Have you ever wondered whether you — or your older relative — might be taking too many medications?
You’re certainly right to ask yourself this. I consider this for all my own patients, and wish every doctor would.
In part, this is because over the years, I’ve had countless older adults express their worries and frustrations, related to their medications. These include:
- The hassle of having so many pills to take
- Worries about side-effects
- Frustration with medication costs
- Wondering whether a given medication is the “right” one for you, or for your condition
- The sneaky feeling that some of those medications don’t seem to help much
- The hassle of coordinating a long medication list among multiple doctors
Needless to say, all of this is not so good for quality of life while aging.
And unlike some things that people worry about, these concerns are all actually justified, given what geriatricians know about older adults and medications.
So if you’ve ever experienced the above worries — or if you (or your older relative) are taking more than five medications — then I want to make sure you know about a process that can improve or resolve all those problems that older adults have with their medications.
It’s called deprescribing, and it’s really essential to optimizing the health of an older person.
In this article, I’ll cover what every older adult and family caregiver should know about it:
- What is deprescribing?
- Why is deprescribing especially important for older adults?
- How does deprescribing work?
- What medications are most important for older adults to consider deprescribing?
- How can older adults and family caregivers get doctors to address deprescribing?
This way, you’ll have a better shot at what everyone wants when it comes to medication:
- To only take medications that are more likely to help than to harm
- To be taking the minimum amount of medication necessary, to optimize health and well-being
What is deprescribing?
In literal terms, deprescribing means what it sounds like: it’s the opposite of prescribing.
So instead of adding a medication to someone’s care plan, healthcare providers remove — or reduce the dosage — of one or more medications.
The Canadian Deprescribing Network has an especially nice definition here:
Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm. The goal of deprescribing is to maintain or improve quality of life.
Of course, there’s a little more to deprescribing. The truth is that it requires a long-needed shift in mindset and approach to health care, for doctors and patients alike.
That’s because deprescribing comes down to doctors and patients regularly asking themselves:
- Is this medication still needed?
- Does the likely benefit of this medication outweigh any risks or harms that it might cause?
- Could we manage without this drug, or could we make do with a lower dose of it?
You might think this would be the default in healthcare, but unfortunately, it isn’t. For many reasons — the influence of drug companies, the shortage of time during visits, etc. — it tends to be much easier for doctors to prescribe medication, than it is for them to deprescribe.
And once prescribed, medications tend to just…stay. And be refilled almost indefinitely.
The result of all this is that older adults are often on a lot of medications. But when we take a close look, many of these can and should be deprescribed.
Why is deprescribing especially important for older adults?
Deprescribing is especially important to address in older adults because:
- People tend to be prescribed more medications as they get older. A 2015 study found that almost 40% of older Americans take five or more prescription medications.
- Many older adults experience “inappropriate prescribing.” Studies have found that 20% to 79% of older participants were taking a potentially inappropriate medication. Despite recent efforts to educate doctors about safer medication prescribing in aging, it remains common for seniors to be prescribed medications on the “Beer’s List”, which is a regularly updated American Geriatrics Society list of “Medications that Older Adults Should Avoid or Use with Caution.”
- Many “potentially inappropriate medications” are bad for the brain, or increase the risk of falls. Falls and declines in mental abilities are two very common problems that most older adults want to avoid. Yet many of them don’t realize that they are often taking medications associated with increased risk for these problems.
- Older adults are more vulnerable to side-effects and harm from their medications. The CDC estimates that every year 177,000 older adults visit the emergency room due to medication problems.
- Most older people would like to be on fewer medications. Surveys generally find that older adults don’t like being on many medications.
- It is often possible — and usually safer — to treat many health conditions with non-pharmacological methods, such as therapy and lifestyle changes.
Geriatricians have long known that many of the prescription drugs seniors take are not strictly necessary. Some are even causing harm to those who take them.
So really, deprescribing means doing what geriatricians are very proactive about doing: eliminating medications that aren’t needed, or are more likely to harm than to help.
Fortunately, since the concept of deprescribing is becoming more common in healthcare, it’s becoming easier for seniors and families to get help with this, even if they can’t see a geriatrician in person.
How does the process of deprescribing work?
Deprescribing requires doctors and other clinicians to follow these basic steps:
- Create an accurate and up-to-date list of all the drugs a person is currently taking.
- The best way to do this is to ask a person to bring in all the medications they are taking, and review the bottles.
- Clinicians should avoid relying on the medication list they have in the chart or computer. These lists are often inaccurate or out-of-date, especially if the person has been seeing multiple doctors.
- Review the reason each medication has been prescribed.
- Doctors should consider whether this use of the medication is in line with best practice guidelines, or otherwise is likely to benefit the person, based on good clinical evidence.
