Multiple Drugs Acting on Brain can Increase Risks of Falls in Elderly

Multiple Drugs Acting on Brain can Increase Risks of Falls in Elderly

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 Highlights:
  • More elderly people in the United States are being prescribed three or more drugs acting on the brain.
  • Such prescribing patterns could increase the risk of falls and fractures in this group.
  • Non-pharmacological methods like psychotherapy should be offered to patients instead of medications whenever possible.
The number of seniors in America taking three or more drugs that act on their brain has increased over the last ten years, was a study that had been recently publlished inJAMA Internal Medicine.
Multiple Drugs Acting on Brain can Increase Risks of Falls in Elderly

There are several types of drugs that affect the brain.
  • With the ever increasing rise of depression in the modern age, the prescription of antidepressants is on the rise.
  • Antipsychotic drugs are used to treat psychosis - which can be considered the opposite of depression.
  • Tranquilizers are used to calm agitated patients or to enhance sleep at night.
  • Though mild pain is treated with acetaminophen and non-steroidal drugs like ibuprofen and diclofenac, severe pain that may be caused by diseases of older age like arthritis and cancer are treated with opioids, which again act on the brain.
The researcher team from the University of Michigan and VA Ann Arbor Healthcare System found that the number of older patients who receive three or more of these medications is on the rise. The team analyzed data collected by the Centers for Disease Control and Prevention (CDC) from doctors' offices between the years 2004 and 2013.

In their study, the researcher team found that:
  • The number of doctor visits by people over the age of 65 years taking three or more medications that act on the brain doubled from 0.6% in 2004 to 1.4% in 2013
  • In fact in rural areas, rate of doctor visits by seniors taking combinations of drugs that act on the brain more than tripled
  • Nearly half the patients taking multiple brain medications are not formally diagnosed as suffering from the condition like a mental health problem, insomnia or pain for which they need the medication. Ideally, patients should meet the underlined criteria for the condition before the medication is prescribed
One of the reasons for the need for multiple medications could be that there is more awareness about mental conditions like depression that can be treated. However, taking multiple medications that act on the brain can have serious consequences especially in older adults.
  • The liver which metabolizes these drugs may not be functioning to its maximal capacity in old age, due to which the drug levels may be higher than in younger adults. The kidney function may also be reduced, as a consequence of which the levels of drugs that are excreted unchanged in the urine will rise in the blood
  • In addition, the multiple drugs could interfere with the metabolism of each other, thus increasing their blood levels
  • The drugs will have an additive effect on the brain that could affect memory and thinking and cause decline in cognitive functions. The brain of older individuals may also be extra sensitive to these effects
  • The additional drowsiness caused by the combinations could interfere with driving and increase dependence on others. It could also increase the chances of falls and subsequent fractures
  • The US FDA has warned against the use of an opioid with a benzodiazepine due to an increased risk of death
However, it does not mean that treatment should be denied for the patient if he/she needs it. It is first necessary to reach a correct diagnosis. Many of the conditions can be treated with non-pharmacological treatments like psychotherapy. These should be offered to the patient, and medications should be prescribed only when definitely needed.

Reference:
  1. JAMA Internal Medicine, DOI:10.1001/jamainternmed.2016.9225


Source: Medindia

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