medication safety Archives - Better Health While Aging

Deprescribing: How to Be on Less Medication for Healthier Aging

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: [Read more…]

How to Choose the Safest Over-the-Counter Painkiller for Older Adults

by Leslie Kernisan, MD MPH 163 Comments

Q: My 88-year old mother often complains of various aches and pains. What is the safest over-the-counter painkiller for her to take? Aren’t some of them bad for your liver and kidneys?

A: Frequent aches and pains are a common problem for older adults.

If your mother has been complaining, you’ll want to make sure she gets a careful evaluation from her doctor. After all, frequent pain can be the sign of an important underlying health problem that needs attention. You’re also more likely to help your mom reduce her pains if you can help her doctors identify the underlying causes of her pain.

That said, it’s a good idea to ask what over-the-counter analgesics are safest for older people.

That’s because improper use of OTC painkillers is actually a major cause of harm to older adults.

So let me tell you what OTC painkiller geriatricians usually consider the safest, and which very common group of painkillers you should look out for.

What’s the safest OTC painkiller for an older parent?

[Read more…]

Preventing Falls: 10 Types of Medications to Review if You’re Concerned About Falling

by Leslie Kernisan, MD MPH 39 Comments

Have you been concerned about falls for yourself, or for an aging parent?

If so, do you know if any of your medications might be increasing your risk for falls?

In its Stay Independent brochure, the Centers for Disease Control (CDC) recommends older adults do the following four things to prevent falls:

Begin an exercise program to improve leg strength and balance.
Ask your doctor or pharmacist to review your medicines.
Get annual eye check-ups and update your glasses.
Make your home safer.

In this article, we’ll focus on medications for three reasons:

Medications are among the most common causes of increased fall risk in older people.

Medications are usually among the easiest risk factors to change, when it comes to falls in older adults.

Medication-based risks are often missed by busy regular doctors. Older adults and family caregivers can make a big difference by being proactive in this area.

I want you to understand just what types of medications you and your doctors should be looking for, when you address medication review as part of fall prevention. This article will also explain exactly what to do, once you’ve identified any medications that are associated with falls. [Read more…]

Medications Older Adults Should Avoid or Use with Caution:
The American Geriatrics Society Beers Criteria (2019 Update)

by Leslie Kernisan, MD MPH 23 Comments

Today we’re covering a touchstone resource for geriatricians: the “Beers List” of medications that older adults should avoid or use with caution.

(Technically, it’s called “The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.” I personally think of it as the list of “risky medications” for older adults.)

If you want to know which medications older adults, in particular, should be careful with, this is the list!

Now, I have good news and bad news about the Beers criteria.

The good news is that they were just updated and revised, so the Beers Criteria published in January 2019 is about as up-to-date as you can get for this type of guideline document. (Yay!)

The bad news is that this year, the American Geriatrics Society (AGS), which has historically made the list freely available to the public on HealthinAging.org, has not released the updated information for free on its page about the Beers Criteria. (Bummer!)

Instead, they’ve posted a notice that “To access the complete AGS Beers Criteria^® and its related resources, please visit GeriatricsCareOnline.org.” From there, the article is available for purchase.

(My suggestion for those who really want the list: consider getting the handy 2019 AGS Beers Criteria® Pocketcard, which is $9.99. Or, ask your health provider to print it for you.)

[Update Dec 2020: I have found a PDF copy of the 2019 Beer’s criteria posted here.]

I think it’s really too bad that it’s become harder for regular people to access this wonderful resource, but oh well.

Whether or not you obtain access to the full 2019 Beers Criteria, I still think it’s important for older adults and families to at least be aware that this resource exists, and to understand how it can help make the medical care of older adults safer.

You absolutely should know that experts in geriatrics and in medication safety go through a very careful process of reviewing the research on medications, and of updating this list of medications that older adults should avoid or use with caution.

So in this article, here’s what I’ll be sharing with you: [Read more…]

How to Review Medications for Safety & Appropriateness in Aging

by Leslie Kernisan, MD MPH 5 Comments

By now you’ve probably heard that older adults are often taking “too many” medications.

You also hopefully know that older people are often prescribed medications that may be harmful, or no longer necessary. The CDC has estimated that adverse drug events send older adults to the emergency room 450,000 times per year.

Why does this happen? Research has shown that “inappropriate prescribing” is common in older adults. Meaning that, when patient charts are carefully reviewed, experts often find that older adults are receiving medications that are ineffective, duplicate the effect of another medication, or otherwise lack a basis for being prescribed.

So what can you do?

To reduce the chance of being harmed by inappropriate medications, the answer is not to look for a super doctor. The answer is to regularly conduct a methodical medication review, in which all medications are reviewed for appropriateness and safety. This is part of a process called “deprescribing.”

Scheduling such regular medication reviews is becoming more common in well-run primary care clinics. But if your doctor’s office doesn’t yet offer this service, you can ask for it.

Geriatricians are trained to do this, but if you can’t find a geriatrician, you should be able to get a decent review from the primary care doctor.

But before you go in, it pays to do a little homework on your own. That’s because the input of a patient and her caregivers is actually crucial to determining whether each medication is appropriate for her.

To help you complete this background preparation for a medication review, just follow the 5-Step process I describe below. This will free up some time when you’re actually seeing the doctor — which might mean more time for questions or discussion — and can help you spot safety issues that a non-geriatrician might otherwise not notice. [Read more…]

What’s the safest OTC painkiller for an older parent?

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