Seniors and Medications:
Know what you are taking
with Jason Black, MD

Many people are alive today because of the miracles of modern medications. Without medications to lower cholesterol, control blood pressure, prevent fractured bones, control diseases like diabetes, treat cancer, stop strokes in their tracks, and reduce the complications of cardiac disease, we would not have so many people living well into their 80s and 90s and even beyond; however, there are two sides to the miracles of medications that we all need to consider.

Jason Black, MD, a specialist in geriatric medicine at GBMC, says, “Medications are frequently central to the treatment of many illnesses and conditions that afflict older adults. As people age, their medical problems tend to increase. With multiple medical problems come multiple medications and sometimes multiple side effects.”

For instance, Dr. Black gives the example of an elderly patient with diabetes who may be taking two or three medications to keep his blood sugars under control. The same patient is likely to have high cholesterol and high blood pressure, and is taking medications for those conditions. If this patient also has osteoporosis (a thinning of the bones), as many older people do, medications such as calcium, Vitamin D, and Fosamax may also be prescribed. It’s not surprising that this patient may be taking 10 to 14 pills on a daily basis to treat his varying conditions. Add a third medical condition, such as cardiac disease or arthritis, and the list of medications keeps growing.

While there’s no doubt that many medications are keeping patients alive and relieving painful conditions, medications can also become part of the patient’s problem. Many medications have side effects that are particularly prominent in the older population, which tends to be less tolerant of some drugs than their younger counterparts taking the same medications.

A recent highly publicized example of potentially dangerous side effects involves the cox-2 inhibitors, such as Vioxx, Betra and Celebrex. While these drugs are extremely effective for many patients in relieving the debilitating joint pain of osteoarthritis, studies indicate that there may be a small increase in the incidence of cardiac complications among those who take these drugs. As a result, two of these drugs have been taken off the market. Instead, doctors may recommend mild opiates like acetaminophen with codeine, but these medications also have the possible side effect of constipation. Calcium, which is frequently taken for osteoporosis, also has constipation as a potential side effect.

Dr. Black says, “It’s not clear in many older patients that adding extra medications to their daily regimen will be helpful or harmful. The very oldest adults are not included in most clinical trials because their many health conditions and variables make them difficult to study, so there is not much research out there indicating how effective multiple medications really are in this age demographic.”

Doctors treating the elderly typically rely on how the patient has responded to the medications in question. If the patient feels better and if the usual measurements of effectiveness, such as bone density tests and lipid panels, indicate that the drugs are effective, then they probably are. If, however, the patient does not feel good and has side effects, such as an upset stomach, nausea, headaches or fatigue, then the doctor and patient need to weigh the benefits of the medications against the risks.

In a patient who has many medical problems, physicians often need to prioritize which conditions to treat in consultation with the patient. An important question is: Which medications are going to have the most significant impact not just on the length of the person’s life but on their quality of life? “The patient’s preferences,” says Dr. Black, “are very important in treating older adults.”

Dr. Black continues, “It’s always easy to look at a given situation and see a simple solution. We can say to a patient, ‘you have illness A, so you should take pill B,’ but it isn’t that easy with elderly patients who have many medical issues going on. We also have to consider possible side effects and interactions with other medications. We need to be careful about piling pills on top of each other.”

Dr. Black lists the following recommendations for older patients and their caregivers in dealing with medications:

• Communicate clearly with your doctor. Make sure your physician’s list of the medications you are taking corresponds to your list of medications.

Your primary care physician needs to know all the medications you are taking. Sometimes the patient has gone to a specialist who has added a new medication to the list and the patient forgets to mention this to the primary care physician. Also, sometimes patients make their own decisions about what medications to stop taking or to add to their list. These decisions should be made in consultation with your physician. (This includes over-the-counter medications, nutritional and herbal supplements, which your doctor also needs to know about.)

•  Make sure you’re taking the correct medications.

Many older patients become confused about what medications they should be taking, perhaps because of issues like poor eyesight or general forgetfulness. Older patients should have all their medications organized in a pillbox marked by the day of the week. Organizing pills is a very helpful way caregivers or family members can assist older adults who are taking multiple medications.

•  The patient or caregiver should carry a list of the medications (along with dosages and frequency) the patient takes.

When the patient visits the emergency department or the doctor’s office, it is always important to have this information readily available. There is no way most people can recall the specifics about 10 or 15 medications. So keep this information written down and carry it with you.

• Always discuss side effects with your doctor and pharmacist.

When you start a new medication, make sure you discuss potential side effects with your doctor and also with your pharmacist. The pharmacist is an under-utilized resource who usually has a deep knowledge of medications and their potential side effects. If side effects do develop, always discuss them with your doctor as soon as you are aware of them. Sometimes side effects occur when you first start to take a drug and then subside, but your doctor will be able to tell you if you should stop taking the medication or try another one.

• Don’t be afraid to ask your doctor if there is a less expensive alternative medication.

Many times generic drugs are less expensive and just as effective as the medication you are taking. One of the primary reasons older adults do not take their medications regularly is that they can’t afford them. Medications today are very expensive and there is no reason not to consider less expensive options.

Dr. Black says, “People today are living longer than ever before, in part because of medications. We’re now able to effectively treat diseases that used to be fatal to people at much younger ages. The end result is that while people are living longer, they are also living with chronic conditions that can dramatically affect their quality of life. It’s inevitable then that older adults find themselves on many medications that can have side effects and interact negatively with each other. So that medications work best, patients and their caregivers need to communicate clearly with their physicians and make sure that their preferences and priorities are understood.”