Harm from medications is a major problem in America and older adults are the age group most likely to suffer, being four times more likely than younger adults to experience harm. Harm from medications can be classified as adverse drug events, or ADEs. ADEs are now the fourth or fifth leading cause of death by disease, albeit a man-made disease. However, many ADEs can be prevented, with estimates ranging from 26 to 95%. So what can you do to prevent harm from taking medications that are intended to help you live longer and better?
Your Role- Yes, you have a major role in preventing harm from medications, and it starts before the prescription is written.
Evidence- Many medications may not be necessary in older adults, primarily because of two reasons:
1) The medication may not have evidence behind it in someone your age
2) Non-drug methods may be as helpful at yelping you achieve your goal
The use of some medications in the older adult just doesn’t have good evidence to back up their use, especially in those over 80. A good example is the use of statins, those cholesterol lowering drugs that have benefits in younger adults, but many older adults not at high risk for a heart attack or stroke, may not gain any benefit yet are at higher risk for serious side-effects.
When your doctor suggests you need a medication, you should ask the question: “Is there good evidence that this medication is beneficial in people my age and in my circumstances?”
Another question you should ask is “Are there non-drug methods I can try first?” Many conditions in which we take medications we can find evidence that non drug methods are as effective, if not more effective and safer than drugs. Examples are drugs to treat urinary incontinence and insomnia. Non-drug methods are preferred in the long run and are not associated with side-effects such as memory loss, falls, daytime sedation, dry mouth, constipation, among others.
Safety- Another question you should always ask your doctor is “Is this medication safe in people my age?” Sometimes a study produces positive results, only to find that he study population wasn’t a group of older adults but a much younger group. They may have also been taking fewer prescription medications which is not what we see in the real world. A good example is the drug spironolactone, used in heart failure and associated with lower hospitalization rates and lower mortality, or so one study showed. However, when the use of that drug expanded to those in their 80s and 90s, hospitalizations soared as well as mortality in those using the drug. The reason was due to the drug causing high potassium levels, which is more common in older adults due to poor kidney function as we age.
Monitoring- Forty to sixty percent of ADEs can be prevented with better monitoring, and that means that you should be asking “What side-effects do we need to monitor for?” Yes, the MD needs to know what to monitor for, as well as you. Is it muscle cramps, dizziness, or other side-effect that when caught early can stave off a more serious ADE.
Interactions- Drug interactions are thought to account for anywhere from 16 to 26% of ADEs. You should be asking “Did you check for drug interactions?” Now the MD or pharmacist must give you an accurate answer so they are held accountable. I say this since many drug interactions are over-ridden computer systems due to the many false alerts we receive. We call this alert fatigue. So don’t assume anything but ask the question.
Avoid Potentially Harmful Medications- Many medications are considered generally unsafe in older adults. Even some that are available without a prescription. A couple examples are OTC pain medications like Motrin, Advil, Nuprin (ibuprofen), Aleve (naproxen) and OTC sleep medications that contain Benadryl or diphenhydramine, eg. Tylenol PM. Pain meds can cause stomach ulcers and bleeding and can also interact with blood thinners to cause serious bleeding and death. OTC sleep products contain sedating antihistamines that cause falls and also memory impairment. Yet non-drug interventions can help with problems with poor sleep.
There are other medications that are associated with harm in older adults. Ask your pharmacist.
Start low and go slow- One thing that can be done to prevent an ADE is start with lower doses and go up with the dose slowly, and only as needed. It is thought that 50% of ADEs can be prevented or mitigated just by using lower doses. Ask your doctor “Is this the lowest starting dose we can try?”
Proper Administration- Several drugs, when not taken properly, can cause serious side-effects. A couple examples are Flomax (tamsulosin), which needs to be taken with food. Otherwise it can cause a quick drop in blood pressure, dizziness and cause a fall. The same thing can happen with Coreg (carvedilol). A unique side-effect can also occur from eye drops. Eye drops, when not properly administered, can be absorbed into the body and cause dizziness and falls. In fact, the leading risk factor for falls in those with glaucoma is the use of timolol eye drops. Who would have thought?
“I know how I feel”: Always suspect a drug until proven otherwise- Many practitioners do not have the broad knowledge base to recognize that some of your complaints or symptoms can actually be from a medication. So after starting a medication, if you suspect something different in how you function or feel, tell your doctor. But also I recommend that you find out if that symptom can be from your medication. Being prepared before asking the question can be more useful in getting the doctor to listen. Self-reported ADEs was found to be useful in several studies and lessening the harmful effects form drugs. However, those who didn’t report them, and those whose doctors didn’t listen were not so lucky. I learned a long time ago “Listen!”
So there’s your quick guide to a better office visit and better health, hopefully by avoiding harm from your medications.