PUBLISHED: May 26, 2017 at 9:00 am
Photo by Photograph by George Sakkestad
Dr. Elizabeth Landsverk, a geriatrician speaks about how different medications can affect elders as they age. The Tuesday event at Alameda Family Funerals and Cremations, called “Medications and Elders: the Good, the Bad and the Ugly,” was sponsored by the Saratoga Chamber of Commerce.
Geriatrician Dr. Elizabeth Landsverk addressed elder medication during a presentation in Saratoga on Tuesday. Her talk, “Medications and Elders: The Good, the Bad and the Ugly,” addressed the common medications prescribed for elders, their effectiveness, dangers and how they work differently in bodies and brains as humans age.
“It’s interesting; I’m contrary to what’s often done out in the community for behavioral issues in elders,” Landsverk said. “I follow the academic geriatric principal and the Beers Criteria List, which list meds that probably shouldn’t be given to elders as they have worse side effects than they do in younger adults.”
Landsverk founded ElderConsult, a geriatric medicine practice that provides house calls throughout the Bay Area. House calls are when a doctor or nurse-practitioner, sometimes bringing along a social worker, makes regular visits to frail or home-bound patients with complex needs. Landsverk looks at her patients’ medication lists and decides what can be safely removed.
“We physicians are really good about adding medications, not as good about taking medications away,” Landsverk said. “So what I spend time doing is looking at a med list and figuring out what meds some elders shouldn’t have anymore, such as if someone has bad heartburn to the point where they’re not eating or swallowing, and they’re on a diuretic, aspirin, or maybe iron or Prednisone, those can be irritating to the stomach, so it’s important to be careful with medications that have effects on different parts of the body.”
Landsverk mainly treats patients with dementia or agitation. Most drugs specifically developed to improve dementia seek to increase the levels of choline, a chemical that brain cells need to communicate with each other. Yet several common medicines are anticholinergic, meaning they decrease levels of choline. These drugs can make dementia worse, resulting in more confusion, memory loss and agitation. They can also cause blurred vision, constipation, dry mouth, lightheadedness, difficulty starting and continuing to urinate and loss of bladder control.
Antihistamines like Benadryl, anti-anxiety medications like Ativan and Xanax, and antidepressants such as Prozac and Cymbalta are all anticholinergic. A more complete list of anticholinergic medications can be found at elderconsult.com/anticholinergicmeds/.
She also talked about common challenges with treating the elderly, including having too many doctors, overmedicating, and how over-the-counter medications can sometimes cause more harm than good.
Medications work differently in elder brains than younger brains. Some medications can often have stronger effects, and some drugs affecting the brain can lessen mental abilities in older adults. These issues, especially when coupled with dementia, are a recipe for reduced brain function and agitation, according to Landsverk.
“I use no sleeping pills, no Ambien and no benzodiazepines like Ativan and Xanax,” Landsverk said. “Xanax is short-acting and even if taken as directed could make you more anxious in between doses; it’s the ‘crack of benzos.’ Xanax in elders with dementia could cause irritation and agitation, and stopping the prescription can put some into withdrawal. In elders with dementia, these medications shouldn’t be started unless they only need it for a couple of days.”
Landsverk said that one common error that physicians often make is treating blood pressure too low in elders.
“Younger adults should have 130 over 80. As folks get older, it should be treated less aggressively. If you’re treating their blood pressure down to 120 when they’re sitting, there’s a good chance that when they stand up, it would drop below 100; it could make them dizzy and increase risk for falls. Newer guidelines say not to treat hypertension until its 150 over 90 standing.”
Another error Landsverk identified that physicians often make is in treating diabetes. In younger adults, physicians will often use sliding scale insulin to treat blood sugar to what would be considered a “normal” blood sugar level of 70 mg to 140 mg, as higher blood sugar can create complications in the long term. For the elderly, blood sugar is best at 100 mg to 200 mg, as long-term complications are much less of an issue.
Landsverk also noted that physicians are treating pain for elders as if the patient was a younger adult who may abuse the pain medication.
“Elders that have fractures are sent home from the emergency room with as-needed Tylenol when they have serious pain, such as a fracture or bone-on-bone arthritis,” Landsverk said. “They’re not getting Norcos or opiates. Young people are overdosing from narcotics, whereas most old people will take half a tablet twice a day or so for serious pain, and don’t overdose and don’t escalate doses.”
Some medications are good for elders, such as low-dose aspirin, vitamin B12, vitamin D, calcium and Tylenol to control pain. Some types of antidepressants can work well for elders. With ElderConsult, Landsverk takes a holistic view of the patient’s issues and the side effects of the medications they are on, then decides which medications are best for the patient’s overall well-being.
Landsverk, an adjunct professor of medicine at Stanford University, is triple board certified in geriatrics, internal and palliative medicines. She was a medical director for Kensington Place Redwood City Memory Care Community and Silverado Belmont Hills Memory Care Community, and has been a hospice director for Vitas Hospice of Marin and Sonoma. She also consulted for the San Francisco Elder Abuse Forensics Center.
The event was hosted by Social Lights 4 Change and held at the Alameda Family Funeral and Cremation on Saratoga-Sunnyvale Road. For more information, go to sociallights4change.com.