- Clinicians and patients together should consider whether the medication is providing symptom relief, or otherwise seems likely to be providing a meaningful benefit to the person.
- It’s important to consider whether the likely benefit is a good fit for someone’s health situation and values. For instance, if the likely benefit is a 1-in-60 chance of avoiding a heart attack over the next 10 years, this may be more worthwhile to someone in their 60s than to someone in their 90s.
- Consider whether the medication is likely to be risky, or cause harm to the person.
- For older adults, clinicians should pay special attention to medications known to be risky in seniors, such as those on the Beers List of “Medications that Older Adults Should Avoid or Use with Caution.”
- Consider whether any safer alternatives are available, for a given purpose.
- It is often possible to treat a given health concern with non-drug alternatives, or with medications that are less risky for older adults.
- Discontinue or reduce dosages of medication when possible.
- Many medications will require a tapering process, in which the dose is lowered over time.
- Make a plan to follow-up on the deprescribing plan.
- It’s essential to follow-up after medication changes, to check on related symptoms or health conditions.
Deprescribing isn’t something that you can do for yourself or a family member; you should always work with a health professional before stopping or reducing any prescription medications.
However, you can certainly get a head-start on the process by doing a little research and preparation before discussing medications with your health providers. I explain how to do this here: How to Review Medications for Safety & Appropriateness.
Which medications are the most important to consider deprescribing in older adults?
Here are some of the medications that are especially important to assess for deprescribing:
- Medications associated with falls. These include sedatives such as benzodiazepines and other sleeping pills, antidepressants, antipsychotics, anticholinergics, blood pressure medications, and also medications that lower blood sugar.
- For more on these medications, see 10 Types of Medications to Review if You’re Concerned About Falling.
- Medications associated with diminished brain function and cognitive impairment. Most of these, such as sedatives and anticholinergics, are also associated with falls.
- For more on these, see 4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory.
- Non-steroidal anti-inflammatory drugs (NSAIDs). These are painkillers in the same class as ibuprofen. They are easily available over-the-counter, but are also prescribed by doctors. They are usually used to treat arthritis or other conditions related to pain and inflammation.
- In older adults, chronic use of NSAIDs can provoke internal bleeding, decreased kidney function, water retention, and other problems.
- For more on the risks of NSAIDs and finding better alternatives, see How to Choose the Safest Over-the-Counter Painkiller for Older Adults.
- Medications that lower blood sugar (for people with diabetes). Most people with diabetes take medication to keep their blood sugar from getting too high. It’s important to be careful that such medications don’t overtreat the person and cause too much low blood sugar.
- Low blood sugar (known as hypoglycemia) can provoke a fall or otherwise leave a senior feeling weak and unwell. Frequent episodes of hypoglycemia have also been associated with developing dementia and with higher mortality.
- Many experts, such as the authors of this 2016 review, recommend “moderate” blood sugar control for older adults, which means aiming for a middle ground in which blood sugar is kept not too high but also not too low.
- Proton-pump inhibitors (PPIs). This is a class of anti-acid drugs; they have been widely prescribed to treat gastroesophageal reflux disease, which can cause pain in the stomach area. They are also used to reduce stomach acid to treat other health problems.
- Research suggests that long-term use (e.g. more than 8 weeks) may be linked to an increased risk of problems such as bowel infection, hip fracture, malabsorption of key vitamins, and other problems.
- Commonly used PPIs include omeprazole, esomeprazole, lansoprazole, and pantoprazole (US brand names Prilosec, Nexium, Prevacid, and Protonix, respectively).
- For more on these, see You May Be At Risk: You are currently taking a proton-pump inhibitor (PPI)
- Medications used in Alzheimer’s and other dementias to manage difficult behaviors. Antipsychotics and sedatives are often used in people with Alzheimer’s and other dementias, to try to control difficult behaviors. But these medications are often prescribed before safer alternatives have been tried, and families are not always aware of the risks.
- For more on this, see 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
- Opioids and other medications prescribed for pain. Pain is common in older adults, so many are taking opioids or other prescription painkillers. Although prescription medication for pain is often needed and appropriate, it’s essential to regularly review the use of these medications.
- Per this review, it is not yet clear if overdose and misuse are as big a problem among older adults as they are in the general population.
All of these medications are frequently prescribed to older adults. Most of them are commonly — although not always — reduced or discontinued by geriatricians and others who are particularly knowledgeable about medications in older adults.
If you or your older relative are taking any of these medications, remember that this is not necessarily inappropriate. In some situations, there’s no good alternative available to continuing with the medication. Sometimes after a careful review of the situation and alternative options, we do conclude that the likely benefits of continuing a “risky” medication do outweigh the risks.
