age

Appropriate medications – same at 30, 60, and 90?

Posted on by Michelle Fritsch, Pharm.D.
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Appropriate medications over age 60

Should the same medications and doses be prescribed for all ages? No! However, we find that often they are.   If a medication was a good choice for you at 30, is it still a good choice at 60 or 90? Not necessarily. So, why does age matter?  How do you know that you are taking all appropriate medications?

What changes as we age?

Even if you eat right, exercise regularly, and make good choices about alcohol and tobacco, changes occur over time.

  • Kidney function starts a very gradual decline in your late 30’s or early 40’s.
  • Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
  • Food and medications move through the intestine more slowly.
  • The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
  • For men, the prostate gland increases in size.
  • For women, the urethra shortens and comes thinner. So, risk of urinary tract infection goes up.
  • Muscles weaken as growth hormone levels decline.
  • Aldosterone levels decrease, so risk of dehydration goes up.
  • The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
  • Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
  • The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
  • The amount of water in the body goes down while the body fat goes up.

This list is not meant to depress anyone. These are just some of the very natural changes that occur in all of us. So with all of this change, the need for medication, the types of medications that are needed, and the doses of medications are all different.

Nearly all medications leave the body through the urine or the stool. Most medications are changed as they pass through the liver. There are enzymes in the liver that break down those medications. When the kidneys and liver become less functional, it takes longer to get the medications back out of your body. This means a single dose can last longer or have a bigger impact.

Most medications have a preference for water (hydrophilic) or fat (lipophilic). Since body water and fat both change, medication concentrations also change.

Guidelines for taking appropriate medications

There are so many changes to manage that guidelines have been written to try to decrease some of the more common mistakes that are made. These are oriented to people over age 65. The Beer’s List was first developed by a group of doctors in 1991. It has since been updated many times. It contains a list of medications not to use and another list to use with special precautions. There is also a guideline called STOPP that lists medications to avoid in adults over 65. For both guidelines, there are safe options to use in place of the medications on the lists.

If you are 60+, is there a specialist in medication use for people of your age monitoring your medication use? Can you really afford to avoid this review? We have found there is some issue to address 98% of the time we provide an assessment. For your personal assessment, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Medications change as you age. And so do so many other things. Many of these changes are wonderful! You benefit from the many lessons you’ve learned through your life so far. You are able to share those experiences, insights, and lessons with others. You probably sweat the small stuff less. You also tend to enjoy the little things more.

I heard a message today that really captured my attention. A picture was painted about grace and faith and their relationship.

As stated by John Stott, ‘Faith’s exclusive function is humbly to receive what grace offers. Grace gives and faith takes’.

Grace is offered to you on a constant basis. But, it has been my experience, it takes time and lessons learned to really develop faith so that grace can be received. Faith tends to grow with time and experience.

Ephesians 2:8 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God,

Hebrews 11:1 ESV

Now faith is the assurance of things hoped for, the conviction of things not seen.

Romans 10:17 ESV

So faith comes from hearing, and hearing through the word of Christ.

Salvation by grace is a gift. Faith is how you receive that gift.

Ponder this great news this week!

Blessings,

Michelle

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Medications to avoid when over age 65

Posted on by Michelle Fritsch, Pharm.D.

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Since 1991 there has been a group of geriatricians and other physicians identifying medicines that might be inappropriate in people over age 65. Dr. Mark Beers originally led this group, so it is called the ‘Beers Criteria’. This list has been updated every few years. The most recent update was this month.

The medications on this list have SAFER and/or MORE EFFECTIVE options available.

Some of the reasons for medications to make the list include:

  • blood pressure lowering medicines that cause more dizziness and falls than other options
  • medicines with anticholinergic (very drying) effects that can have several negative effects including worsening memory
  • anxiety medicines that cause thinking/memory problems and falls
  • depression medicines that cause several problems
  • allergy medicines that cause drowsiness, driving accidents, and falls
  • medicines that are cleared from the body through the kidneys which slow down with age
  • medicines that are cleared from the body through the liver which can slow down with age
  • medicines that are ok at low doses but dangerous at high doses
  • medicines that can cause delirium
  • medicines that can worsen memory
  • medicines that can cause constipation
  • medicines that can make urination with prostate enlargement even more difficult

This year, for the first time, guidelines for safer options to replace these dangerous medicines were written. This is exciting news!

If you are over 65, please talk with your prescribers about these lists of potentially inappropriate medicines and these lists of safe alternatives.

For a personal evaluation of your medicines, please contact www.medsmash.com.

Biblical Application

In your daily walk with God, what are the most effective steps and activities? What does the Bible say you should do regularly?

And, where are the pitfalls? What should you avoid?

Just as the Beers List guides prescribers to select the most beneficial and safest medicines, the Bible guides our spiritual practices. Your heart, your tongue, your thoughts, your study, your time, and your actions are included in this guidance.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Colossians 3:5-10 ESV

Put to death therefore what is earthly in you: sexual immorality, impurity, passion, evil desire, and covetousness, which is idolatry. On account of these the wrath of God is coming. In these you too once walked, when you were living in them. But now you must put them all away: anger, wrath, malice, slander, and obscene talk from your mouth. Do not lie to one another, seeing that you have put off the old self with its practices and have put on the new self, which is being renewed in knowledge after the image of its creator.

James 1:19-20 ESV

Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God.

Ephesians 4:32 ESV

Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you.

James 1:22-27 ESV

But be doers of the word, and not hearers only, deceiving yourselves. For if anyone is a hearer of the word and not a doer, he is like a man who looks intently at his natural face in a mirror. For he looks at himself and goes away and at once forgets what he was like. But the one who looks into the perfect law, the law of liberty, and perseveres, being no hearer who forgets but a doer who acts, he will be blessed in his doing. If anyone thinks he is religious and does not bridle his tongue but deceives his heart, this person’s religion is worthless. Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world.

There are certainly many more verses that guide our lives. These can be a start in developing a strategy to avoid inappropriate, dangerous behaviors and replace them with life-giving, holy options.

Blessings,

Michelle