The upper number of blood pressure, also called systolic, is very important in older adults as it tends to rise with age, which was another risk factor from this study that was correlated with stroke risk. In my experience with helping older adults it is common to find isolated systolic hypertension, occurring in about 30% over the age of 80. Isolated systolic hypertension is where the upper number is elevated but the lower (diastolic) number is normal. Treatment of this type of high blood pressure is very effective at preventing strokes in which only 13-18 people need to be treated to prevent one stroke. What is also important to note is that “silent strokes”, in which you have very small strokes that go undetectable but contribute to cognitive decline, can be reduced by better management of your high blood pressure.

My advice, pay attention to your blood pressure and if that upper number is higher than 140, see your doctor and start a conversation. Also keep in mind that self-monitoring of your blood pressure and sharing those recordings with your doctor is more likely to catch high blood pressure, and is also known to be more accurate than the occasional blood pressure check in the doctor’s office.

The 8th stage is where the older adult reflects upon their life and either becomes satisfied or develops a sense that it was not a life worth living, hence Despair. Erikson is quoted as saying: “Despair expresses the feeling that time is now short, too short for the attempt to start another life and to try out alternate roads…” He also states that we do have one firm foothold in this stage to fall back on and that is “Basic trust”, and “life without it is simply unthinkable.” He states that Wisdom is the healthy product of the 8th stage where we can develop “an informed and detached concern with life in the face of death itself”. We must also note that those in their later years, long past their “Generative years”, still need a purpose and involvement in society. How can they still be useful and give back? That is the question many older adults have and probably why so many volunteer to form a labor force of unpaid caregivers and doers for others in need, truly purposeful living. However, there is another stage, the 9th.

Erikson also points out that “I am persuaded that if elders can come to terms with the dystonic elements in their life experiences in the 9th stage, they may successfully make headway on the path leading to gerotranscendence.” What is gerotranscendence? Principles regarding gerotranscendence from the Erikson’s book “The Life Cycle Completed” are: Letting go of the material things; gaining the wisdom of humility; defining ourselves by what we give back; to rise above, outdo, go beyond, independent of the universe and time; to leave behind those things we can not carry any longer as they are  too heavy a burden; gaining new spiritual gifts. It’s as if the the older adult in the 9th stage transcends to be a playful child once again, not caring about the material things nor the false pretense of power and stature. Sounds like a nice place to be!

So what’s my point in bringing all this up? My perspective is that the last stage gives us the opportunity to find peace with ourselves and transcend into a different person who is at peace with the world. A loving, caring human being truly of value to the world. That would be by my definition of “successful aging”.

Falls, for example, can be caused by a number of risk factors such as medications, leg weakness, protein malnutrition, vitamin D deficiency and urinary incontinence, all of which can be altered with a little knowledge and effort. If we are protein malnourished we can always eat more protein, and that combined with the proper exercise regimen can improve our leg strength. We can also do balance exercises that help reduce our risk of falling, along with altering some of those medications known to cause falls, such as blood pressure medications, medications for insomnia among many others. Incontinence can be managed with behavioral modifications thereby avoiding medications that can affect our memory and cause falls. Vitamin D deficiency, known to be associated with poor balance, falls, and memory loss in some, can be corrected with the right replenishment of vitamin D. All of these are easy to identify when screened for and easily altered to improve function and quality of life. We all know our body’s organ systems decline with aging but we can slow down that decline and alter the trajectory with these interventions.

What I recommend is to go to the National Institute of Aging web site at: www.nihseniorhealth.gov or www.nia.nih.gov, and go to the Publications section, Age Pages, and search for the condition that affects you or your loved one. The brochures can be printed in PDF format or can be read on line with altering text size for those with low vision. It’s a great way to continue your life-long learning and age well. One other point is that medications themselves can cause geriatric syndromes which are assumed to be a normal part of aging. A medication review with an experienced pharmacist can help identify medications associated with geriatric syndromes and help you age in place. Don’t subscribe to the stereotype that falls, urinary incontinence and memory loss are always a normal part of aging. They may not be in your case!

