You’ve done a great job monitoring your parents as they age, managing daily tasks, and getting help when needed. You have listed all their medications and keep track as they take them as prescribed. Good job!
But did you know there is a list of almost 100 medications that are potentially harmful to those over 65?
Most people over 65 take at least one medication, with 66% of the population taking three or more, according to the CDC. The American Heart Association found that older adults in Cardiac ICUs are taking 12 medications on average. There are a lot of medications to manage in a critical situation!
As you age, changes occur in how medications are metabolized in your body. Our liver is responsible for metabolizing drugs, and it’s the ability to filter slows down as we age. Remember from school that your liver filters everything you put in your mouth, up your nose, or in your arm. So, Love your Liver!
Other factors are dosage, concentration, and time of medications, other diseases or conditions (comorbidity), and body composition impact how you react to any medicine as well. Getting this right for your parents may take some trial and error, so actively work with their physician. Getting it wrong can lead to injury, falls, and hospitalization.
Autopilot with parents’ meds
The number and amount of medications can creep up on you. It generally starts with either a persistent pain, a result of a surgery, an attempt to reduce cholesterol, or some other condition. A few years go by, and you’re adding another medication for a different ailment, then another and another. If you are not paying attention, your parent ends up taking four, or five, or fifteen medications, not knowing what they are for but doing so at the direction of a doctor. That was my Dad’s situation.
When my sister and I finally saw how many medications he was taking, we scheduled an appointment with his doctor. We found pills for raising his blood pressure, he was dizzy when getting out of a chair, and another one to lower his blood pressure. There were others where we could not determine why he was taking them. He moved from one town to the next, had two surgeries and two general practitioners, so it was no wonder there were conflicting meds. It took nine months to wean him off some and get the dosage correct on others. The net result was down to 5 medications, and he felt a lot healthier.
The Beers list was developed initially by Mark Beers, a geriatrician, in 1991 with a panel of experts. There was concern that medications were not having the intended effect on their older patients, so they got together to develop a list of drugs that could have potential issues. Yes, I see the irony of a guy named Beers talking about the impact the liver has on metabolizing drugs.
It was updated every so often until 2012 when the American Geriatrics Society (AGS) used an evidence-based approach to determine the impacts of medications on older people. It was subsequently updated in 2015 with the latest version published in March of 2019. The tool is now called: The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.
The listing defines five categories of medications by potential risks and outcomes.
1. Avoid by most older people, except for hospice or palliative care.
2. Avoid by older people with specific conditions.
3. Avoid in combination with other treatments, i.e., drug-to-drug interactions.
4. Caution for potentially harmful side effects.
5. Different dosages with people with reduced kidney functions.
The AGS Beers Criteria® has tools for doctors to use when seeing older adults; cards, checklists, and programs. Electronic health records systems used by many health networks already have drug-to-drug interaction tools built-in, and some have the AGS Beers Criteria® installed. Still, it may need to be turned on or included in your parent’s medical record.
You can find the list online from multiple sources, make sure it is the 2019 version. You can also order it directly from the American Geriatrics Society at 2019 AGS Beers Criteria.
What to do?
First, write down all medications your parent is taking. List who prescribed it, dosage or amount, length to be taken, and refill limits. Add any over the counter drugs used regularly as well as any vitamins or supplements as well.
Third, take this list to your parent’s doctor and ask what each medication is for and if they are still needed, obviously you should bring your parent as well. Ask if any are on the AGS Beers Criteria® list and what actions need to be taken.
Fourth, make a note of any changes if any medication will be stopped, or your parent weaned off over what length of time. Check any additional medications your parent may receive in the future.
The Beers Criteria® was established after noticing different effects on older people. Keep this in mind as your parent ages to ensure good health for as many years as possible. Stay engaged, be your parent’s advocate.