What Not to Prescribe to Older Adults

[FIREd_2015]

Article in Medscape on what not to prescribe to older adults

Aspirin - Since the risk for major bleeding increases with age, for primary prevention of atherosclerotic cardiovascular disease, the harm can be greater than the benefit in older adults...Aspirin remains indicated for secondary prevention in individuals with established cardiovascular disease.
Warfarin - For treatment of atrial fibrillation or venous thromboembolism...Warfarin has a higher risk for major bleeding, particularly intracranial bleeding...
Antipsychotics - These include...aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and others. The guidance says to avoid these agents except for FDA-approved indications such as schizophrenia, bipolar disorder, and adjuvant treatment of depression. Use of these antipsychotics can increase risk for stroke, heart attack, and mortality...
Nonsteroidal anti-inflammatory drugs (NSAIDs) - Used frequently in our practices...in older adults, we often underappreciate the risks...Upper gastrointestinal ulcers with bleeding occur in approximately 1% of patients treated for 3-6 months with an NSAID and in 2%-4% of patients treated for a year. NSAIDs also increase the risk for renal impairment and cardiovascular disease...
Other medications to avoid (if possible)...

https://www.medscape.com/viewarticle/997792?ecd=wnl_infocu10_broad_broad_persoexpansion-algo_20240518_etid6526588&uac=135679MK&impID=6526588

 

[aja8888]

Thanks for the article. Most of us older folks (I'm 80 and in great health) know this already. I take one drug (Flowmax) which many men take as they age.

 

[Koolau]

Yes, risk vs benefit must always be considered and those risks and benefits change over time. It takes a skillful/alert doctor to tailor meds to their patients. My doctors emphasize and tailor everything except costs! They assume (rightly in my case) that cost is less important than efficacy and safety.

 

[pacergal]

Weighing risk/benefit is an important discussion with your Dr anytime a medication is introduced. Your Dr should also know about any OTC meds and herbals you take.
And sometimes the best person to talk to if you have questions is the Pharmacist.

 

[RetMD21]

People like taking a lot of those drugs especially benzos, sleep meds, aspirin, and proton pump inhibitors. Our EMR graded us on prescribing them. It's hard to get people to stop if they have been taking them for a while. The good thing about being a specialist was that I learned to not get involved

 

[badatmath]

There is an actual list called BEERS that addresses this as well. Medications on the Beers Criteria List.

I'm not 65 yet but I will note the kidney doctor I saw for a checkup was very strongly against NSAIDs. I started taking Tylenol for routine pain though I was not found to have any kidney problem.

 

[Trooper]

Thanks for the article. Most of us older folks (I'm 80 and in great health) know this already. I take one drug (Flowmax) which many men take as they age.

Congrats! I'm only on Flomax also, but I've got about a decade and a half to 80.

I wonder if statins should be on the list. There's increasingly more evidence that higher cholesterol, specifically LDL, helps with longevity in seniors. That's if you believe LDL is bad in the first place.

 

[OldShooter]

I have a PCP who worries about this stuff. I do not select my own medications, nor do I do my own appendetomies.

 

[RetMD21]

There is an actual list called BEERS that addresses this as well. Medications on the Beers Criteria List.

I'm not 65 yet but I will note the kidney doctor I saw for a checkup was very strongly against NSAIDs. I started taking Tylenol for routine pain though I was not found to have any kidney problem.

Did you read as far as sentence two of the link? He refers to the ist and provides a ink

 

[RetMD21]

Yes, risk vs benefit must always be considered and those risks and benefits change over time. It takes a skillful/alert doctor to tailor meds to their patients. My doctors emphasize and tailor everything except costs! They assume (rightly in my case) that cost is less important than efficacy and safety.

The tailoring is important. If a patient becomes aware that one of their drugs is on the list it may be worth having a conversation about the actual benefit. Patients have told me that they had been on NSAIDs for arthritis for years and their doctor wants them to continue although it wasn't helping. It wasn't my role to get involved but I am sure the physician wouldn't have confirmed that reasoning.

 

[badatmath]

Retmd, no I didn't read it as I am not over 65 and not really interested. But I can't undo the post to delete it or if I can I don't know it.

Apologies for making people read something already there.

If anyone knows how to remove it or a mod wants to that would be great.