Published on: October 24, 2012
by Jeff Anderson for A Place For Mom:
Look in any senior’s medicine cabinet and you’ll likely see a vast assortment of pharmaceuticals. In 2010 the Kaiser Foundation reported that the average senior is prescribed six drugs at a time. Some seniors take much more. Many seniors accumulate more and more prescriptions over the years until it gets to the point where it would take a database to organize them all. Often, the senior and the senior’s family don’t understand what pill does what, when to take which pill, what side effects to look out for, and so on. It’s medication chaos.
The risk of medication chaos increases as seniors see multiple specialists and do not have a primary care physician who is responsible for the big picture and what all these medicines are doing in concert. The results can range from acute episodes of toxicity—a bad reaction leading to an emergency room visit— to outright misdiagnosis of illnesses. In fact, the Alzheimer’s Association reports that medical reactions are the most common cause of misdiagnosed or “reversible” dementia.
How Medication Side Effects Can Masquerade as Dementia
Drug interactions and side effects often mimic the symptoms of age-related cognitive disorders. For example, drugs that affect cognition and mobility, such as anti-anxiety meds, can make dementia symptoms worse—or even create a facade of dementia in people who don’t suffer from the disease, a condition known as pseudodementia. For example, many anti-anxiety drugs commonly prescribed to seniors such as Valium and Xanax have side effects that are indistinguishable from dementia including:
Of course, at high does, negative reactions like these are even more likely. Other medications can also cause pseudodementia, including cholesterol lowering statin drugs like Lipitor, which many seniors take. In fact, any medicine that can cause cognitive impairment could lead to a misdiagnosis of dementia. Classes of drugs including anti-histamines, antibiotics, corticosteroids, anticonvulsants, antiemetics, muscle relaxants and opioid pain killers all carry this risk.
While the right medicine can reverse the course of serious diseases and improve a senior’s quality of life immeasurably, medications also cause problems. We received this pointed comment on our Senior Living Blog, which is worth quoting in full:
“My mother was fading fast. In the course of two months, she went from needing general assistance to not being able to stand or assist with her own transfers. She went from minor memory lapses to neither recognizing people nor her surroundings. Over the course of about three weeks, she had deteriorated to the point where she could not take her medications. Without meds, she regained her mind and most of her mobility. It came down to the medications she was on. We began reintroducing them one at a time with minimal doses for the most important issues. If we saw a return of symptoms of dementia, we would reverse course and she would come right back. It has made me wonder how many of our elderly end up in homes, or deteriorate catastrophically because they are on too much medication. It almost killed my mother. She’s 80 years old. Who cares if her cholesterol is a little elevated if the combining of her meds is destroying the last years if her life?”
This reader’s fears are not unfounded. A 2012 study published in online Medical Journal PLOS One found that 20% of the medications prescribed by seniors’ primary care physicians are inappropriate because they could cause adverse reactions. The same study from PLOS One found that 35% of seniors’ medical reactions occur in outpatient settings, suggesting that at a supportive environment with medication management, these unintended side effects would be reduced.
Senior Living and Non-Chemical Approaches
For many seniors, a move to an assisted living community can help get this medication chaos under control. Most assisted living communities require that residents have a doctor’s visit before admission. Families and physicians often use this visit as an opportunity to “press the reset button” on prescriptions. A complete reassessment of the senior’s medication regime can (and should) take place at this time. Under doctor’s supervision, many seniors are able to go off of medicines that are redundant, have outgrown their usefulness, or are outright contraindicated.
Once a senior is admitted to assisted living, a care plan is put in place. Care plans lay out goals and strategies for the resident’s care, and medicines are a big part of the equation. The community, family, senior and medical professionals discuss what medicines will be given to the resident, why, and often set goals for reducing them. In fact, seniors, particularly those with Alzheimer’s and dementia, are often able to reduce their medications after moving to assisted living communities with memory care.
For example, many seniors who have been prescribed anti-anxiety medications we discussed above find themselves in an undignified stupor that’s not only painful for loved ones to witness, but also can lead to falls, head injuries and broken bones. Today’s memory care communities instead attempt to reduce agitation and anxiety non-chemically with methods such as:
Loren Shook, CEO of Silverado Senior Living, which specializes in memory care, confirms that many residents who move to Silverado communities are able to significantly reduce their medicine intake, and with great benefit.
Medication Management and Healthy Senior Living
While decreasing the volume of prescribed medications is ideal, it’s not always possible. In some cases, seniors require every medicine they’re prescribed. But even in these cases, assisted living plays an important role. Even if medicines can’t be reduced, it’s important that that they be taken correctly. Medication management, which is offered at nearly all assisted living communities, assures that seniors get the right medicine, at the right dose, at the right time. For seniors with a cornucopia of medicines, or with memory loss, this benefit alone can be a lifesaver.
If your older loved one is on more medicines than anyone can reasonably be expected to keep track of, or is showing changes that you believe may be related to drug interactions, arrange a doctor’s visit to reevaluate medications. Talk to the doctor about what medicines are essential, and what medicines may be doing more harm than good. And if your older loved one cannot take medication safely, and you can’t be there to help, consider assisted living or homecare.
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