Older people are often prescribed multiple kinds of medicines (polypharmacy). Polypharmacy 3 may cause adverse side effects such as drug interactions and other complications. The problem affects all ages, but older people are more vulnerable because they have slower metabolism and can’t excrete chemicals as efficiently as younger people.
Although opioids are sometimes necessary to treat acute pain, they can cause sedation and dizziness, and can increase the risk of falling. Besides, prolong exposure to these drugs leads to addiction.
North America is currently experiencing opioid epidemic or crisis. This is due to rapid rise of using opioid drugs for pain management in the past 20 years. Recent investigation also found that opioid prescriptions in England has nearly doubled in 10 years.
Last week, two separate research studies again cautioned drug prescription to older people.
Opioid use links to fall risk and increased likelihood of death in older adults
Data analysis on 67,929 patients aged 65+, who were admitted for injury, showed that those who were using opioid were 2.4 times more likely to have a fall injury. In addition, patients whose falls were linked to opioid use were also more likely to die during their hospital stay.
The study was published in the Canadian Medical Association Journal1 on April 23. 2018.
Dementia is associated with some common medicines
A research study published in the British Medical Journal 2 on April 25, 2018, found that long-term use of anticholinergic* medicines links to dementia. These medications include those for treating depression, bladder control and Parkinson’s disease. Less potent anticholinergics, such as antihistamines and travel sickness drugs, appear harmless.
This is an extensive study carried out by researchers from the University of East Anglia, UK. The medical records of 40,770 patients with dementia were compared with those of 283,933 patients without the disease; and their prescriptions over two decades were analysed.
*Anticholinergic drugs block the neurotransmitter acetylcholine in the central or peripheral nervous system. Anticholinergic drugs are used to treat many conditions: depression, gastrointestinal disorders, Parkinson’s disease, urinary incontinence, epilepsy, and allergies.
- Raoul Daoust, Jean Paquet, Lynne Moore, Marcel Émond, Sophie Gosselin, Gilles Lavigne, Manon Choinière, Aline Boulanger, Jean-Marc Mac-Thiong and Jean-Marc Chauny. Recent opioid use and fall-related injury among older patients with trauma. CMAJ April 23, 2018 190 (16) E500-E506. http://www.cmaj.ca/content/190/16/E500
- Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett, Noll L Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E Matthews, George M Savva, Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315. https://www.bmj.com/content/361/bmj.k1315
- Duerden, M., Avery, T., & Payne, R. (2013). Polypharmacy and medicines optimization. Making it safe and sound. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf