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Bad Medicine for Older Adults

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Medicine today is full of miracles.  But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled.  Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold.  The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders.  The elderly are fully half of all prescription drug-related deaths annually.

Let me tell you about a list you should know about.  If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991.  That is when they first came out with the “Beers List.”  Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs).  Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals.  This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers’ most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS).  Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly.  Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications.  It is an important elder resource you should know. 

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard.  You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene).  There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine).  It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid.  It is not quite that black and white.  Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs.  Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema. 

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list.  Check it out: Beers List 

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

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