Acetaminophen Safe for Most Older Adults—But May Increase Stroke Risk for Those with Diabetes

Journal of the American Geriatrics Society Research Summary

Acetaminophen (otherwise known by brand names such as Tylenol) is one of the most widely used pain relievers. Almost 60 years of widespread use have made acetaminophen a household product. It’s distributed over the counter (OTC) in most countries and judged safe by the scientific community. However, acetaminophen is also one of the most common medications involved in overdoses (the medical term for taking more of a medicine than you should) and is the most common cause of drug-induced liver failure.

Surprisingly, we are only now coming to understand how acetaminophen works—and recent research shows that we may need to develop a better understanding of the need for caution when using acetaminophen, especially when it comes to avoiding some of the risks associated with its use. Past research suggests these can range from increased asthma to interactions with other medications or the risk for developing other health concerns (such as kidney toxicity, bone fractures, or blood cancers).

Another important reason to look more carefully at all medications is that our bodies may react to these treatments differently as we age. Older adults experience physical changes as they age including, for example, reduced muscle mass, more fat tissue, changes in body composition, and less fluid in the body systems. Older people may also have multiple chronic conditions and take several different medications. These issues affect many different body functions, and that can raise your risk of having an unwanted reaction to a medication.

For all these reasons, a team of researchers decided to study the safety of acetaminophen in a nursing home setting. Their study was published in the Journal of the American Geriatrics Society. Continue reading

Antipsychotic Use in Older Adults After Heart Surgery

Journal of the American Geriatrics Society Research Summary

Delirium is the medical term for an abrupt, rapid change in mental function that goes well beyond the typical forgetfulness of aging. Delirium can cause you to become confused, potentially aggressive, agitated, sleepy, and/or inactive. Post-operative delirium can occur after you’ve had an operation, and is the most common complication older adults experience after they have surgery. Older adults are at high risk for post-operative delirium after they have heart surgery.

When older adults have post-operative delirium, they are often given antipsychotic medications (APMs).  However, these drugs are not proven to be effective for treating delirium and may be harmful. Experts suggest that these drugs do not reduce how often or for how long older adults may experience delirium, or how serious the effects of delirium may be.

Additionally, some studies in older adults with dementia have found that APMs may cause heart rhythm problems and other drug-related side effects. Taking these drugs can increase the effects of anesthesia, and can cause stroke, pneumonia, and even death. Older adults who have had heart surgery are more likely to experience these dangerous events.

In a new study published in the Journal of the American Geriatrics Society, researchers looked into the use of APMs in older adults following heart surgery. Continue reading

Avoiding Dangerous Side Effects of Medications in Nursing Homes

Journal of the American Geriatrics Society Research Summary

Experts from the University of Iowa recently published a study in the Journal of the American Geriatrics Society examining the kind of medication errors and side effects that nursing home residents experience. They also looked at staffing and work systems in nursing homes that could affect medication errors and side effects. This is important because more than 1.4 million older adults lived in nursing home facilities as of 2015. Of these, 85 percent were 65-years-old and older and 41 percent were 85-years-of-age or older. In 2014, there were 15,600 nursing homes in the United States.

Older adults who live in nursing homes are at greater risk for injuries related to the medications we might take as we age (these injuries are also known as “adverse drug events”). There is a greater risk for adverse drug events for this population due to age, frailty, disability, and the multiple chronic illnesses we may be managing at any given time. For these illnesses, nursing home residents usually need several medicines, sometimes including riskier medicines like antipsychotics, antidepressants, and antiepileptics.

Some adverse drug events are due to preventable errors. Others are considered “non-preventable” because they can occur even when the medications are correctly given at normal doses. Continue reading

Commonly Prescribed Heartburn Drug Linked to Pneumonia in Older Adults

Journal of the American Geriatrics Society Research Summary

Researchers at the University of Exeter have found a statistical link between pneumonia in older people and a group of medicines commonly used to neutralize stomach acid in people with heartburn or stomach ulcers. Although proton-pump inhibitors (PPIs) are still a valuable group of medicines, research is indicating that PPIs are not as completely safe for older people as previously thought.

PPIs are medicines commonly prescribed to reduce gastric (stomach) acid production and to protect the stomach. Approximately 40 percent of older adults receive PPIs, although according to some experts, up to 85 percent of people who receive PPI prescriptions may not need them.

Researchers say people should not stop using their PPI medication, but should discuss with their prescribing healthcare professional whether the PPIs are still needed. Just stopping PPIs could be dangerous as PPIs may be useful, for example, to prevent stomach bleeds in some people.

Once thought to be relatively harmless, PPIs have more recently been linked to increased rates for certain health concerns like fractures, cardiovascular disease, and some bacterial infections. The association between PPI use and pneumonia was studied because stomach acid helps to prevent infections spreading from the gut in some individuals. Since pneumonia is a major cause of death for older adults, it is important for healthcare providers to understand the links between PPIs and pneumonia.

The Exeter team designed a study to look at statistical links in medical records between long-term PPI use and pneumonia in older adults. Their study was published in the Journal of the American Geriatrics Society. Continue reading

Are High-Risk Anticholinergic Medicines Prescribed Too Often for Older Adults?

Journal of the American Geriatrics Society Research Summary

Anticholinergics are a class of medications that are often prescribed for allergies, lung disease, and urinary incontinence. They also often can increase health risks for older adults. These medicines can affect your memory and ability to think, and they can even lead to increases in the risk for falls, dementia, and death. Additionally, older adults often have a difficult time tolerating anticholinergics because of age-related physical changes, such as reduced liver and kidney function, and because medications can impact our brain chemistry more strongly as we age.

Experts use tools to help older adults and healthcare professionals understand the risks associated with medications like anticholinergics. One of these tools is the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AGS Beers Criteria details medications with risks that may outweigh their benefits for older adults. The AGS Beers Criteria identifies 52 “high-risk” anticholinergics. Thirty-five of these are included on a list of medications worth avoiding altogether for older people, unless a healthcare professional has a compelling reason for prescribing them on a case-by-case basis.

Recently, a team of researchers decided to study how frequently healthcare providers prescribe potentially inappropriate medications like anticholinergics in light of recommendations like those from the AGS Beers Criteria. Their study was published in the Journal of the American Geriatrics Society. Continue reading