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.
Antipsychotics in and of themselves
associated with a higher risk of fall and fracture.
Also associated with a
higher risk of mortality overall.
So, really should be avoided.
When they’re absolutely necessary,
in cases of dementia with severe agitation,
a shared decision-making
should be practiced with the family.
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.
Glyburide is associated with this long half-life
and, therefore, higher rates of hypoglycemia.
It should be avoided among older adults
because there are other options
out there if you need a sulfonylurea.
Benzodiazepines, you know, higher
risk of delirium, higher risk of falls.
Sedative drugs, essentially the same.
anything that is anticholinergic properties
is dangerous for older adults.
It can promote constipation.
If the vision is blurry due to
macular degeneration or cataracts,
it can make that worse.
And also, worst of all, I think causes
orthostasis, which may lead to falls as well.
So, other medications that
are kind of on the watch list,
you may need to use them.
Just be careful with them.
Anticoagulants are underused overall
for conditions such as atrial fibrillation.
If you think about the average risk of stroke in most
older adults with atrial fibrillation is about 5% per year.
The risk of a major bleed as well, lower than that.
Therefore, the benefit-to-risk ratio is still positive.
Nonetheless, if patients are
falling, you know, every week,
that's going to be too much of a risk.
And therefore, that needs to be corrected before
considering or continuing anticoagulant therapy.
I've mentioned the risk of NSAIDs with GI bleeding,
renal impairment and
possible cardiovascular risk.
And then antihypertensive drugs,
the systolic blood pressure
per JNC 8 guidelines may be allowed increase
to 150 among older adults above age 60.
I generally will try to be a little
bit more strict with my control.
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.
So, therefore, something to consider.
Patients may need a down titration
of their antihypertensive drugs
as they move into that
category above 75 or 80 years.
Hopefully, that was a helpful
introduction to the care of older adults.
Thanks very much for your attention.