So the next step is to get her a medication box so she has some structure to those medications instead of a bunch of bottles on the kitchen counter that Albert Einstein would have trouble with remembering how to take correctly. OK, so Albert is not a good example since he was known to wear two different colored socks, if he remembered to put socks on at all. But the point is that she now has a rather complex medication regimen, along with impaired vision, weakness in her legs and is at further risk of decline due to her being home bound. Believe it or not, you can actually help mom manage this situation, with a little help. You may not be able to do all of the above on your own, but with the help of a geriatric pharmacist you can incorporate some small changes and help mom stay at home and avoid a serious adverse drug event that could land her in the hospital. One critical step when medications are being added, as in the example above, is to have medications screened for drug interactions and also for risk of adverse effects that can affect function and quality of life.

Resources to help with a situation like this can be found at ElderDrugs or another local geriatric pharmacist, or perhaps a geriatric care manager. The links to find these professionals are:

Certified Geriatric Pharmacist- http://www.ccgp.org/consumer/locate.htm

Geriatric Care Manager- http://www.caremanager.org/displaycommon.cfm?an=1&subarticlenbr=306

Older adults don’t have to experience premature functional decline but can stay in their homes longer and live a higher quality of life with their remaining time. Finding the right resources for your mother or father, aunt or uncle, or someone you are close to is at your fingertips. Not just any health care professional knows the idiosyncrasies of older adults but the Certified Geriatric Pharmacist or Care Manager got into this business because they have a passion for helping older adults age in place.

Explanation
Based on observation, and verification in the literature, it is clear that medications can be the cause of many problems instead of the cure. The literature shows that adverse drug events hasten decline in older adults by precipitating geriatric syndromes, such as falls, memory loss, incontinence, among others. These types of ADEs I call “soft ADEs”, as opposed to the usually reported ADEs of GI bleeding, electrolyte imbalances, hypoglycemia, and others. “Soft-ADEs” are instances where a side-effect of a medication can cause or worsen a geriatric syndrome, which alone can affect another area of function. The development of the drug-induced syndrome can also lead to the prescribing of additional medication for symptom management which can cause another geriatric syndrome, when in fact what is needed is an adjustment of the current medication regimen by withdrawing the drug, altering the dose, or finding a cleaner acting drug. The BBPP© model simplifies the complexity of the interrelationship between geriatric syndromes in relation to medications commonly used in older adults.

Here’s how it works
Falls is a geriatric syndrome and a leading cause for loss of independence in older adults. There are many risk factors in play so one approach is not enough to effectively lower risk. To some degree there is an over-reliance on bone health drugs to prevent fractures when in fact preventing falls is more effective at reducing fracture risk. We also know that taking a medication that causes cognitive impairment can contribute to or cause falls. Examples are Tylenol PM, antihistamines, Valium-like drugs (benzodiazepines), or in rare instances statins. Using statins as an example, they are now validated to be a risk factor for falls due to the muscle weakness and pain that exist as side-effects in some individuals. Statins can also cause memory loss and what may happen is Aricept may be prescribed to someone we think has dementia when it can actually be medication-induced. However, Aricept can cause urinary incontinence thereby increasing fall risk. A drug for incontinence is then often prescribed which antagonizes the beneficial effects of Aricept and can cause further cognitive impairment. Incontinence also leads to social isolation which also is a risk factor for depression. Depression also leads to memory loss issues even in those without dementia. So you can see that medication use can affect several different areas such as Bones (falls), Brains (memory loss, depression), Pee (urinary incontinence) and Pain (muscle pain), and all caused by medications.

This was a brief overview of the BBPP© concept that teaches you to 1) If you have issues with BBPP©, always suspect your medications until proven otherwise, 2) Don’t over-rely on medications to manage your health risk, and 3) Understand that many of our organ systems are interrelated and taking a medication can affect more than one system leading to functional decline or loss of independence. If you are taking more than four medications and have concerns with your ability to function, please consider a comprehensive medication review to rule out medications as the cause of your problems.