What’s most important that seniors and their doctors regularly discuss any associated risks and available alternatives. This is how you can ensure that you are only taking medication that is truly needed, or otherwise is more likely to help than to harm.
How can older adults and family caregivers get doctors to address deprescribing?
The most important thing to do is to regularly ask your doctors to review your medications with you, and ask for help with deprescribing.
Fortunately, several excellent resources online can make deprescribing easier for you, and for your doctors. The Canadian Deprescribing Network, in particular, has some of my favorite resources. They include:
- Informative brochures to help older adults request deprescribing for several types of risky drugs. These brochures have been proven, in randomized control trials, to help seniors stop certain medications. What I especially like about them is that they often include a sample schedule of how the medication can be safely reduced. Available brochures cover:
- Anti-inflammatory medications like ibuprofen(Non-steroidal anti-inflammatory drugs or NSAIDs)
- Antipsychotic medication as sleeping pills or for dementia
- Medications for allergies and itchiness (First-generation antihistamines)
- Medication for type-2 diabetes (Sulfonylurea diabetes medication)
- Sleeping pills & anti-anxiety medication(Sedative-hypnotic medication, such as Ativan, Ambien, and others)
- Stomach pills for acid reflux (Proton-pump inhibitors)
- Tips on starting a deprescribing conversation. I especially like the suggested questions you can ask, which include:
- Why am I taking this medication?
- What are the potential benefits, and potential harmful effects?
- Can it affect my memory?
- Can it cause me to fall?
- Can I stop one of my pills? Do I need to reduce the medication slowly?
- Who do I follow-up with and when?
- Deprescribing algorithms, and other useful resources for healthcare providers. These provide step-by-step guidance to doctors and other clinicians, which makes it much easier for them to work with you in reassessing the use of risky medications.
- Find these here: Tools for Your Doctor, Pharmacist, or Nurse
Remember, it will really help if you can regularly remind your doctors that your goal is to be on the minimum number of medications necessary.
To do this, you and your doctors will have to work together to regularly reassess every medication you are taking.
Again, healthcare providers are supposed to be regularly reassessing all your medications, but they are often too busy to do so unless you remind them.
So if you want to be proactive about maintaining health and well-being in aging, learn more about your medications. And then talk to your doctors about deprescribing!
Have you ever asked your doctor to deprescribe a certain medication, or for help reducing your medications overall? Please share your stories and questions in the comments below!
I also hope you’ll listen to this related podcast episode featuring deprescribing expert Dr. Cara Tannenbaum: Deprescribing & Reducing Risky Medications in Aging.
This could save billions in health care costs. The book Save Trillions with Universal Health Care reports on many other ways to reduce medical costs through individual and social transformation.
Reducing the use of unnecessary medications could certainly save money, and ultimately our care system needs to be financially sustainable for everyone.
However, I think saving money should be a secondary goal when it comes to deprescribing, or any other approach that prunes back medical care that doesn’t help much. What is most important is making sure people get more of the healthcare (and other care) that they need, and less of what they don’t need.
Hi Leslie. I agree when someone says,”So many people spend their health gaining wealth, and then have to spend their wealth to regain their health”.I have read an article somewhere that Experts have found that the drug Gabapentin stay in the body for 5-7 hours.Do you agree?
There are pharmacological reference materials, such as Micromedex, which describe the “pharmacokinetics” of medications. Micromedex says that the half-life of gabapentin is 5-7 hours, so this means it takes 5-7 hours for the concentration of the drug in the bloodstream to go down by 50%.
You can usually find information on a drug’s half-life by searching Google.
However, since gabapentin is mostly removed from the body by the kidneys, it will stay in the body longer if a person has decreased kidney function. Most people’s kidney do work less well as they get older, so that means gabapentin is likely to last longer in older adults.
Deprescribing less medication as you mention is a very good practice for the doctors but how many will do that, hardly anyone I met so far. There is always not enough time to examine, ask and answer questions in 20 mins. for each patient so why not have the schedule more flexible. Kaiser is in that
category. For seniors they show less patience to communicate.
I feel desperate as each visit is $35 or above out of pocket and yet not getting problems solved or alleviated. I feel sorry. Some of my friends feel the same too.
Thank you for bring up this important issue. Yes, families do tell me that sometimes they find it hard to get the doctors to address deprescribing. Here are a few things that can help:
– Tell the doctor ahead of time that you want to address deprescribing. Send your request in writing or by secure message if possible, because then your request will definitely be in the record. It may be better to schedule a visit specifically for this purpose.
– Ask if it might be possible to do a preliminary consultation with a pharmacist, followed by another visit with the doctor. This might make the deprescribing process easier for the doctor to manage.
