Medications for Older Adults

00:00 So, let's talk about a few of these classes of drugs and things that may come up on your exams and stuff you want to avoid.

00:06 Antipsychotics in and of themselves associated with a higher risk of fall and fracture.

00:10 Also associated with a higher risk of mortality overall.

00:13 So, really should be avoided.

00:15 When they’re absolutely necessary, in cases of dementia with severe agitation, a shared decision-making should be practiced with the family.

00:23 Maybe it keeps the patient in the home as opposed to going to an assisted living facility, but at the same time it is associated with a higher risk of death.

00:32 Glyburide is associated with this long half-life and, therefore, higher rates of hypoglycemia.

00:38 It should be avoided among older adults because there are other options out there if you need a sulfonylurea.

00:44 Benzodiazepines, you know, higher risk of delirium, higher risk of falls.

00:48 Sedative drugs, essentially the same.

00:52 Anticholinergic drugs, anything that is anticholinergic properties is dangerous for older adults.

00:56 It can promote constipation.

00:58 If the vision is blurry due to macular degeneration or cataracts, it can make that worse.

01:02 And also, worst of all, I think causes orthostasis, which may lead to falls as well.

01:09 So, other medications that are kind of on the watch list, you may need to use them.

01:13 Just be careful with them.

01:15 Anticoagulants are underused overall for conditions such as atrial fibrillation.

01:19 If you think about the average risk of stroke in most older adults with atrial fibrillation is about 5% per year.

01:26 The risk of a major bleed as well, lower than that.

01:29 Therefore, the benefit-to-risk ratio is still positive.

01:33 Nonetheless, if patients are falling, you know, every week, that's going to be too much of a risk.

01:41 And therefore, that needs to be corrected before considering or continuing anticoagulant therapy.

01:45 I've mentioned the risk of NSAIDs with GI bleeding, renal impairment and possible cardiovascular risk.

01:52 And then antihypertensive drugs, the systolic blood pressure per JNC 8 guidelines may be allowed increase to 150 among older adults above age 60.

02:04 I generally will try to be a little bit more strict with my control.

02:08 But certainly above age 75 or 80, the BP can become a liability when it becomes too low, and too low might be like 110.

02:17 So, therefore, something to consider.

02:19 Patients may need a down titration of their antihypertensive drugs as they move into that category above 75 or 80 years.

02:28 Hopefully, that was a helpful introduction to the care of older adults.

02:32 Thanks very much for your attention.