These days, I am all about decluttering. The extraneous weight of all my belongings sometimes makes me feel insane! I go through waves of cleaning out closets and cabinets in a frenzy while my family often stands by watching me in shocked wonder and resignation. “There goes Mom–she’s at it AGAIN!” I feel the same way about my patients’ medication lists–however that decluttering event is a much more controlled and thoughtful process (in geriatrics, we have this mantra–“Start low and go slow).
I always approach medication lists in a systematic way, considering truly necessary quality of life sustaining medications vs medications that played a role at some point and now remain on there due to “clinical inertia” (lack of movement off the med list–trust me, it’s a thing). As we gracefully age, some of the medications we relied on to improve quality and quantity of life can actually begin to cause adverse effects, which is why the Beers Criteria/List was created. Not all medications are created equal, especially for our esteemed elders. The Beers Criteria is a list that raises a cautious eyebrow at certain medications, suggesting that seniors might want to reconsider their use due to their potential to cause disorientation, falls, strokes, cardiac events or other not so pleasant complications that may arise. Here’s a closer look at 10 medication classes on the Beers List and why elders should consider discontinuing their use.
Now obviously, as you read this, remember that nothing replaces a conversation with your trusted primary care provider who delivers you more personalized care than this blog ever could. These are merely points to consider as you reevaluate your health or that of your loved one. And keep in mind that this particular list does not cover all the medication classes on the Beers List–this is merely a sampling. Phew. Now with that out of the way, on to the list……..everyone loves a good list!
1. Benzodiazepines:
These tranquilizers may calm the nerves, but they can also bring a host of side effects, including drowsiness, dizziness, and an increased risk of falls. Seniors, known for their wisdom, might want to explore alternative methods for managing anxiety or insomnia. This drug class includes some well known members such as: Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam). These drugs can create a dangerous physical dependency as well, so if you have been on one of these drugs for many years and wish to stop taking it, consult your health care provider—this is a must as these drugs must be tapered appropriately to avoid life threatening complications with discontinued use.
2. Anticholinergic Medications:
These medications can cause dry mouth, blurred vision, and constipation—hardly the recipe for a comfortable golden age. They’re linked to an increased risk of cognitive decline, making them less than ideal for seniors who cherish their mental acuity. Popular drugs with anticholinergic effect include: Benadryl (yup, you got it, your friendly sleep aid and itch buster!), vistaril, oxybutynin and tolterodine (for overactive bladders–Ditropan and Detrol LA)
3. Proton Pump Inhibitors (PPIs):
While PPIs are fantastic for managing acid reflux and helping to heal stomach ulcers, their long-term use can lead to an increased risk of fractures and infections. Seniors may want to explore lifestyle changes and dietary adjustments before committing to a prolonged relationship with PPIs. This is the drug class that suffers from the most “clinical inertia.” Patients are put on these drugs for dyspepsia (stomach upset, acid reflux, ulcers, etc) and then they are NEVER TAKEN OFF. It’s almost as if we, as providers, forget about them–it’s wild. The problem with these drugs is that they alter the pH of the gut and significantly disrupt absorption rates of various key nutrients like B12, calcium, magnesium and iron. They also, over time, can lead to osteoporosis (likely due to the aforementioned calcium depletion) and increase one’s risk for fractures. Common drugs in this class: Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole). A word of advice to those of you planning to stop these medications–talk to your primary care provider about a gentle and prolonged taper (if appropriate) to avoid a pretty significant rebound acid reflux!
4. Tricyclic Antidepressants:
The side effects of tricyclic antidepressants, including blurred vision and constipation, may outweigh their benefits for seniors. Considering the array of newer and often more tolerable antidepressant options available, it might be time for a medication makeover. One commonly used medication in this class is Remeron (mirtazapine).
5. NSAIDs:
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be harsh on the stomach and may contribute to gastrointestinal bleeding. With alternative pain management strategies and safer pain relievers available, seniors may want to bid farewell to the NSAID era. This is not by any means discounting their usefulness for minor acute aches and pains. This is merely suggesting that you reconsider chronic long term use of this class of medication. Commonly used drugs in this class are found over the counter (ibuprofen, naproxen) and by prescription (meloxicam, diclofenac).
6. Skeletal Muscle Relaxants:
While these medications may ease muscle spasms, they also have a sedative effect, increasing the risk of falls and fractures. Seniors who cherish their independence might want to explore other avenues for muscle relaxation, such as physical therapy or gentle exercises. Common medications in this class include tinazidine, Robaxin (methocarbamol), flexeril (cyclobenzaprine).
7. Antipsychotics:
Ooohhhh antipsychotics…so useful and yet potentially so dangerous. Antipsychotics are truly a double-edged sword, possibly increasing the risk of stroke and mortality in seniors with dementia while at the same time preventing dangerous behaviors that would otherwise remain uncontrolled despite other less invasive interventions. If possible, exploring non-pharmacological interventions for behavioral issues might be a safer route for those navigating their golden years. Medications in this class include: Seroquel (quetiapine), Risperdal (risperidone), zyprexa (olanzapine), Haldol (haloperidol), Abilify (aripiprazole)
8. Oral Hypoglycemic Agents:
For seniors with diabetes, certain oral hypoglycemic agents can lead to low blood sugars and an increased risk of falls. Adjusting lifestyle factors, monitoring blood sugar closely, and exploring alternative medications might offer a safer path to diabetes management. Common drugs in this class include glipizide and glyburide.
9. Antibiotics:
Long-term use of certain antibiotics can lead to an increased risk of infection and resistance. Seniors and their healthcare providers should engage in thoughtful conversations about the necessity and duration of antibiotic therapy. Antibiotics are NOT a “cure-all” and prolonged use of certain antibiotic classes can lead to clostridium difficile (known as C.Diff) infection which is a devastating opportunistic infection resulting from the depletion of the beneficial microflora in the gut. It causes a profound diarrhea that can lead to dehydration, increased hospitalization rates and significant morbidity and mortality. So when your primary provider says no to an antibiotic–there is, more often than not, very good reason for that response!
10. Estrogen Therapy:
Estrogen therapy, though once hailed as a beneficial treatment for various conditions, including menopausal symptoms and osteoporosis, is now on the Beers List. Estrogen therapy involves the use of estrogen hormones, which are typically administered to address symptoms related to menopause, such as hot flashes, vaginal dryness, and mood swings. Additionally, estrogen has been prescribed to help prevent osteoporosis, maintain bone density, and reduce the risk of fractures in postmenopausal women. However, the Beers List points out that the use of estrogen therapy in older adults may come with increased risks, including an elevated likelihood of stroke and venous thromboembolism (blood clots). These risks are significant considerations, especially when assessing the overall health and well-being of elderly individuals.
Conclusion:
The Beers List serves as a gentle reminder that as we age, our medication needs may evolve. Seniors are encouraged to have open and honest discussions with their healthcare providers about the potential risks and benefits of medications, exploring alternatives and discontinuation plans when appropriate. Aging gracefully doesn’t just mean accepting the passage of time—it’s about making informed choices that enhance the quality of life in our golden years. Just because someone has been on a medicine for 20+ years, does not mean that it is still the best option for optimizing their health. So, seniors, consider this your invitation to have a prescription spring cleaning and embark on a journey toward healthier and more vibrant aging. Now go forth and DECLUTTER!
