Elizabeth A Landsverk MD Specialist in Geriatric Medicine
Elizabeth A. Landsverk, MD Specialist in Geriatric Medicine Founder Elder. Consult Geriatric Medicine Medications: The Good, The Bad, and The Ugly June 15, 2018 Elder Justice Summit Sonoma, CA
Medications • Affect elder brains differently • Can often have a stronger affect • Some drugs affecting the brain can lessen mental abilities in older adults
Common Challenges • Too many doctors • Too many medications • Over the counter • • Herbs Supplements Pain relievers Sleeping pills
Medications That are Helpful • • • Low dose aspirin Vitamin B 12 Vitamin D Calcium Tylenol to control pain
Medications • Certain prescriptions affect the brain and the nervous system • Some of these medications can also cause side effects, including difficulty walking, a higher risk of falling, and "cognitive decline" – a decline in the ability to think and remember • Stopping the drugs or lowering their doses, however, may reverse these "cognitive" changes
Medications That are Challenging • • Anti-Cholinergic medications Psychoactive Medications Ativan Xanax Paxil Prozac Effexor Cymbalta
Anticholinergic Medications Can cause: • Confusion • Anxiety • Memory loss • Blurred vision • Constipation • Dry mouth • Lightheadedness • Difficulty starting and continuing to urinate • Loss of bladder control
Drugs May Cause Memory Loss • Common side effects of anticholinergic drugs include: • • • Confusion Anxiety Memory Loss Blurred vision Constipation Dry mouth Lightheadedness Difficulty starting and continuing to urinate Loss of bladder control
The Ugly • Too many medications prescribed - Primary Care Doctor Hospitalist Specialists Hospice Doctor • Duplication of medications - Too many different doctors • Over the counter not reported to MD • Common Errors
Common Errors • Blood Pressure - For those over 80 don’t treat BP unless over 140 standing - Don’t go too low- fainting/falls • Diabetes - Blood sugar best 100 -200 • Continuation of medications no longer needed • Medications to treat side effects of medications
Medication Challenges Review medications regularly with your doctor Work on good health- diet and exercise Engagement- stay connected Blood pressure for those over 80, check BP standing – treat SBP over 140 • Blood sugar for those over 80, keep at 100 -200 • Treat pain regularly, not as needed • •
Case Study: Arthritis Pain • 85 year old Female with agitation, treated with: - Tylenol 500 mg q 4 h prn, - Norco 5/325 mg prn, - Ativan 0. 5 mg prn who has • Has been evicted from 2 facilities. • Must always have a history • Spinal arthritis - - Treated with Vicodin in the past
Case Study: Arthritis Pain • • • Tylenol 650 mg 3 times a day Gabapentin 100 mg at night Tapered Ativan Avoid Benzodiazepines, sleeping pills Methadone 5 mg ½ tab at night Norco 5/325 ½ tab twice a day
Summary • We are more at risk to medications as we age • Minimize medications, Review • Do not over treat • What’s good for the heart, is good for the brain
Questions? Comments? Thank You! • Elizabeth A. Landsverk, MD – Geriatrician • FB/Elder. Consult • Elder. Consult. com - “Ask A Question” - Information
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