Study Finds that Most Older Adults are Aware of Medication Risks

JAGS graphicJournal of the American Geriatrics Society Research Summary

Geriatrics experts know that certain medications may have risks for older adults that outweigh their benefits, especially when safer alternatives are available. Medications that could be “potentially inappropriate” for older adults are included on recommendation lists that your healthcare provider can consult, such as the American Geriatrics Society (AGS) Beers Criteria or the STOPP-START list.

However, despite these recommendations, 25 percent of older adults take at least one potentially inappropriate medication every year. Taking these medications can increase the risk of being hospitalized due to a medication-related problem. Although 70 percent of older adults are willing to stop taking certain medications, healthcare providers continue to prescribe some potentially inappropriate medicines to older adults.

Researchers from the Institut Universitaire de Gériatrie in Montréal, Canada, designed a survey to learn about older adults’ awareness of drug-related health risks. They conducted the survey over the telephone with 2,665 participants, aged 65 or older. Continue reading

Some Frail Older Adults May Receive Potentially Inappropriate Medications When Admitted to Nursing Homes

JAGS graphicJournal of the American Geriatrics Society Research Summary

Medical experts know that older adults who have dementia or other mental health concerns that impact thinking or decision making should avoid certain “potentially inappropriate medications” (PIMs). PIMs can worsen confusion and raise the risks for falls, fractures, and even death, particularly for people with complex health needs.

PIMs may include treatments like:

  • Benzodiazepines (medications sometimes called “tranquilizers” and used to treat sleep problems, anxiety, or to relax muscles)
  • Antipsychotics (medications sometimes used to address mental health conditions)
  • H2-blockers (medications sometimes used to decrease the production of stomach acid)
  • Anticholinergics (medications that block a substance called acetylcholine, a “neurotransmitter” that transfers signals between certain cells to impact how your body functions. Anticholinergics have been used to treat several different conditions, including incontinence and chronic obstructive pulmonary disorder, or COPD).

A Canadian research team investigated how often healthcare providers prescribed PIMs to older adults living with dementia or other mental health concerns and who were being admitted to nursing homes. The research team examined records from more than 40,000 people with dementia or cognitive impairments who were over the age of 66 and had been admitted to nursing homes between 2011 and 2014. The team published their study in the Journal of the American Geriatrics Society.

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New Study: Proton Pump Inhibitors Do Not Contribute to Dementia or Alzheimer’s Disease

JAGS graphicJournal of the American Geriatrics Society Research Summary

Proton pump inhibitors (PPIs) are medications used to treat digestive problems such as ulcers and reflux disease by reducing the body’s production of the acid that helps us digest food. Ulcers are sores that develop on the lining of our digestive system; when they develop in the upper part of the small intestine they are called “duodenal ulcers.” Reflux disease is a condition in which stomach acid or other fluids in the digestive system irritate our food pipe, also known as the esophagus.

Recently, safety questions about these medications have been raised in several studies. These studies suggested that PPIs increased the risk for dementia and Alzheimer’s disease in people 75-years-old or older. Noting that the prescription of PPIs is on the rise among middle-aged and older adults, a team of researchers designed a new study to examine PPIs and the risk of dementia, mild cognitive impairment, and Alzheimer’s disease. They published their study in the Journal of the American Geriatrics Society. The researchers also examined whether people with mild cognitive impairment who took PPIs were at higher risk for developing dementia or Alzheimer’s disease. Continue reading

For Older Adults, Antibiotics May Not Be Appropriate Treatment for Some Urinary Tract Infections

JAGS graphicJournal of the American Geriatrics Society Research Summary

In a new research paper published in the Journal of the American Geriatrics Society, Thomas E. Finucane, MD, of the Johns Hopkins Geriatrics Center at Johns Hopkins in Baltimore, suggests that prescribing antibiotics for urinary tract infections (or “UTIs”) may often be avoided among older adults.

Here’s why:

  • “UTI” is a vague, overused diagnosis that may be applied to older adults who have no symptoms but may have bacteria in the urine and also may be experiencing confusion, falls, or other vague signs (including changes in the odor or color of urine). In most cases, antibiotics do not benefit these older people.
  • Researchers are coming to a new understanding about the kinds of bacteria, viruses, and other microorganisms that live in the human body naturally. We now know that everyone’s urine contains bacteria and viruses, for example. We also know that these microorganisms are usually helpful to overall well-being.
  • In some cases, antibiotic treatment can be harmful, especially for older adults.

Some groups of people do still benefit from antibiotic treatment of UTIs. These individual include:

  • People who are sick enough to require urgent antibiotic treatment regardless of findings in the urine.
  • People with invasive bacterial diseases, especially kidney infections.
  • Pregnant women and people about to have bladder or urinary tract surgery.

In his paper, Dr. Finucane says that microbiome studies—which examine the benefits and harms cause by the billions of organisms that naturally live in the human body—suggest that UTI treatment with antibiotics actually may be more harmful than we previously thought. If you think you have a UTI, or if you’re currently using an antibiotic to treat a UTI, it’s important to speak with a healthcare professional first before changing your care plan. Your doctor, nurse, or other provider can work with you to find a treatment plan that’s best for you.

This summary is from “Urinary Tract Infection: Requiem for a Heavyweight.” It appears online ahead of print in the March 2017 issue of the Journal of the American Geriatrics Society. The author is Thomas E. Finucane, MD, Co-director, Elder House Call Program, Johns Hopkins Bayview Medical Center and Professor of Medicine at Johns Hopkins Medicine.

Specific Long-Term Therapy May Not Prevent Fractures in Older Women

JAGS graphicJournal of the American Geriatrics Society Research Summary

Osteoporosis is a disease that causes thinning of the bones, loss of bone density, and increasingly fragile bones.  This puts people at higher risk for bone fractures. Risk for the disease increases as we age. In fact, 50% of women over the age of 50 will experience a bone facture due to osteoporosis.

By 2020, an estimated 61 million American adults will have low bone mineral density. A group of medications known as “bisphosphonates” are sometimes used to treat osteoporosis.  These medications increase bone mineral density, which strengthens bones and is thought to make them less likely to fracture. Studies have shown that the risk for bone fractures lessens when women with low bone mineral density take these medications for between 1 and 4 years. However, little is known about whether taking bisphosphonates for longer periods of time has the same effect.

Recently, a team of researchers examined whether older women taking bisphosphonates for 10-13 years had fewer bone fractures than older women with similar fracture risks who took these medicines only briefly. Their study was published in the Journal of the American Geriatrics Society. Continue reading