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Drugs to avoid for the over 65s

MagazineSeptember 2015 (Vol. 26 Issue 6)Drugs to avoid for the over 65s

Older people are now taking an average of 30 prescription drugs-and the reactions to them are the exact same as we've assumed are the result of growing old

Older people are now taking an average of 30 prescription drugs-and the reactions to them are the exact same as we've assumed are the result of growing old

Do not get old, but if you must, don't take too many prescription drugs. An elderly person in the UK is now taking 30 prescription drugs most days, according to the latest estimates-and that figure could be higher in the US, where a more aggressive form of medicine is practised.

Polypharmacy-as multiple drug use is known-comes with many unknowns, especially in the older patient. For one, the safety of drugs is never tested on the over-65s, which is astonishing as the vast majority of prescriptions are written out for this very age group. For another, nobody is testing for the interactions between different chemical agents.

Because an older person metabolizes chemicals differently, the chances of an adverse reaction to any one prescription drug rises to 20 per cent, compared with just a 3 per cent risk in a healthy, young patient.1 And the possibilities of a serious reaction could skyrocket when multiple drugs are being taken at the same time.

Several new studies bear out this concern-and the reactions are similar to those normally associated with getting older. In other words, problems like being unsteady on one's feet, forgetful and incontinent could be caused by drugs rather than the simple fact that someone is elderly.

Common drugs for insomnia, respiratory problems and bladder conditions are doubling the risk of a serious fall in the elderly, one study has found.

The drugs known as 'anticholinergics' block acetylcholine, a chemical that aids the communication, or neurotransmission, that takes place between nerve cells in the brain.

As a result, the elderly patient can suffer blurred vision, increased heart rate, sedation and confusion, which doubles the risk of a serious fall resulting in injury, say researchers at Trinity College Dublin.2 The same family of drugs-which are also given for treating dementia and early-stage Alzheimer's-are causing alarming, and life-threatening, weight loss in older patients.

The drugs, which include donepezil, galantamine and rivastigmine, are causing at least a 10-lb (4.5-kg) weight loss in one out of every 21 patients over just a year.

The weight loss often leads to a poorer quality of life, hospital care and even death, say researchers from the University of California at San Francisco.3

Despite this, polypharmacy among the elderly is dramatically escalating. Last year, doctors in the UK wrote one billion prescriptions, which averages out to around 20 for each person in the country. As many people-and especially the young and middle-aged-don't take any drugs at all, it's not unreasonable to assume the elderly must be taking at least 30 different drugs each year.

In 2004, the average was 13 drugs per person. The biggest increase has been in prescriptions for cholesterol-lowering statins, which have doubled over the past decade, followed closely by prescriptions for antidepressants, which have risen by 97 per cent. Katherine Murphy, of the Patients Association, says the UK is fast becoming a nation of pill-pushers and that prescribing is now "out of control".4

Worryingly, the vast majority of pills being pushed to the elderly shouldn't even be given to them in the first place.

The American Geriatric Society (AGS) regularly updates its Beers list of medications that are "potentially inappropriate" for the elderly. There is "high" evidence that anticholinergics shouldn't be prescribed to the older patient, and the same goes for the antiarrhythmics used for controlling irregular heartbeat, tricyclic antidepressants (TCAs), barbiturates for anxiety, benzodiazepine tranquillizers and many others (see box, left).

But while drug companies test their medications only on the young and have no clue about the toxic effects of polypharmacy, it's a problem that will only get worse.

REFERENCES

1 Br J Clin Pharmacol, 2004; 57: 121-6
2 J Am Geriatr Soc, 2015; doi: 10.1111/jgs.13543
3 J Am Geriatr Soc, 2015; doi: 10.1111/jgs.13511
4 The Telegraph, 7 July 2015; www.telegraph.co.uk/news/nhs/11724515/Warning-of-a-nation-of-pill-pushers-as-figures-show-55-per-cent-rise-in-prescriptions.html


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