– Politely express your concerns to the clinic management, if you feel the doctor isn’t getting around to addressing your medication concerns or alleviating the problems. Again, in writing is more likely to generate some changes. Tell them you’d like to know what you can do to help them address this more effectively.
All of this means more work for you, of course, and I’m sorry for that, because it really shouldn’t be so hard for patients to get the right care. But yes…when things aren’t happening as they should, one has to ramp up the persisting and insisting. Good luck!
We have Kaiser and my husband is on quite a number of medications (for pain and heart issues) which are quite necessary. He was offered (received a letter in the mail) a phone consultation with a pharmacist to go over each and every medication and its appropriateness. This was very reassuring and I’d bet anyone could request this of their Kaiser doctor.
Professional advice about medication can be very helpful, even if no medication changes are suggested. You might be interested in this podcast about inappropriate medications in older adults.
It is so difficult when you have to almost make a specific appointment with doctors since most doctors will only give you two issues to discuss during your visit. Doctors are busy waiting rooms are full and quite honestly, it’s a difficult situation. What also may work is having a good rapport with your pharmacist and I know that some pharmacies offer an evaluation of medications.
Agree that it can be hard to work around how busy doctors often seem to be. As a patient I’ve been told when I walk in the room “we have time to discuss 1-2 things, what do you want to discuss,” and I find it rather off-putting (even though I understand why the doc is doing this).
Talking to a pharmacist first, or finding other ways to get the process going, is a good idea.
“Thanks for sharing this, Leslie. What I’ve observed is that some seniors are too hopelessly dependent of
medicinal drugs. I can give you my uncle’s example, who believes that quitting anxiety pills will cause his
brain to burst. I’ve tried several times to explain it to him that this is all in his head, but he wouldn’t
listen. So how would deprescribing work for him, and several other older adults like him?”
Well, nobody likes to hear that one of their concerns is “all in their head.” When an older person is resisting sensible suggestions, then it’s important to try to back off and try a different approach. Start with a lot of listening and validating of their concerns and experience. Frame any suggestions as a way to help them reach their goals. Propose small steps.
Also, it often helps to get someone else, such as a professional with good communication skills, to help out. I have some more suggestions here: 4 Things to Do When an Older Person Resists Help.
Good luck!
Hi..I couldn’t really understand how to place a new comment, so i’ll post it here since it is similar to what i wanted to say. I am 58 yrs old and take most meds for anxiety, and sleep: xanax and Lunesta. That’s all i take. I have no problem with my doctor to continue prescribing them as long as i’m taking them correclty and i do. No one is going to deprescribe this meds that work so well for me and doctor agrees. Why should i walk a\round anxious as a rat and not sleep? with my meds i feel no anxiety, and sleep like an 8 hr baby. Why, please tell me, why should i fix something that’s not broken? This whole article really didn’t make me feel confident in your profession.
I’m glad that you have a good therapeutic relationship with your doctor and thanks for sharing your experience.
As Geriatricians, Dr. K and I mostly work with adults over the age of 60. We use some general principles about physiologic changes that are a natural part of aging to give advice about medications that might be more likely to cause side effects and should be avoided. These principles are scientifically based, and of course information gets updated as new research comes out, but the data we have right now shows that sleeping pills can increase the risk of falls and other dangerous outcomes.
Here’s an article that reviews the risks of medications like lunesta in older adults that you might find interesting: https://pubmed.ncbi.nlm.nih.gov/33258763/
Excellent article, Leslie! You should write a book.
Warm regards,
Angela.
Thank you, I’m so glad you found it helpful!
I’d love to write a book, maybe some day I’ll find the time…
And she now has.
It’s exciting isn’t it? Have you picked up your copy yet? If not, you can get more information here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/
I am very fortunate to have a lovely doctor who listens and takes time with me. Before I go I always write down on a little note pad the topics I wish to cover. I go back in my file and see what we went over the last time and if I have had any tests etc. I make a note to ask about them. ie. blood work, x-rays, etc. I also take copies of any reports that I’ve had since the last time at other doctors. I take a current list of my medications and allergies also. All of this saves a lot of time for the doctor I think. I know they are very busy and I want to get the most for my money. I do this for my husband also, who has dementia, and cannot answer her questions very well. So, I go in with him, and help him answer.
These are wonderful suggestions, thank you for sharing. I’m glad you are being so proactive.
several comments have been about too little time to review meds with the doctor.
You can do an annual wellness visit with your GP….Medicare pays for it and even sent me a bonus $25 for doing it. Provided a great opportunity to review meds.
Thanks for this suggestion. My experience has been that providers differ in how they handle the Annual Wellness Visit, but I agree that it can be a good opportunity to get some extra time and attention from the doctor. As far as I know, fee-for-service Medicare does not pay patients a bonus for getting the wellness visit. So I am guessing you are in a Medicare Advantage plan (also known as a Medicare HMO).
