. And because of the aging process, neuron-to-neuron connections are lost, says George T. Grossberg, professor of neuroscience and professor of psychiatry at Louis University. San Luis School of Medicine. “As a result, brain aging can lead to sensory or cognitive changes” caused by certain drugs.

Cholinergic drugs that block receptors for the neurotransmitter acetylcholine, including some drugs used to treat allergies, depression, breathing problems (such as asthma), kidney disease, heart disease, and Parkinson’s disease. There is confusion in the elderly, dementia in the elderly,” Grossberg said.

The problem, Grossberg said, is that many doctors have access to medical, drug and psychiatric records, and some doctors may not know the risks of using certain drugs in adults. This may be in part because these drugs were only tested in adolescents, which showed few problems in adults, Karlovsh wrote. “The information is delayed.”

Cultural prescription.

For complex cases, “older people go to hospitals more often, which reflects both health care providers and the fact that older people have more health problems,” Karlovish said.

Another reason to take PIMs: People and doctors often stick with certain medications because they think they work well and don’t need to be changed much. This person is old now. It is known as an ancient drug and according to research it is especially common among antidepressants and proton pump inhibitors.

“Doctors are reluctant to stop prescribing if a patient has been taking it for a long time,” Armstrong said. “But your 80-year-old self is different from your 40-year-old self, so it may not be the best solution.”

Talk to your doctor about PIMs.

It is important for seniors and possibly their family members to review their medications at their medical appointments. Tell your doctor if you experience withdrawal symptoms of PIM, which may be related to the medications you are taking. Even if you don’t, Kalashrishtha suggests looking at your existing products and asking: Why do I need this particular product? what’s wrong with me? And is it safe to take for my age, even if I take it for a short time?

       "This can make the doctor think twice about treatment," added Kalashrishtha.

The goal is to test all products and identify products that are not needed.

“We need to focus more on the concept of resilience in the elderly,” Grossberg said. Briefly, the definition includes lowering or reducing the dosage of drugs that may cause harmful or adverse effects. Nothing more is needed. This is especially important for the elderly.

“When we get people off dangerous drugs, we can see how real they are,” Grossberg said. “They’re usually pretty good.”

In other cases dose adjustment may be required. As you age, the dose may need to be adjusted or reduced to avoid the effects of PIM, Armstrong says. “It’s an ever-changing place. We have to treat patients the best they can when they come to us.”

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