Judd Matsunaga
No doubt about it — modern day science and medicine are keeping people alive a lot longer. Medications are, of course, a mainstay of modern medicine. They are often key to how we manage a variety of health conditions. Studies show that over 90 percent of adults over age 65 take at least one prescription medication, while more than 66 percent of the same group take more than three prescriptions a month (source: www.myclevelandclinic.org).
Medicines can be life saving. But sometimes, taking too many drugs can be dangerous — especially for older adults. The use of multiple drugs to treat diseases and other health conditions is known as “polypharmacy.” Polypharmacy is a growing concern for older adults, many of whom have two or more chronic conditions such as arthritis, asthma, coronary heart disease, depression, diabetes and hypertension (also known as “multiple chronic conditions (MCC)”.
Aging also makes people more susceptible to these negative side effects. As we age, our bodies change. Certain medications can change the way our bodies respond. This can affect how medications absorb into our bodies.
For seniors with MCC, the use of excessive or unnecessary medications increases the risk of adverse drug effects. Quite often, a medication prescribed to treat one condition worsens another or causes a whole new problem.
Polypharmacy also creates a tremendous burden for patients and their families, who need to understand the purpose of the many prescriptions written by multiple providers, get refills, take each medication at the correct time of day and recognize side effects. Ideally, doctors should discuss the risks of the medication with the older person (and with family when closely involved). However, research has repeatedly confirmed that, in many cases, the risks were not explained to the patient and/or their families or that safer alternatives were offered.
Over the years, geriatricians have noticed that some medications, in particular, are more likely to cause problems or create extra risks. Researchers are studying “deprescribing” to reduce these risks and improve outcomes in older adults with MCC.
Therefore, geriatricians and other experts in aging health spend a lot of time reviewing medications and consider whether to deprescribe them (source: www.betterhealthwhileaging.net). The “Beers Criteria” is essentially an extensive list of “potentially inappropriate medications” that should be avoided or used with caution, when it comes to the health care of adults aged 65 and older.
“Potentially inappropriate” means that in most older adults, the likely risks of using the medication (i.e, side effects) outweigh the likely benefits of taking the medication, especially when compared with other available treatment options. It’s important to know that just because a medication is “potentially inappropriate,” this does not mean that it’s always “wrong” to prescribe it to an older person.
There are close to 100 medications or medication classes on the 2023 “Beers Criteria” list, which is updated every few years (most recently in 2023) and is overseen by the American Geriatrics Society. The Beers Criteria is a list of medications that a health-care provider may reference when prescribing medications to a person over age 65. This list can help a provider make a decision about safely prescribing medications. The following list isn’t comprehensive, but it gives an example of a drug in each category and the reason why it’s harmful:
- Analgesics (meperidine): Neurotoxicity, delirium.
- Antibiotics (ciprofloxacin with warfarin): Increased bleeding.
- Antiseizure medications (carbamazepine): Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
- Antihistamines (brompheniramine): Confusion, cognitive impairment, delirium.
- Antihypertensives (alpha-blockers): Hypotension.
- Antiplatelets or anticoagulants (edoxaban): Renal impairment.
- Antipsychotics (any): Stroke, cognitive decline, delirium.
- Anxiolytics (benzodiazepines): Impaired metabolism, cognitive impairment, unsteady gait.
- Cardiac medications (disopyramide): Heart failure.
- Central nervous system agents (dimenhydrinate): Confusion, cognitive impairment, delirium.
- Diabetes medications (chlorpropamide): Hypoglycemia.
- Gastrointestinal medications (H2-blocker for delirium): Worsening delirium.
- Hormones (estrogen): Breast cancer, endometrial cancer.
- Hypnotics (barbiturates): Dependence, overdose.
- Musculoskeletal agents (muscle relaxers): Confusion, dry mouth, constipation.
- NSAIDs [aspirin (more than 325 mg/day)]: Ulcer, gastrointestinal bleeding or perforation.
- Respiratory medications (atropine): Confusion, cognitive impairment, delirium.
- Urinary medications (desmopressin): Low sodium in blood (hyponatremia).
- Vasodilators (ergoloid mesylates): Lack of intended results.
Never stop taking a medication without first talking to your doctor or health-care provider, even if a medication you’re taking is listed on the AGS Beers Criteria list. Instead, review all of the medications you are taking with your doctor and pharmacist.
In conclusion, if your medication is on the AGS Beers List, ask your doctor or pharmacist about the potential side effects. Finally, make sure you report any side effects, questions you may have about them or any problems with taking them as prescribed (such as cost).
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
