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

PTSD, Certain Prescriptions for PTSD May Raise Risk for Dementia

JAGS graphicJournal of the American Geriatrics Society Research Summary

Researchers are discovering that post-traumatic stress disorder (PTSD) is a significant risk factor in developing dementia. Dementia is a memory problem that affects a person’s ability to carry out usual tasks. Dementia is a leading cause of serious illness, disability, and death.  It often requires care in a nursing home or other long-term care facility for people aged 65 and older.

Until now, researchers didn’t know whether the kinds of medications used for people with PTSD could increase risks for dementia. (These medications include including antidepressants, antipsychotics, sedatives, or tranquilizers.) A new study, published in the Journal of the American Geriatrics Society, examined this connection.

In their study, researchers examined information from 3,139,780 veterans aged 56 and older. At the beginning of the study, in 2003, the veterans were receiving health care from a Veterans Health Administration facility. Almost all the veterans were male and 82% were white.

Of the veterans in the study, 5.4% had been diagnosed with PTSD. As the researchers looked at the data over the study’s nine-year follow-up period, they also included veterans who were diagnosed with dementia.

Research has previously shown that veterans with PTSD are more likely to have health problems linked to a higher risk for dementia. These include traumatic brain injury, diabetes, chronic obstructive pulmonary disease (COPD), psychiatric disorders, substance abuse, and other health issues. Continue reading

Safe Use of Acetaminophen

FDA_Whyte-9922R

John J. Whyte, MD, MPH
Director, Professional Affairs & Stakeholder Engagement
U.S. Food and Drug Administration

Millions of people use pain relievers every day and when used correctly, these medicines are safe and effective. As we age, we may find ourselves using these medications more often than in the past. Making sure we use them according to the label directions is important because they can really take a toll on our health when not used correctly.

The key is making sure you know the active ingredients of, and directions for, all your medicines before you use them.

Many over-the-counter (OTC) medicines that are sold for different uses actually have the same active ingredient. Also, active ingredients in OTC medicines can be the same as ingredients in prescription medicines. For example, a cold-and-cough remedy may have the same active ingredient as a headache remedy or a prescription pain reliever.

There are two basic types of OTC pain relievers. Some contain acetaminophen and others contain non-steroidal anti-inflammatory drugs (NSAIDs). These medicines are used to temporarily reduce fever, as well as temporarily relieve the minor aches and pains associated with:

  • minor pain of arthritis
  • headaches
  • muscle pain
  • backache
  • menstrual pain
  • toothaches
  • the common cold

We’ll focus on acetaminophen here. Acetaminophen is a common pain reliever and fever reducer, but taking too much can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines containing acetaminophen. Continue reading

Older Adults and Medication: A Geriatrician’s Experience

ST picStephanie Trifoglio, MD, FACP
AGS Member
Private Practice Internist & Geriatrician 

As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC).  One patient’s story highlights why this is still very important and worth the time and effort.

A new patient, Mrs. B, came to me for help in managing her dementia. Her husband was remodeling their home to make it accessible as she was now barely able to walk.  She was becoming more confused.  She had previously seen an internist and two neurologists.  Her husband gave a history of Parkinson’s disease, along with a several-year history of colitis and longstanding diarrhea.

The initial history revealed that Mrs. B. had progressive weakness, unsteady gait, and confusion.  She had muscle jerks at night.  She had three recent car crashes and subsequently stopped driving.  She had even lost her ability to do sudoku. This was significant as she had been a doctorate-level biologist.  A review of her medications showed that she had four years of taking Pepto-Bismol, two tablets, four times per day, prescribed for collagenous colitis.  She took this dose consistently.

The active ingredient in Pepto-Bismol is bismuth, and I have never before had a patient take this much bismuth.  Being naturally curious, and always looking for potentially reversible causes of dementia, I did a bit of research and ran basic blood tests on Mrs. B.  I also instructed her to stop taking the bismuth. Continue reading