I am 74 and read you newsletters with great interest. I am suffering from occipital neuralgia as a result of a whiplash accident. I have seen many neurologists, physiotherapists, etc. and tried many treatments.The neurologist prescirbed pills such as Trepelyne, Lyrica. Epilepten, etc. All these meds made me extremely sick. My house dr then prescribed ativan for my pain. I gradually went up to 3mg per day. When that was no longer helping, I decided to reduce my dosage after I had read on the internet how terribly addictive these pills can be. I am now taking 1,5mg per day and using cannabis oil on my neck. I find I cannot ingest it. It also makes me ill. However, I am still suffering a lot. Do you perhaps have any suggestion that might help me.
I’m sorry for your whiplash and resulting pain, chronic neuropathic pain can be very difficult. Unfortunately, I cannot offer any specific suggestions for you. Generally treating chronic pain requires working closely with a skilled and attentive clinician (or team of clinicians), and also a multipronged approach. My main suggestion would be to try to find a chronic pain provider or clinic that offers more than just pills. Some people also find it very helpful to enroll in a program on living with chronic pain, such as this one: Chronic Pain Self-Management Program.
I will also say that tapering off Ativan can cause discomfort or worse. A slower taper is often more tolerable. Good luck!
Me again 🙂 … there’s no end to the usefulness of the things you talk about.
Telling a friend about deprescribing just now, googling led me to http://deprescribing.org, which now has an app. Do you know about it / have you tried it / got any opinions?
hi Dave, as always I’m glad you find the info here useful. Yes I know of deprescribing.org. Didn’t know of their app but just tried it. It is for clinicians and honestly I’m not finding it very user friendly. I think it’s easier to work with the info at the Canadian Deprescribing site here https://www.deprescribingnetwork.ca/.
Thank you for highlighting this site for both patients and health providers. Well-organized with links to many resources. In Ontario, pharmacists are compensated by our provincial health plan (OHIP) for carrying an annual MedsCheck (voluntary) interview with patients taking 3 or more prescription medications (plus vitamins and other supplements).
P.S. On my monitor the print in the reply box is very pale–would be difficult for someone with impaired vision.
I’m so glad you enjoyed the article. My practice is in Ontario (the land of OHIP). Another Canadian Deprescribing website you might be interested in is Deprescribing.org from the Bruyere centre in Ottawa. It’s a great resource for health professionals, but also has a lot of valuable information for non-pros as well.
Thanks for the tip about the ease of reading the comments. I’m not sure if we can change the font or size of text, but I know I have my screen set to make the print bigger for my aging eyes. Especially on my phone, that helps a lot!
Leslie, as you know, I live in a continuing care community and your last letter on understanding blood tests was a big winner with my Health Services Committee!!! And now this one, another gem.
So much of our problem is health/medical illiteracy and the medical community does not address that or so it seems. See today’s WSJ (11/30/19) about dealing with chronic illness. In the old days, there were nurses on hand to teach patients after their consultations, so that patients and families could manage what came their way in dealing with illness after the doctor visit.
With 15 minutes per patient today, that does not allow for patients, especially we elders, to understand what we must do and what to be concerned about. I would gather there is no way to reach the physician community. They seem to be so beleaguered with their work load and EMR’s to think much beyond that.
Do you see any help for us, the patients?
Thanks again or writing such pithy essays.
sue
Thanks on behalf of Dr K for the encouraging comments! I agree that the pace of interactions with healthcare providers has really picked up, and those who need more information may not receive it. Low health literacy seems to be a risk factor for lack of access to health care. I would inject a note of optimism and say that sites like betterhealthwhileaging.net help to bridge the knowledge gap and improve access to reliable health related information.
hello Sue and thank you for your comment. I’m really SO glad that the articles here are helpful to you, and love the idea of you and others sharing this information in your communities.
Obviously I agree with you and Dr. Didyk: patient visits have become very rushed and it’s often almost impossible for older adults and families to get the information they need and deserve.
This is a lousy situation and I’m not really sure when it is going to get better. I did indeed create Better Health While Aging to try to address this information gap. We are helping somewhat, I’d like to think. But the system really should be better and I hope it eventually will be.
In the meantime, I’m grateful to you and our readers for appreciating the articles here, and grateful to fellow geriatricians like Dr. Didyk for contributing as well!
I have spoken to my doctor many times about trying to get off hydroxazyine due to your articles and each time they assure me there are no problems and act like they know best and what do I know. It’s discouraging when you try to work with the doctor and even though they SAY they want you to be involved in your health plan they really don’t want your input.
