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

Taking the Keys Away: A Geriatrician’s Perspective

okhraviHamid R. Okhravi, MD
Associate Professor of Medicine/Geriatrics
Director, Driving Evaluation Clinic
Director, Memory Consultation Clinic
Glennan Center for Geriatrics and Gerontology
Eastern Virginia Medical School

As geriatricians, we often need to have difficult conversations with our patients, their families, and/or their caregivers. One of the most difficult of these is when we have to tell a patient that he or she is no longer capable of driving safely.

Not so long ago, I had this discussion with a patient of mine, Mr. M, a 79-year old with mild dementia. His daughter brought him to our Memory Clinic when she became worried about his driving skills.

According to Mr. M, he’s a good driver. But his daughter told me that Mr. M had caused two minor accidents within the last year. She also said that he occasionally got lost when driving outside his familiar routes.

I gave him tests to gauge his ability to think and make decisions, and he did poorly on all three of them.

When I discussed his test results with Mr. M and his daughter, I explained that his impaired performance didn’t necessarily prove that he’s an unsafe driver. However, his scores did show that his driving skills needed further evaluation. I suggested that medical disorders, such as cognitive impairment, could worsen his skills and increase the risk of driving errors that can lead to vehicle crashes.

Naturally, Mr. M was unhappy to hear what I had to say. He told me that he’s always been a safe driver, and he refused to stop driving. He told me that not being able to drive would change his life for the worse, and that it would be terrible not to be able to shop for groceries or attend the two weekly social activities he enjoys with his friends.

Despite his concerns, with his daughter’s encouragement, he agreed to have his driving evaluated. Continue reading

Aging Well Through Arts

image001 (3)For too long, old age has been associated with negative images, words, and ideas. This special report from NextAvenue—public media’s first and only outlet dedicated to older adults—examines the vitality, excitement, and joy that comes to those who connect aging and art. Learn more here.

This post and the original special report first appeared on NextAvenue.org.

 

On Becoming an Older Driver

altshul headshotSara Altshul
AGS Staff Writer

I didn’t run right out and get my driver’s license on my 16th birthday, like so many of my high school pals did. In my rural hometown, a car was more necessity than luxury. Town was three miles away, school even further.

But my overprotective mom was reluctant to let me learn how to drive on her new manual-shift Saab. Instead, she chauffeured me wherever I wanted to go, and if I wanted to get somewhere when she wasn’t around, I walked or got a ride.

I finally got my license at 18, a few months before landing the coolest summer job of all time – as a Good Humor truck driver. Soon, I bought myself a $500 Simca, a tiny four-door French beauty whose battery was tied on with a shoelace. I had it for years before it literally fell apart.

Since then, I’ve driven hundreds of thousands of miles. Two cars I owned during my 40’s topped out at nearly 200,000 miles each. For the three years I lived there, I even zipped through the Italian countryside, up hills and through narrow, cobblestoned streets, in my second-hand, four-on-the-floor Mitsubishi. Coming to a stop on Tuscan hills in first gear took plenty of practice. Just ask my husband.

Thankfully, I’ve never had a crash and despite a speeding ticket or two over the years, my driving record is pristine.

I’m 66 now. My faculties are sharp and intact. But when I’m driving, I recognize that I have to be more conscious, more focused, and more alert than my younger self ever was. I exert a deliberate effort when I’m behind the wheel: I don’t pass as frequently, I don’t go as fast, and I don’t take chances like I may have done in the past. I am acutely aware of keeping myself, and my passengers, safe on the road. Continue reading

A Flu Shot is The Best Shot at Prevention for People 65 and Older

cdc-dj-vaccination-clinic_title-2Daniel B. Jernigan, MD, MPH
Director of the Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

For millions of people, the flu can mean a fever, cough, sore throat, body aches, and fatigue for a week or more. But did you know that if you are 65 years or older, you are at increased risk of serious flu-related complications, like pneumonia?

“People’s immune systems can become weaker with age, which places older adults at high risk of serious flu-related complications,” says Dr. Lisa Grohskopf, a medical officer with CDC’s Influenza Division.

While flu seasons vary in severity, people 65 years and older bear a comparatively greater burden of serious flu-related illness compared to other age groups during most flu seasons. Data from recent seasons shows that between about 70 to 90 percent of seasonal flu-related deaths in the United States have occurred among people 65 years and older. For hospitalizations, this number is between about 50 and 70 percent.

This is why flu vaccination is especially important for people 65 years and older. While flu vaccine can vary in how well it works, there are a lot of scientific data showing that flu vaccination prevents illness and hospitalizations, even among people 65 and older for whom the vaccine may not work as well. A new CDC study published this summer in the journal Clinical Infectious Diseases (CID) found that flu vaccination reduced the risk of flu-related hospitalization among people 65 to 74 years by 61%. Vaccinated people 75 and older were similarly protected (57%).

Continue reading