Medication Errors in the Elderly- Hormones Matter

As many of us care for our aging parents and many of our parents are on multiple medications, I thought I’d take a look the rate and risks for medication errors in the elderly. It’s not pretty. Older adults are 7 times more likely to have drug side effects and 2-3 times more likely to have adverse drug reactions. Compared to younger adults, individuals over the age of 65 years account for one-third of all medications prescribed in the US. Sometimes this polypharmacy (>5 medications at a time) is necessary to manage multiple chronic conditions and sometimes it’s a process of cascading prescribing practices; prescribing medications to treat the side effects of other medications. A recent study of 3000 US adults ages 57-85 years old showed that:

81% were taking at least one prescription medication
29% took five or more medications; of those aged 75-85 years, 36% took five or more medications
46% used at least one over-the-counter medication

Of the 700,000 annual ER visits for adverse drug reactions in the US, almost 100,000 resulted in hospitalizations from adverse drug reactions in individuals 65 years and older; most were unintentional. Four medications accounted for 67% of the hospitalizations: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). An estimated 88% of those adverse reactions are considered preventable.

In Europe, fully 22% of people aged 65 and older are taking nine or more medications simultaneously. The four highest rates of polypharmacy (>9 meds) by country:

Finland 41%
the Czech Republic 39%
Iceland 32%
The UK 20%

With older adults the physiological systems that process medications are generally compromised by aging alone. The kidneys and the liver don’t work as well as when the individual was 20 years old, the muscle to fat ratio is skewed and everything just takes a little longer. When chronic health conditions and multiple medications are added to mix, the risk for overdose and drug-drug interaction is high, even when medications are taken exactly as prescribed. It’s important to work with your parents and your parent’s physicians to minimize these risks. Here are some resources to help you do that.

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

The Beers list was developed in 1991 and updated regularly. It includes a list of medications that should be avoided in the elderly, if at all possible. In some cases, the medications are necessary and can be utilized safely, if monitored. Talk to your parent and his/her physician about these medications.

Never attempt to withdraw your parent (or yourself) from a medication without physician’s approval and supervision. Many medications have dangerous withdrawal syndromes that require medical management.

Below is a part one in a video series about medication management and older adults. It’s a little technical in places but provides a solid foundation for understanding how medications work and don’t work in older adults. Part two and other videos on the same topic are available on Youtube and on the Caring for Older Adults website listed below.

If any of our community members have experience with medication interactions or know of resources that we should share, please comment and/or write a blog post for us on the topic.