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Multiple medications may lead to increased numbers of falls, dizziness, delirium

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About three out of four older Americans have multiple chronic health conditions, and more than 20 percent of them are being treated with drugs that work at odds with each other – the medication being used for one condition can actually make the other condition worse. Use of multiple medications can also lead to increased numbers of falls and delirium, dizziness, fatigue and anorexia. See, "The public health crisis of adverse drug reactions."

As a result, some older adults walk away from conventional medicine and turn to food and certain adjusted doses of plant extracts as medicine, consulting with physicians trained in integrative, functional, restorative or naturopathic medicine and nutrition. As for conventional medicine, this approach of treating conditions “one at a time” even if the treatments might conflict with one another is common in medicine, experts say, in part because little information exists to guide practitioners in how to consider this problem, weigh alternatives and identify different options.

One of the first studies to examine the prevalence of this issue, however, found that 22.6 percent of study participants received at least one medication that could worsen a coexisting condition. You can check out the abstract of the new study online. The work, "Potential Therapeutic Competition in Community-Living Older Adults in the U.S.: Use of Medications That May Adversely Affect a Coexisting Condition," comes from researchers in Connecticut and Oregon, and is published online since February 25, 2014 in the journal PLOS One.

In cases where this “therapeutic competition” exists, the study found that it changed drug treatments in only 16 percent of the cases. The rest of the time, the competing drugs were still prescribed

“Many physicians are aware of these concerns but there isn’t much information available on what to do about it,” explains David Lee, an assistant professor in the Oregon State University/Oregon Health & Science University College of Pharmacy, according to the March 13, 2014 news release, One in 5 older Americans take medications that work against each other.

“Drugs tend to focus on one disease at a time, and most physicians treat patients the same way,” Lee says in the news release. “As a result, right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse.”

More research in this field and more awareness of the scope of the problem are needed, the scientists observe

It may be possible to make better value judgments about which health issue is of most concern, whether all the conditions should be treated, or whether this 'competition' between drug treatments means one concern should go untreated. It may also be possible in some cases to identify ways to treat both conditions in ways that don’t conflict with one another.

“There are several types of beta blocker that don’t cause this negative interaction, but many of the other types are still prescribed anyway,” Lee says in the news release. “It’s this type of information that would be of value in addressing these issues if it were more widely known and used.”

A common issue, for example, is patients who have both coronary heart disease and chronic obstructive pulmonary disease, or COPD. Beta blockers are often prescribed to treat the heart disease, but those same drugs can cause airway resistance that worsens the COPD

The chronic conditions in which competing therapies come into play include many common health concerns – coronary artery disease, diabetes, COPD, dementia, heart failure, hypertension, high cholesterol, osteoarthritis and others.

This study was done by researchers from OSU and the Yale University School of Medicine, with 5,815 community-living adults between the years 2007-09. The lead author of the study was Dr. Mary E. Tinetti at Yale University, and it was supported by the National Institutes of Health. The analysis included a nationally representative sample of older adults, and both men and women.

Common competing chronic conditions where medications for one illness may exacerbate the other

The research identified some of the most common competing chronic conditions, in which medications for one condition may exacerbate the other. They included hypertension and osteoarthritis; hypertension and diabetes; hypertension and COPD; diabetes and coronary artery disease; and hypertension and depression. These issues affect millions of older Americans.

“More than 9 million older adults in the U.S. are being prescribed medications that may be causing them more harm than benefit,” says Jonathan Lorgunpai, according to the news release. Lorgunpai is a medical student at the Yale School of Medicine and co-author of the study. “Not only is this potentially harmful for individual patients, it is also very wasteful for our health care system.”

Direct competition between medications is just one of the concerns, the report notes

Use of multiple medications can also lead to increased numbers of falls and delirium, dizziness, fatigue and anorexia. The researchers pointed out that the presence of competing conditions does not necessarily contraindicate the use of needed medications, but rather the need for this competition to be more seriously considered in treatment.

So should people consider using changes of food, supplements, or lifestyle as an alternative to adding one drug on top of another to stop the side effects of the first or second drug? Or is it better to get to the root cause of the problem to see whether it's caused by not being able to absorb nutrients properly, toxic heavy metals, air, water, processed foods, or plastics pollution?

Food is a major factor in healing for some people. But a lot of professionals in medicine still don't consider food a major factor in medicine. Now, the question for study may be whether nutrients do a better job than prescription drugs in reversing some of the most common chronic diseases?

Body weight increases from age 40 to 60, mainly due to increased fat, then decreases from age 60 to 70, with even sharper declines from 70 on

Therefore, the amount of a drug per pound of body weight or per pound of body water will often be much higher in an older adult than it would be if the same amount of the drug were given to a younger person. Drugs that concentrate in fat tissue may stay in the body longer. Also, when muscles begin to turn to fat, there's that much more fat in which medicines can accumulate.

There's more fat, less water in an older person's body, even if the person weighs less than when young. Older adults may have a decreased ability in the liver to process medicines.

The liver may not work as well in older adults. As a result, older adults are less able than younger people to process certain drugs so that they can be excreted from the body.

This has important consequences for a large proportion of the drugs used to treat heart conditions and high blood pressure, as well as many other drugs processed by the liver. The ability of the body to rid itself of drugs can be affected by this decrease in liver function. The kidneys also lose their ability to clear drugs out of the body in the same way as they did when the person was younger.

The ability of the kidneys to clear many drugs out of the body decreases steadily from age 35 to 40 on. By age 65, the filtering ability of the kidneys has already decreased by 30%. Other aspects of kidney function also decline progressively as people age. This has an effect on the safety of a large number of drugs. And as people age, they may have an increased sensitivity to numerous prescription and over-the-counter drugs as well as some supplements or foods. What adverse reactions have you developed as an older adult to foods you could eat when younger that agreed with you?

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