I’m sorry to hear that you are feeling frustrated. It sounds like you are very proactive, and here are some tips about having the deprescribing conversation with your doctor.
Just a few comments. I’m in my mid 80s, live alone. I have good energy, lots of great hobbies. I’m dealing with osteopenia and learned about it in about April, 2019. Also migraine without aura.
I had loved dairy products, but as I aged I mainly ate cottage cheese, yogurt. When I started calcium supplements, D3, K2 also, and learned that I would need to be sure and get the right amount of Magnesium, I am addressing that.
I now have a worsened problem with constipation, but am doing lots of research, upping the fiber, lots more vegetables, some bran, continuing my oatmeal, more eggs, less meat, more fruits, nuts. Another problem, for past two years, is that I suddenly got “migraine aura without headache” also called “late life onset migraines” and soy allergy, also nitrates in meat, so I have to deal with that or else have occasional brief visual effect and very minor but annoying aftereffects. My opthalmologist has the same problem. I’m working hard on researching, balancing all the supplements, eating more correctly, and also find the new Blue Blocker yellow glasses that fitover my prescriptions assist with the aftereffects for sure, especially at computer, tablet, tv.
I’ve been able to give up all pain pills for years, all prescriptions for years (I just couldn’t take the anxiety RX/anti-depressant prescribed when the doctor told me my test revealed not osteoporis, rather it was osteopenia severe in left hip, not bad in other areas. (For a week, I had misunderstood the diagnosis so of course I was anxious at the beginning of the visit, talked trying to give info I could thinking I had a severe, urgent problem.) I quit the medicine entirely, was able to resume living. I just don’t tolerate medicines well. The Rx caused me to sleep almost constantly for a week, lost 7 lbs in 8 days. I’m sure the doctor said take calcium and eat more bulk.
I’m writing because I’m finding it hard to research, learn and find supplements mixtures for getting right calcium, D3, K2 just because the labels are complicated and tiny print. I think I am getting it all in order, and may need bile salts. I’m getting more exercise, and also working on getting some sun when it isn’t overcast. My sons are very health conscious and that is helping too. I feel that now I am learning far far more online, printing, than in medical visit.
Hi Mary Lou, and congratulations on working so hard to stay informed and proactive about your health! I appreciate your commitment to try non-prescription approaches to your wellness, however, do note that many dietary supplements and vitamins can have side effects as well. For example, constipation can be worsened by calcium, iron supplements, and other compounds. Fluid intake is also critical to keeping the bowels moving. Many experts will advise using food first as a source of vitamins and micronutrients. It’s usually cheaper and more enjoyable than reading labels and trying to find just the right supplement. Hope you continue to learn and stay informed!
Hi Dr Nicole,
Thanks so much for your response.
My constipation problem has just improved greatly by taking my supplements excepting the calcium. I began skipping the 1200mg of so of calcium about a week ago. One son arrived for holidays and I began to eat just about everything, lots of vegetables, ribeye, etc. and digestion just fine.
Oh, and I did find that I needed to give more attention to drinking water.
Now I plan to begin drinking the powdered milk daily as well as watching which vegetables are high in calcium. (I became lactose intolerant in old age but find that I tolerate the nonfat dry milk fine). If I need it, I have powdered kale on hand and that will probably get me up to the 1200mg of calcium I need to remedy the osteopenia (severe only in left hip).
I was already feeling well, good energy, walking, with some good hobbies.
I’m so happy that vegetables and bulk have made the big change in regularity.
I need to lose about 25 more pounds, and that is going very well with all of the improvements in diet. Not difficult either. It means more cooking, but I’m getting better at cooking for one, and am finding that my sudden big problems with MSG and then soy also turn out to be a blessing because it pressed me to cook more, not eat “natural flavoring” and not use anything with soy. (My research led me to “Late Life Onset Migraine Aura Without Headache” as my problem on the MSG and the soy.)
I’ve cut carbs and sweets which just seemed to trigger my appetite. I find that if I bake and freeze baked goods that I still get the pleasure in it but only eat one or two pieces.
I really appreciate having this site.
Thank you again. I’ll be back if I run into snags in my plan to resolve the osteopenia and aiming for a good report on next bone density test.
Mary Lou
Dear Doctor & Staff:
In the article, I did not see any mention of statins; I wonder or worry about a few BRANDS that I have read are ‘suspect,’ to wit: Vytorin [Zocor & Zetia]; Crestor; Lipitor. What concerns me more is that NO RED FLAGS regarding these brands were found in the medical literature – I learned about them from a journalism site (“Salon,” Jan. 22, 2016; article entitled: “4 Commonly Prescribed Drugs that may be more dangerous than Big Pharm is Telling You”
I also have two general questions re: drugs if I may:
1. drugs over the long term seem to ‘condition’ the body to expect the drug; does this alter the endocrine system in some way?
