Baby boomers once declared they would never trust anyone over 30. Needless to say, that was a long time ago.
As this generation approaches Medicare eligibility, it may need to revise its watchword. Today’s senior citizens need to be wary of the prescriptions they receive. To take a phrase from another ’60s icon, Ronald Reagan, they should trust but verify each medicine.
Research published in the journal PLOS ONE (Aug. 22, 2012) suggests that older people frequently receive prescriptions for drugs that are not ideal. A meta-analysis of 19 studies found that 20 percent of the medications prescribed to those over 65 are considered inappropriate.
Experts in the field of geriatric medicine have been sounding the alarm for more than two decades. Lists of medications that should generally not be prescribed for elders are widely available in the medical literature. That’s why the results of the new study are so discouraging.
One of the drugs the researchers say is overprescribed for older patients is amitriptyline. This medicine was originally developed as an antidepressant, but it is often used to treat insomnia or pain.
In seniors, the side effects may become overwhelming, as this reader reports: “I’ve been on amitriptyline for 15 years for fibromyalgia. It seemed like a miraculous cure. I slept through the night and my pain was gone.
“As I’ve grown older (I’m now 75), the long-term side effects combined with my age have gotten bad. I now have heart problems and can’t wake up in the morning. My memory loss is not just because of my age. And my sex life has been wiped out. Most people complain about constipation and dry mouth, but amitriptyline can cause all kinds of other complications.”
His story illustrates that someone may be started on a medicine that is helpful (like amitriptyline for fibromyalgia) during middle age. With increasing years, however, the brain and the body can become more susceptible to side effects. Unless the physician is paying careful attention, a patient may end up taking a drug at 75 that is usually discouraged for anyone over 65.
Older people frequently have more health problems than younger ones, but that is not an excuse for administering drugs that can make them worse. Usually medications flagged as unsuitable for geriatric patients have side effects such as dizziness, confusion, constipation, drowsiness or unsteadiness. Sometimes one of these drugs leads an older person to be mistakenly diagnosed with dementia, as this reader shared:
“My mother was going downhill fast, showing signs of memory loss, confusion and depression. She was always exhausted and frequently slept all day. Her balance was poor and she was prone to falls. After stopping the sleeping pill flurazepam, her balance and her memory both improved.”
Primary care prescribers may need to be reminded which drugs are inappropriate for aging baby boomers. We have included lists of medicines that can cause confusion and memory problems as well as those which should generally be shunned in our book, Top Screwups Doctors Make and How to Avoid Them. We also offer a cost-effect Guide to Drugs and Older People.
