Medications are the most efficient form of health care we have available to prevent, manage and treat disease. They make up only 10 % of health care expenditures yet improve quality of life and save lives. However, reckless use of medications is wrought with danger and harm. In 2000, hospital data nationwide measured 2.12 million adverse drug events and of these 106,000 resulted in death! If adverse drug events was its separate disease it would be the 5th leading cause of death by disease in the United States. As a pharmacist I must say I’m embarrassed. However, a lot can be done to prevent these from happening. It is estimated that we can prevent up to 50% of these adverse drug events and eliminate unnecessary trips to the emergency room or doctor’s office.

Other data show that one out of three older adults experience an adverse drug event each year if they take at least  5 medications and that rises to 100% if they take more than 8 medications! Simply put, more is NOT merrier! There is a strong correlation of the number of medications you take with  your risk of a serious, potentially life-threatening adverse drug event. The most serious events involve insulin, Lanoxin (digoxin) and Coumadin (warfarin).

Insulin- When we use insulin and perhaps miss a meal or perhaps start a medication that can cause loss of appetite or enhance insulin’s effect, we can have a life-threatening lowering of our blood sugar. Since insulin is vital in managing our diabetes which can affect our ability to function later in life, we must learn about how to constantly juggle what we eat with our activity level and monitor our blood sugar frequently. Otherwise we can become too distant from managing our condition and be surprised with severe low blood sugar. Note: The risk of severe hypoglycemia also exists in older adults who take oral sulfonylureas (glipizide, glyburide, glimepiride, among others).

Lanoxin (digoxin)- As we age our kidneys slowly lose function, actually starting in our 40’s. By the time we get to 70 or 80 our doctor must watch our level of Lanoxin in body more closely since it is eliminated by the kidneys. In other words, as we age our kidneys close like the gates on a dam and the Lanoxin is the water that accumulates behind the dam until too much causes toxicity. There are also numerous medications that can alter our potassium level which can also encourage Lanoxin toxicity, which can be fatal.

Coumadin (warfarin)- This drug is a life-saver but can also kill. Coumadin prevents blood from clotting which can be essential in many older adults with cardiac rhythm disturbances. It prevents clots from forming in the lungs or the legs. However, Coumadin interacts with numerous medications and also vitamin K-rich foods. Whenever you have a new medication added your doctor and pharmacist should work together to ensure there are no significant interactions with Coumadin (warfarin). You should also develop a healthful diet that is balanced and does not very much in vitamin K-content foods each day. Drastically reducing vitamin K or increasing it can alter the effect of Coumdain.

Drug Interactions- There are three drug interactions that are worth noting that lead to ADEs in older adults. 1) Your risk of severe hypoglycemia goes up considerably within one week of starting a sulfa-antibiotic (Bactrim or Septra). Also, the risk of digoxin toxicity goes up considerably after starting a macrolide antibiotic (Clarithromycin, Erythromycin or Azithromycin) and, lastly, the risk of life-threatening high potassium increases after starting a potassium-sparing diuretic (triamterene or spironolactone to name just two) if you are taking an ACE inhibitor like lisinopril or enalapril, among others. So, when starting a new medication, ALWAYS make sure your pharmacist has checked for any drug interactions.

Falls & Delirium- I can go on for hours talking about this subject but I’ll talk about a couple more areas of adverse drug events that are frequently known to cause admission to a hospital in older adults. The two areas that are closely related to the number of medications you taker are falls and delirium (a loss of knowing oneself or like having dementia).

There is a strong correlation with excessive or inappropriate medication use in older adults and falls. There are many risk factors for falling and medications can worsen those areas of risk. For example lower leg weakness, gait and balance disturbances, poor vision, and cognition. In fact, one element of a falls screening program is to screen someone’s medication if they take more than four, yep that’s it, only four or more medications is a risk factor for falling. Again, more is NOT merrier!

Another area of concern is how medications, not necessarily just one, but a combination of medications can have additive toxic effects and cause cognitive impairment or, put another way, anti-memory effects. Sometimes when we are challenged by an acute episode such as upper respiratory infection with dehydration, these medications can take hold in a negative way and cause delirium. Delirium presents itself as if the person had dementia of the Alzheimer’s type, and rather advanced. Someone with delirium is combative, can hallucinate and not be oriented to their surroundings thereby presenting as a danger to themselves. In fact, cognitive impairment and especially delirium are risks factors for falling. So, if you take more than four medications and are concerned with your mental sharpness or have a history of falls or, if you think something is just not right, please consider having an expert look into your medications.

Stay well and stay upright