It is all too common. Seniors come to our clinic with a list of health issues and a list of prescriptions and over the counter drugs they are taking. After analyzing their symptoms and medications, it becomes apparent that symptoms they are experiencing are not caused by medical conditions but their medications. This situation is known as adverse drug reactions (ADRs).
The most common clinical situations arising from elderly ADRs are falls, orthostatic hypotension, delirium, renal failure, gastrointestinal bleeding, and intracranial bleeding.[1]There are several contributing factors as to why seniors are more prone to ADRs as follows.Age-related physiological changes are one of the risk factors for ADRs. With aging, there is a decrease in lean muscle mass and water content relative to total body fat.[2] This can cause an increase in the volume of distribution of drugs and increased risk of toxicity.
A decrease in kidney function (renal blood flow and glomerular filtration rate) will reduce drug excretion and increase the likelihood of ADR.[3]Also, lower levels of a blood level that transports medications (albumin) lead to an increased amount of free drug fractions.[4]There is also the problem of elderly patients taking multiple drugs( known as polypharmacy), which can cause toxicity.[5] As well, liver and kidney detoxification becomes overwhelmed leading to drug toxicity.[6] As people age, their ability to detoxify medications decreases. A senior should generally not be prescribed the same dose of a medication as a younger or middle-aged adult.It is also known that women have an increased risk of ADRs compared to men due to physiological differences in their immune and hormonal systems.[7]
The drugs most involved in overdose deaths in the United States are opioids (methadone, morphine, hydrocodone), benzodiazepines (alprazolam and diazepam) and stimulants (methamphetamine).[8] Medications that are also problematic included diphenhydramine, acetaminophen, citalopram, tramadol, amitriptyline, clonazepam, and gabapentin.Make sure you understand from your doctor why you are taking the medications you have been prescribed and that you are taking them properly. Also, ask your pharmacist for a list of drug and food interactions for the medications you are taking. And better yet, work with a holistic doctor to use diet and natural agents to wean off as many medications as is possible. The doctors at the Stengler Center for Integrative Medicine can help you with this evaluation.*******************************************************************************[1]
Lavan A, Gallagher P. 2016. Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety 7:11-22. [accessed 2019 Aug 28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716390/[2] Ibid[3] Farinde A. 2019. Pharmacotherapy Considerations. Todaysgeriatricmedicine.com. [accessed 2019 Aug 28]. https://www.todaysgeriatricmedicine.com/news/ex_072413.shtml[4] Lavan A, Gallagher P. 2016. Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety 7:11-22. [accessed 2019 Aug 28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716390/[5] Brahma D, Wahlang J, Marak M, Ch. Sangma M. 2013. Adverse drug reactions in the elderly. Journal of Pharmacology and Pharmacotherapeutics 4:91. [accessed 2019 Aug 28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669588/[6] Lavan A, Gallagher P. 2016. Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety 7:11-22. [accessed 2019 Aug 28]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716390/[7] Ibid.[8] Brauser D. Top Ten Drugs Tied to Overdose Deaths. Medscape. 2019 [accessed 2019 Sep 30]. https://www.medscape.com/viewarticle/906434
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