2. should a ‘class’ of drug be avoided when the sudden cessation of it – a common warning not to do so – causes serious organ damage?
Thanks for your site and your responsiveness.
Respectfully,
Laurence
So, statins certainly can cause side-effects and like all medications, they should be used in a thoughtful manner and only when the likely benefits outweigh the risks, and the benefit is in line with the patient’s health goals.
That said, statins were not included in the 2019 Beers List of medications that older adults should avoid or use with caution. They are probably being overused in some cases but generally I don’t particularly push to deprescribe them, I start by focusing on medications that affect thinking or falls first!
Re your other questions, whether a drug “conditions” the body depends on the particular drug, but yes, in many cases the body makes physiologic changes in response to the chronic presence of a drug. Whether that affects the endocrine system depends on the specific drug in question. A pharmacist might be able to help answer questions you have about a particular drug.
Re avoiding a class of drug if sudden cessation is dangerous: that can be a consideration, especially if we have reasons to worry that the patient may not be able to consistently take the drug (e.g. cognitively impaired older adults living alone). Hope all this info helps!
I am 75, have a number of conditions including peripheral neuropathy (severe) and dystonia in my toes, severe cervical and lumbar stenosis (advised not to be intubated by anesthesiologist as it would cause paralysis), asthma, macular degeneration (beginning), osteoporosis, MGUS and more. Two weeks ago, I had a stent put in my left circumflex artery (85% blocked) and while not stented, the LAD (55% blocked) and RCA (65% blocked). Until now, I’ve managed to keep my meds at a minimum-gabapentin 2X a day, and acylovir (2X a day). I now am taking Plavix (mandatory with stent and a beta blocker). Now they want to put me on Repatha, with trying Zetia first. I know their reasoning, but I don’t want to go on these strong medications as they cause way more side effects. Any thoughts on this? I’ve already left one doctor because she insisted. I’m also taking stronger vitamins because of macular degeneration.
Hi Nan and sorry to hear about your recent heart issues. I’m not a cardiologist and repatha (evolocumab) is fairly new. It has been studied in some very large trials with over 25,000 patients, and does seem to be very effective at reducing levels of LDL cholesterol, and can also reduce the risk of having a cardiovascular event like a heart attack, stroke, hospitalization for angina or the like. Evolocumab actually appears to have a mild side effect profile, and there was less muscle pain (one of the side effects of cholesterol reducing drugs – the statins) than even ezitimibe (zettia, or ezetrol here in Canada).
A more effective medication does not always mean more side effects, but everyone is different and more an individual with a more complex medical story should consult with a pharmacist and physician before taking any medication.
Hello.
My mother is 86 years old. Her blood test came back indicating iron deficiency anemia. The doctor scheduled a colonoscopy. This alarmed me considering that my mom is quite frail and I had recently been through the prep and colonoscopy myself, and could not see how my mom would handle such a ‘brutal’ regime. After a lot of reading I found your site and saw that the baby aspirin she had been on could be a likely culprit. It turned out to be a bit of a discomforting experience to suggest to her doctor that maybe we should stop the baby aspirin first for a few months Nd explore that possibility before leaping into a colonoscopy. It was quite clear that the doctor did not like his decree questioned. He sent us to the gastroenterologist who was to do the colonoscopy who also suggested I was out of line and intimated that I was somewhat foolish. I told him that even if my Mom had a cancer she would refuse surgery or treatment anyway because of how frail she was. Anyway, three months later, without baby aspirin, her iron levels are normal. I feel very sad that I find it difficult to trust the doctors. Whatever happened to “ first, do no harm”? This distrust extends to the prescribing of medications as well. The only thing our doctors know about the meds are what the obviously, and undeniably corrupt pharmaceutical companies tell them The pharmaceutical companies are increasingly directing doctor education due to funding of programs in universities too. What has happened to our health care system. It’s unconscionable, and these days we cannot blindly trust our doctors. Some, like yourself, really do have integrity, but as usual, as in most professions, mediocrity rules. How can this be remedied?
Hi Mia. I’m so glad to hear that your mom’s iron levels are improved. Your story of challenges with communication and decision making is all too common, unfortunately.
I think the tide is turning regarding to the influence of the pharmaceutical industry on doctors, and it is starting with medical students and residents. At McMaster University (in Ontario, Canada) where I trained, it was strictly forbidden to accept any kind of conditional funding or gift from a pharmaceutical company, and even now, I rarely see so called “drug reps” unless the company has provided an unrestricted grant for an educational activity (which means they can provide funding for a meal or travel for a speaker, but only if the drug company has no say in the topic or material that the speaker is presenting). It’s not perfect, but I think the culture is changing for the better.
