Medication Jenga, a precarious stack

March 25, 2018

 

A few weeks ago, I spotted my neighbor sitting on her concrete driveway, her husband hovering.  She was walking, one arm linked with her husband’s, the other hand holding a cane. She lost her balance, and both fell.  Neither was hurt. She’s 87 y/o, her husband 88. As her granddaughter’s wedding approaches, she walked to build endurance and strength.  I reviewed with her the main areas contributing to falls: vision, medications, home safety, and strength and balance. She mentioned she has difficulty sleeping.  She stopped taking Ambien, as instructed by her doctor, but now takes Advil PM.

 

I receive many client referrals for walking instability.  Most aged over 80 years, and take over four medications daily.  Medications to address chronic diseases, and medications to address other medications’ side effects.  Many fall repeatedly.

 

The following classes of medications contribute to falls:

  • Antidepressants

  • Antipsychotics

  • Benzodiazepines (anti-anxiety)         

  • Sedatives (sleeping pills)

Beers criteria for potentially inappropriate medication use in older adults recommends to avoid first generation antihistamines (ex. Benadryl, drugs with “PM” next to the name, such as Advil PM), as these drugs have a risk of poor coordination, confusion, dry mouth, and constipation in older adults. Metabolism and excretion of many drugs decrease with age.  As a result, these drugs remain in the system of older adults for a longer period, and affect older adults more potently.

 

Review all medications (over the counter and prescription), and any health changes (ex. falls, insomnia, poor coordination, gastrointestinal issues) with your healthcare provider or pharmacist.  An older adult might have six different specialists, each prescribing drugs, and countless sources of over the counter drug information.  With only infrequent short interactions with healthcare providers, drug manifestations go unconnected.

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