Rarely does a new parent give their baby medication without triple-checking the label and probing their pediatrician. Medical professionals recommend the same pause be given when both diagnosing and treating health conditions in older adult populations.
As the body ages — and thus changes over time — medications are metabolized, or broken down, differently. This leads to some medicines becoming extra potent and some losing their effect — but both scenarios can be dangerous. Similarly, the aging body also has an impact on the way that health conditions manifest. A urinary tract infection, for example, might appear as confusion in a senior, rather than the typical presentation of painful urination.
Geriatric medicine is complicated by both abnormal disease presentations and adverse medication reactions. Understanding the basics of why these two happen may help you advocate for individualized care for yourself or a loved one when you feel something isn’t right but aren’t sure what’s wrong.
Why Do Seniors Show Disease Differently?
An atypical presentation is when an individual has a disease, but the first signs or symptoms of the disease are not usual or what’s expected.
Abnormal presentations can also be diverse and common. In other words, the same symptoms can appear in a number of different diseases, making it tricky to deduce what the medical issue might be. According to Dr. Brandon Koretz, a professor in the division of geriatric medicine at UCLA and an adviser to Boom Home Medical in Los Angeles, a few well-known examples of conditions with abnormal presentations are:
— Heart attack, which appears as shortness of breath or confusion.
— Gout, which manifests as gradual discomfort in large and medium joints.
— Gallbladder attack, which presents as nausea and vomiting.
— Bladder infection, which manifests as bloody urine.
There’s no singular reason why an aging body presents disease in abnormal or atypical ways. Sometimes, it’s due to having multiple health conditions simultaneously and those conditions interacting with one another. Other times, it’s because the body’s stress and immune response showcase diseases differently. Each presentation has its own unique physiological process.
Chalking up new-onset confusion or pain to “just being old” can be detrimental. Having a skilled medical professional evaluate new symptoms is imperative because a serious acute condition could be missed otherwise.
[SEE: How to Describe Medical Symptoms to Your Doctor.]
Why Do Drugs Affect Older Adults Differently?
There are several reasons why drugs react differently in the elderly. Age-related changes in the body include:
— Decreased kidney function.
— Decreased liver size.
— Decreased muscle mass.
— Decreased hydration and water mass.
— Increased body fat.
All of these changes impact geriatric pharmacology because of the way medications are processed and moved through the body (called pharmacokinetics) and the way that medications affect the body (called pharmacodynamics).
Dr. Kelleh, CenterWell Pharmacy lead integrated clinic pharmacist at CenterWell Senior Primary Care in Houston, says that one common example is medication processed in the kidneys, like ibuprofen or antibiotics, which can end up taking longer to leave the system since kidney function has slowed down.
The use of multiple medications in elderly patients is a very common occurrence, Koretz adds. “I start with an assessment of the benefits of the drug and weigh them against the potential side effect,” he says. “I consider how the new drug may interact with other medications or illnesses the patient has.”
Medications less potent in elderly patients
There are some medications that won’t be as effective in older adult populations. This may mean that the elderly patient needs a bigger dose, a longer medication course or the medication needs to be administered through an injection rather than a pill.
Less potent medications include:
— Heartburn medications.
— Antifungals.
— Antibiotics.
— Vitamins, like iron, calcium and B12.
Some medications require a more acidic environment to be broken down properly, says Kelleh. The stomach gets less acidic with age, so many types of medications are more challenging for the elderly to break down.
Medications more potent in elderly patients
Medications that are stronger in the elderly can pose their own set of problems. These medications may require different dosages, avoidance of mixing with other medications and frequent medical monitoring. They can include:
— Muscle relaxants.
— Opioids.
— Anti-anxiety medications (anxiolytics).
— Anti-diabetic drugs.
— Benzodiazepines, which can act as sedatives or help with insomnia and anxiety.
Kelleh says that medications that act on the central nervous system are extra potent for older adults.
“Although many use these types of medications on a regular basis for pain and insomnia, these can be especially dangerous as they may lead to confusion, delirium, falls and fractures,” she explains. Some benzodiazepines taken for anxiety can stay in the system for a long time — more than 60 hours, for instance.
“Combining these medications can exponentially increase the risk of harm,” Kelleh warns. Even some over-the-counter medications like Motrin or Tylenol can have a hefty impact on the kidneys and liver, respectively.
Herbal supplements and diet are also no exception, and they may cause other medications to work differently or cause their own side effects. Warfarin, a commonly prescribed blood thinner for the elderly, may be rendered less effective in conjunction with eating foods high in vitamin K, like leafy greens or certain fortified meal replacement shakes. In contrast, consuming grapefruit while taking a statin, which is a type of cholesterol drug, can make the statin more potent and increase side effects.
[See: 10 Superfoods for Older Adults.]
Adverse Drug Reactions in Seniors
An adverse drug reaction is an unwanted side effect of a medication. There are many concerns with adverse drug reactions in the elderly, such as:
— Falls.
— Delirium.
— Dizziness when changing positions or standing up, which is also known as orthostatic hypotension.
— Bleeding, especially from the head or the GI tract.
Adverse drug reactions can be caused by:
— The dose of the medication.
— The way the medication mixes with other medications, or polypharmacy.
— The way the elderly body processes and metabolizes the medication.
When initiating medications, it’s important for the provider to have a list of all the medications and supplements their patient is taking.
“A general principle for initiating medications is to ‘start low and go slow,'” Kelleh says. This is because if someone ends up being sensitive to a medication, it’s better to avoid high doses when not necessary. Geriatric doctors also rarely start multiple medications at the same time because it makes it more difficult to rule out which medication is the culprit of a side effect.
How do doctors figure out which medicine is causing an adverse reaction? Koretz says that “the timing of the symptoms is critical to understand.” He clarifies that he never assumes that a new medication is related to a new problem. “We should give careful thought to the possibility of alternative explanations,” he says.
Close monitoring, evaluation and good communication are essential to senior health to sort out if a new issue has arisen or if a medication needs to be stopped.
[READ: How to Find a Good Doctor.]
Arriving at a Diagnosis and Treatment Plan
Knowing that medications and health conditions impact seniors differently doesn’t mean there is any reason to be afraid of medically necessary treatment. Medical providers are aware of these roadblocks and take them seriously when evaluating their patients and providing individualized care.
Keeping open communication with a trusted medical provider is key. By discussing how you or your elderly loved one are doing and how medications are working, you can prevent misdiagnoses and complications in the future.
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How Conditions and Medications Affect Older Adults Differently originally appeared on usnews.com
