Medication Risks in Older Adults

Diabetes drugs and anticoagulants top the list of medications causing dangerous interactions or side effects.

By Cheryl Platzman Weinstock, AARP | October 29, 2021
Lightly edited for readability, with a clarification to the dietary advice.

A study published in 2021 identified diabetes medications and anticoagulants as leading causes of medication-related emergency room visits among older adults. Anticoagulants help prevent blood clots. However, these medications can also cause adverse side effects or unintentional drug interactions.

“Certain medications may have been safer to use when you were younger, but now that you are older, these medications can be potentially more dangerous and cause side effects,” explains Ula Hwang, M.D., professor and vice chair for research in the department of emergency medicine at the Yale School of Medicine in New Haven, Connecticut.

Older adults typically take more medications than younger patients. As a result, they face more opportunities for harmful interactions. They also metabolize medications more slowly and may be more sensitive to them, Hwang says.

Hwang says the high number of emergency room visits shows that doctors need greater care when prescribing these drugs.

What the Study Found

Researchers compared medication-related emergency room visits among older Americans with those among younger patients. The higher rate among older adults stood out in the study, which JAMA published on October 5, 2021.

The study examined health records from 60 emergency departments across the United States. The records covered January 1, 2017, through December 31, 2019.

Researchers found that almost 96 percent of emergency room visits among patients ages 65 and older involved medication harm from therapeutic use. In other words, these patients were using drugs for treatment rather than intentionally misusing them for recreational purposes.

The Problems With Anticoagulants

Anticoagulants can make a major difference for people at risk of certain blood clots. Doctors prescribe them for conditions such as atrial fibrillation or a clot in a deep vein.

However, researchers found that anticoagulants also accounted for about 20 percent of emergency room visits among adults ages 65 and older.

“All anticoagulants are risky in older patients,” says Hwang. “These drugs can interact with other medications, and for the older adult, who is at greatest risk of falls, being on a blood thinner increases their risk of bleeding with any trauma.”

Anticoagulants can also cause gastrointestinal bleeding.

Reducing the Risk of Bleeding

To reduce your risk of harm, avoid activities that could cause bruising or bleeding.

Dietary advice depends on the anticoagulant you take. For example, leafy green vegetables contain vitamin K, which can affect warfarin. People taking warfarin should keep their vitamin K intake consistent and discuss major dietary changes with their care team. This restriction does not apply equally to all anticoagulants. Learn more through the NHS guidance on anticoagulant medicines. Considerations

Blood Sugar Spikes and Drops From Diabetes Drugs

The article reported that diabetes affected about 1 in 4 older American adults. According to the JAMA study, diabetes drugs ranked second among the most problematic medications.

They accounted for about 11 percent of medication-related emergency room visits among patients ages 45 and older.

Oral and injectable diabetes medications can provide long-lasting blood sugar control. However, blood sugar can rise or fall dangerously depending on the medication, dose, and food intake, says Seema Bonney, M.D., an emergency room physician at the Philadelphia VA Medical Center.

These changes can cause serious problems, ranging from confusion to a coma.

To help manage blood sugar, Bonney recommends consulting diabetes educators or nutritionists about healthy eating. Patients should coordinate dietary changes with their prescribed treatment plan.

How Antibiotics Factor In

The study also examined harm from antibiotics used therapeutically. Overall, these emergency room visits were nearly as common as those involving diabetes drugs.

“Countless times, I hear people say things like, ‘I took antibiotics that were laying around,’ ” says Bonney.

Taking someone else’s antibiotics to avoid a doctor’s visit can expose you to an allergic reaction, she notes.

Additionally, taking leftover antibiotics without a prescription can contribute to antibiotic resistance. Unnecessary antibiotics can also disrupt beneficial gut bacteria.

The CDC’s antibiotic guidance advises patients to take antibiotics exactly as prescribed. It also warns against sharing antibiotics or saving them for later. CDC

Risks From Over-the-Counter Medications

Over-the-counter medications accounted for about 10 percent of emergency department visits across all age groups in the study.

These included:

• Nonsteroidal anti-inflammatory drugs
• Non-opioid pain relievers
• Antihistamines
• Cough and cold medications

Some of these medications can cause dizziness or delirium in older people. Consequently, they may increase the risk of falls, says Hwang.

Depending on the medication, they can also raise blood pressure or cause headaches and chest pain, says Bonney.

Watch for Duplicate Ingredients

Another concern involves duplication errors. These occur when someone takes multiple products containing the same active ingredient.

“If a patient is taking ibuprofen and then takes an anti-inflammatory medication which also has ibuprofen as an active ingredient, now you’re taking too much, which can have ramifications on your kidneys,” Bonney says.

How the Beers Criteria Address Medication Risks

Experts at the American Geriatrics Society developed the Beers Criteria to help address potentially inappropriate medication use in older adults.

The criteria identify medications that may pose particular risks for people ages 65 and older. Some can cause confusion or other side effects. Recommendations depend on the medication and the patient’s circumstances.

Nevertheless, a study cited in the original article found that 1 in 5 adults ages 65 and older received prescriptions for medications on the list.

Many medication harms arise because “we’ve been so cavalier prescribing drugs,” Bonney says.

Guard Yourself From Medication Harm

“The more patients advocate for themselves and scrutinize what they are on, the safer they will be,” says Hwang.

Her tips include the following steps.

Ask About New Medications

When you begin a new medication, ask your prescriber about its risks. Also, make sure the clinician knows about every other medication you take.

Ask which medications could interact with the new prescription. This information may help if your treatment changes later. Your pharmacist can also check for potential interactions.

Review Your Medication List

At your appointment, ask whether you still need every medication you take. Discuss whether your clinician could safely reduce or discontinue any of them.

Organize and Take Medications Carefully

• Use pill boxes that clearly show when to take each medication.
• Avoid leftover medication or someone else’s prescription.
• Follow the recommended dosage. More is not better.
• Keep a medication list in your purse or wallet.

For more information, explore questions to ask healthcare providers on TooMuchRx.

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About the author: Cheryl Platzman Weinstock is a contributing writer who covers health and science research and its impact on society. Her work has appeared in The New York Times, NPR, and Kaiser Health News.

Original source: AARP — Which Prescriptions Send Older Adults to the Hospital?