In this post, I want to share four notable 2014 developments related to better health for older adults. They all struck me as practical information that should be useful to those of you helping an aging person with health and wellbeing.
In no particular order, here are my four geriatrics health highlights from 2014:
1. Two Separate One-Time Pneumococcal Vaccines Now Recommended for Older Adults
For several years now, the CDC and other experts have recommended that all seniors aged 65 or older get a one-time pneumonococcal vaccine. The particular vaccine recommended for older adults was the “23 valent” type (which means it protects against 23 subtypes of pneumococcal bacteria), branded as Pneumovax. Another vaccine, a “13 valent” branded as Prevnar, was recommended for children and some adults with weakened immune systems.
In September 2014, the US Advisory Committee on Immunization Practices (ACIP) published its recommendation that all adults aged 65+ get both types of pneumococcal vaccination (Prevnar and Pneumovax). This recommendation was based on their review of scientific studies.
For the ACIP’s technical statement explaining this recommendation, see “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” This document was obviously not written for the lay public, but it provides a lot of important detail for those who want to dig into the nitty-gritty. (You can find a basic CDC page on this topic here.)
I’ll admit that I’ve read the ACIP’s statement and I don’t yet feel I clearly understand just how much extra protection an older person should expect, if she has already been vaccinated with Pneumovax and now should get Prevnar. (I do tend to err on the side of following guidelines unless I have good reason to believe that the likely harms outweigh the proposed likely benefit.)
Key things you should know: Yes, there are now two one-time “pneumonia” vaccines that are recommended for older adults. You should also know that these are not supposed to be given at the same time. For more information on how to space out these vaccines, talk to your doctor or take a look at the ACIP document mentioned above.
2. Benzodiazepines Linked (Again) to Higher Alzheimer’s Risk
Benzodiazepines are sedatives/tranquilizers that are often prescribed to treat anxiety or insomnia. Commonly used benzos include lorazepam, alprazolam, and diazepam (Ativan, Xanax, and Valium respectively).
Benzos are drugs that geriatricians love to hate, because we’ve known for years that they make thinking and balance worse. Research has also previously linked benzodiazepines to cognitive impairment and falls. Unfortunately, these drugs are habit-forming so it can be tough to get people to stop using these.
In September of 2014, yet another study raising concern about benzodiazepines was published: a study of Canadian seniors found that using benzodiazepines increased the odds of developing Alzheimer’s by about 50%. For great mainstream press coverage of this study, see this post in the NYT New Old Age.
This is important if you’re trying to maintain brain health. In all likelihood, avoiding drugs like benzos is better than eating blueberries.
Of course, some people do have crippling anxiety or insomnia, so as always, one needs to balance benefits and burdens.
But as I noted on this blog earlier this year, another study published this year proved that giving seniors a benzodiazepine risk handout — which included information on other ways to treat insomnia and anxiety — resulted in 27% of seniors stopping this risky medication. (See “How You Can Help Someone Stop Ativan“.)
So, if you want to help someone maintain their brain health, don’t forget to be careful about benzodiazepines. Only accept a new prescription after very carefully weighing your options. And if your loved one is taking a benzodiazepine, get the information handout and try to talk to the doctor about alternatives.
3. Blood Pressure Guidelines Now Recommend a Higher Target for Older Adults
New guidelines for managing high blood pressure were published on December 18, 2013, but since most of the related commentary happened in 2014, I am including this development here.
For the very first time, a higher target blood pressure was proposed for adults aged 60 or older: less than 150/90, instead of less than 140/90 (which was the target recommended in prior guidelines, published in 2003). For older adults with diabetes or kidney disease, the guidelines suggest a target of 140/90.
Although I haven’t heard of a geriatrician who disagrees with these new recommendations, they have been opposed by some cardiovascular specialists. This is probably because cardiovascular specialists worry a lot less about falls than we geriatricians do. Specialists also obsess more over the “statistically significant fewer strokes and deaths” benefits reported by clinical research, but studies have found that medically complex older adults — who are the people you and I take care of — are often not included in the research.
In fact, a clinical research published in 2014 found that blood pressure treatment is linked to serious — meaning bone-breaking — falls.
I myself spend a lot of time checking the blood pressure — sitting and standing — of my older patients, especially if they are prone to falls. I also often end up recommending we dial back the blood pressure medication.
When it comes to the medical care of aging adults, less is often more. But it often takes a proactive patient or family to get the doctors to consider these changes in treatment. If your relative is on blood pressure medication, I hope you’ll learn more about how geriatricians approach blood pressure management.
4. American Geriatrics Society (AGS) Selects 5 More “Choosing Wisely” Treatments to Question in Older Adults
This is another topic that I covered in this blog earlier this year, but it’s so important that I wanted to mention it again.
Choosing Wisely is a health education campaign meant to help patients and their doctors more easily spot common tests and treatments that are often overused.
This is a super important campaign when it comes to involving people in making healthcare better. It is quite progressive, and perhaps a little subversive: the campaign informs people like you — and not just doctors — about commonly used tests and treatments that your doctor might propose, even though research suggests these aren’t likely to help.
In other words, Choosing Wisely is partly about giving you — the family caregiver, or the patient — good information so that you can ask better questions of your doctors, and make better decisions. (It’s also a campaign to educate doctors, of course.)
Every specialty society has been invited to propose a Choosing Wisely list, to reduce overtreatment related to their field. I highly recommend that all older adults and family caregivers learn about the Choosing Wisely items picked by the American Geriatrics Society.
I reviewed the AGS’s 2014 list here: “5 More Treatments You Should Question in Older Adults. This Choosing Wisely list encourages people to be careful about dementia medications, cancer screening, appetite stimulants, new drug prescriptions, and physical restraints during hospitalizations.
For More New Research Highlights
If you like keeping up with new medical research, UpToDate has a page on “What’s New in Geriatrics” which seems to be available to the public for free. It describes some interesting new research findings on a variety of topics. Note: like most UpToDate material, this is written for healthcare professionals, so the language is technical. If you see a study of particular interest to you, consider using Google to search for related media articles; these are often easier to read.
Thank You & Happy New Year!
In closing, I want to thank you, dear readers, for your interest in this blog and in learning about geriatrics. I am especially grateful to those who have taken the time to comment and to email me.
Also, a very special thanks to those who have shared this content with others. Blogs and websites need a community of interested readers to thrive, so I appreciate your helping me connect with more caregivers.
Here’s to more knowledge, understanding, connection, and support in 2015!