It sounds like you are a great advocate for your mom and are thinking about her goals and values when talking to her medical team. Please continue to speak up for your parent when you think that there is information your mom’s doctor needs.
How could one deprescribe antipsychotic medicine? I am on 4 different medications for BiPolar Disease, Type 2, Resistive. They work reasonably well. I still have depression, but it is quite manageable. However, now I have developed insomnia and sleep apnea. I have also been told, on occasion, that I exhibit some low grade paranoia.
It sounds like your bioplar symptoms are well controlled, and I’m not sure why you feel you need to discontinue some medications in light of your diagnosis of sleep apnea and insomnia. In any case, a sleep physician should be able to give you some advice about the type of sleep disorder you have and how your current medications could be affecting your symptoms.
I was surprised to see that medications that are prescribed for conditions caused by lifestyle are not on here, i.e. high blood pressure and high cholesterol. These issues can be improved by diet and exercise. I think those solutions should be tried first if possible, if the senior is mobile. If not, they can eat less red meat and more fruits & vegetables and see if that helps and then re-evaluate whether they still need the medication.
Hi Ashley. You’re correct that lifestyle interventions are very important for conditions like hypertension and high cholesterol, and we usually do recommend these changes as a first line intervention for many patients. The causes of those conditions can be complex, however, and for many individuals, medications are needed, even after lifestyle has been optimized.
Hello again, Dr. Kernisan. I have commented on your articles in the past and your replies have been most helpful. My question this time involves the use of Omeprazole (40 mg daily) for an extended period and its relationship with potential dementia. Having already been diagnosed with White Matter Hyperintensities (which you have written about before), I am very conscious of trying to avoid anything that will predispose me to dementia.
When I do online research, there seems to be conflicting analysis regarding the use of the drug and its being a causal factor for dementia. I read over (as best I could…it was really at a high level) an article from Mayo’s Proceedings magazine and they could not positively link the two. Other sites feel more strongly in favor of the link.
I have been taking Omeprazole continuously for at least three years now. Part of the problem is polyps in my gall bladder which create GI issues that omeprazole relieves. At the same time, I am 66 and very seriously want to avoid any and all medicines which may put me at a higher risk for dementia. I am planning to contact my surgeon this week to have my gall bladder removed and perhaps be able to eliminate the drug entirely.
My question is, from your experience with elderly patients, is it your opinion that the the drug is safe for those who may have issues that predispose them to dementia. Not trying to put you “out on a limb” here but would appreciate an answer as best you can give it.
Thanks again for all you do!
P.S. I receive your articles regularly. Can you perhaps do one in the future on recent advances in drugs for Parkinsons and dementia? If you have done it and I missed it, my apologies.
Great overview with links to detail.
TaperMD, along with McMaster University and the American Society of Consultant Pharmacists are publishers of a potentially inappropriate medicines list available for free at https://www.pimsplus.org .
The idea is to cover content similar to Beers and the STOP/START criteria (though, unlike them, we publish with original references to source literature); since both Beers and STOP/START criteria rights are owned by one company (Ireland based) and subject to licensing for electronic use, and a fee for paper use we developed and published our own list, PIMsPlus, so it could be made web-based and integrated into tools to support deprescribing.
Thanks for the information! As a McMaster graduate, I have a great respect for their approach to medication review and management. And yay for a Canadian collaborative!
It looks like a useful tool and I’ll give it a try. I also like Deprescribing.org as a resource.
Am a now retired relief worker and worked in a stressfull environment with refugees. I lost a lot of sleep over it initially and was advised to take Stillnox /Diazepam. That really helped and I could just buy it at the local pharmacy without prescription. After initially taking 10mg a night, I scaled down to a quarter tablet (2.5mg) I took it for several years . I retired because I was beginning to notice memory problems and I recently learned it could be related to my use of this medication. If so, is there any advice to deal with this and improve? Any solid advice would be much appreciated!!
If you’re still taking the sleeping medication, I would definitely try to stop it. Your doctor should be able to help with this and a good website to learn about the risks of sleeping pills is http://www.mysleepwell.ca. Cognitive behaviour therapy for insomnia (CBTi) can be very effective and has few side effects.
If you’ve stopped the medication, and are worried about its long-term effects, there’s no therapy that I’m aware of that could reverse that. However, going forward, my advice would include:
1. Adopting a Mediterranean and low-salt diet (the MIND diet)
2. Frequent exercise, at least 150 minutes per week of vigorous activity
3. Avoiding other medications that can affect cognition, like those with anticholinergic properties
4. Maintaining a strong social support network.
I have a video about brain health practices that might be of interest, and you can watch it here: https://youtu.be/pWmves9UM_c