Gray matters

Falls, pain management and drug interactions should be top-of-mind when dealing with seniors

According to the Administration on Aging, the United States is similar to many other countries in the developed world — and even a few in the developing world — in that the population is getting older. According to the AOA, people in the United States ages 65 years and older numbered 39.6 million in 2009, a number expected to reach 72.1 million by 2030. In 2000, the elderly represented 12.4% of the population in the United States, but will constitute 19% of it in 17 years.

With aging comes a rise in the associated health problems and the need to take medications to address them. According to a 2006 Boston University study, more than 25% of patients ages 65 years and older use five or more prescription drugs per week. A Centers for Disease Control and Prevention survey of 2010 Medicare beneficiaries found that 68.4% of Medicare beneficiaries had two or more chronic conditions and 36.4% had four or more chronic conditions.

With more chronic conditions and more medications come an increased risks of falls and drug interactions, not to mention the pain associated with many health problems.

Following are three key issues that pharmacists and clinicians should be talking about with elderly patients.

Falls
Many of the drugs taken by seniors can increase their risk of becoming drowsy or dizzy — and in turn increase the risk of falling.

According to the Centers for Disease Control and Prevention, the risk of falls resulting in injury increases dramatically after age 75. The overall rate for all age groups is 43 falls per 1,000 people, and it’s still less than 60 at age 74; but after age 75, the rate increases to 115 falls per 1,000.  The second highest rate, slightly above 60-per-1,000, is found among people ages 12 to 17 years.

According to Emily Hensley, a Safeway pharmacy manager in Chicago, medications that elderly people take can greatly increase the risk of falls, making it an important topic to discuss with patients. These include opioids like oxycodone and fentanyl; anti-anxiety benzodiazepines like clonazepam, lorazepam and diazepam; such antihistamines as cyproheptadine, diphenhydramine and meclizine; and gastrointestinal drugs like ranitidine, atropine and loperamide.

“We tend to start talking about how medication affects you before you drive, but also let them know that if they get too drowsy or sleepy, they may risk falls,” Hensley told DSN Collaborative Care.

Important things patients should do, Hensley said, are make sure they don’t have bumps in their rugs, hold onto something like the armrest of a chair or a counter when standing up quickly, make sure their shoes fit correctly and take measures to avoid slipping in the shower.

Pain management
Pain among elderly people can result from a variety of causes — arthritis, circulation problems, shingles and cancer to name a few. Many elderly people with chronic pain may use such prescription drugs as opioids or such OTC medications as ibuprofen and acetaminophen.

But other treatments also exist, such as acupuncture and homeopathic remedies, which tend not to have drug interactions. “From a homeopathic point of view, those could be introduced without having to change the dose of a prescription drug,” Hyland’s homeopathic medical and scientific director Iris Bell said.

Similar issues that affect the elderly include restless legs syndrome, also known as Willis-Ekbom disease, and muscle spasms — both of which are treatable with homeopathic remedies. According to the Willis-Ekbom Disease Foundation, RLS affects 7% to 10% of Americans. Meanwhile, muscle spasms can result from a wide range of problems, such as electrolyte disturbances and calcium deficiency.

“The first step is always appropriate medical evaluation to rule out any causes that should be treated,” Bell said.

Drug interactions
Use of drugs by elderly people also increases the risk of interactions between prescription drugs, OTC drugs and supplements. 

A 2005 Kaiser Permanente study published in the journal BMC Geriatrics found that 84% of elderly women had used more than one dietary supplement, and 25% had used an herbal.

St. John’s wort can interact with non-steroidal anti-inflammatory drugs, or NSAIDs; anti-clotting drugs; antidepressants; anesthesia; HIV antivirals; and chemotherapy drugs. For other common interactions, see the chart to the right.

In terms of depletions, many drugs can leech essential nutrients from the body. For example, thiazide-type diuretics can deplete potassium from the body, as well as magnesium, zinc and sodium, according to the Chiropractic Resource Organization. Meanwhile, cholesterol-lowering statins can deplete Co Q-10, which can cause an increased risk of heart failure, muscle pain and mood disorders.

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