Minimizing Adverse Drug Events in Older Patients

We live in a very therapeutic society, meaning, a lot of people are taking a lot of medications. Inevitably, there is concern about drug interactions, side-effects of medications, and even compliance with medications.
As you age, you body’s ability to metabolize and clear drugs changes. The two main routes of excretion of medicines are either through breakdown in the liver or clearance through the kidneys. Any disease process that affects your kidney or liver function can have an impact on how long medications stay in your system, which can lead to unwanted side-effects. Likewise, two drugs can compete for the same metabolic pathway, which can cause slower metabolism and longer effective duration of action, again leading to side-effects.
Studies show that once your total number of medications rises above 5 per day, the likelihood of an adverse drug event rises significantly. This is particularly concerning for the elderly, especially when using medications for anxiety, sleep and bladder control that can cross the blood-brain barrier and lead to an increase risk of falls, fractures and delirium.
Insurance companies are quick to encourage physicians to prescribe with the Beers Criteria in mind. The Beers Criteria is a compilation of medications that have the potential to lead to significant safety concerns in the elderly, such a falls and delirium as mentioned above. For this reason, we are encouraged to avoid several classes of medications in the elderly, like sedating anti-histamines, certain types of sleep aides, like zolpidem, benzodiazepines like valium, lorazepam and temazepam, and certain classes of bladder control medications that can lead to confusion and falls. Insurance companies my refuse to pay for medications on the Beers list, or require a PA (Prior Authorization) so they can be assured of the medical necessity of these medicine.
With any medication, we want the risk/benefit ratio to tilt decidedly toward benefit, but we also have to be vigilant for any problems. At each office visit, we will ask how you are tolerating your medicines, and take special care to use the Drug-Interaction software in our electronic health record to alert us to any potential drug interactions. We will try to prescribe with the Beers Criteria in mind too.
We want you to be fully informed about all aspects of your health including the name, purpose, and potential side-effects of all our medicines. You can help the process by bringing all your medicines to each office visit, even if they are prescribed by other specialists in the community.
As always, your health is our number one priority.

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