When a dear older friend was being discharged from the hospital after brain surgery, I sat with her as doctors gave her multiple prescriptions and instructions. Before the surgery, my friend was on only two drugs, but the strong steroids that she now needed to take to keep her brain from swelling also increased her blood pressure, made her blood sugar rise and bothered her stomach. So doctors added blood pressure drugs, insulin and antacids to her list—all in addition to the steroids, plus antibiotics and her normal meds. My poor friend looked perplexed, and I didn’t blame her.

This type of scenario isn’t just confusing—it’s dangerous. With so many drugs, the risk for side effects goes up, as does the chance of having an adverse drug interaction…taking the wrong drug…or taking an incorrect dose.

To help make this sort of situation safer and less overwhelming for older adults, this past February an expert panel sponsored by The American Geriatrics Society updated the Beers Criteria, which lists drugs that should be avoided by older adults—they’re called Potentially Inappropriate Medications (PIMs). After reviewing thousands of studies, the panel listed 53 drugs and drug categories that either should be avoided entirely or used only with lots of caution by older people. For an abridged but reader-friendly list, click here.

PAY ATTENTION TO THE PIMS

So why are certain drugs considered PIMs while others aren’t? Here are some of the reasons that the report cites…

  • Some drugs are not as effective in older people as they are in younger people.
  • Some are more greatly associated with serious side effects (such as delirium, gastrointestinal bleeding, falls and fracture) among seniors than they are among younger age groups.
  • Some PIMs are on the list because they provide the same benefit as other drugs that many elderly people already are on…or because they may interact with other drugs that elderly people commonly take.

It’s not just prescription drugs that are considered PIMs. Even over-the-counter (OTC) drugs are on the list. For example, diphenhydramine, the active ingredient in Benadryl, Tylenol PM and other OTC sleep aids, can cause blurred vision, dry mouth and confusion, especially among the elderly. So taking Benadryl to treat an acute allergic reaction may be appropriate, the report states, but for help falling asleep, there are safer drugs to take. Some other very popular drugs that you might be surprised to see listed are prescription benzodiazepines (sold as Valium and Xanax) that are used as sedatives or muscle relaxants…certain OTC nonsteroidal anti-inflammatory drugs, such as ibuprofen (sold as Advil) and naproxen (sold as Aleve)…and prescription Reglan (metoclopamide), used to treat heartburn.

NO MORE MEDICATION MISTAKES

For tips on how to use the PIMs list, I called Rosanne Leipzig, MD, a professor of geriatrics and palliative medicine at New York City’s Mount Sinai School of Medicine.

The most important piece of advice from Dr. Leipzig—for all patients, but especially seniors—is to bring a list of all medications, including vitamins, supplements, herbals and even medicated lotions with you every time you go to any of your doctors. Make sure that the list includes what the medicine is, how often you take or use it, who prescribed it and why you take it. Ask your doctors if they know about the PIMs list, and if they don’t, e-mail them the link (listed earlier) or print out the two-page document, so your doctors can evaluate whether any of your current drugs are PIMS. A drug manufacturer is unlikely to state whether the drug is a PIM on the packaging. Since there’s nothing to look out for, that makes it extra important to discuss this topic with your doctor.

Other suggestions from Dr. Leipzig that’ll help you avoid medication errors include…

  • Have a primary care doctor. Even if you go to specialists, you still need a “captain” to oversee everything. If your primary care doctor doesn’t seem interested in staying “plugged in” to what your other doctors are doing, then find a new primary care doctor.
  • Use a multicompartment, labeled pillbox. This will help you to avoid taking the wrong drug or the wrong dose (or skipping doses).
  • Buy all your medications from the same pharmacy. The pharmacist may alert you to drug interactions that aren’t picked up by your doctor.
  • Bring a friend or family member with you to the doctor. This person can help you ask questions and interpret instructions.
  • Speak up at your annual wellness exam. If you have Medicare, you are entitled to an annual visit. This free benefit includes a review of your medications. Ask whether you still need to be on every drug on your medication list.
  • Monitor yourself. If you notice any side effects after you start taking a new medication, don’t just chalk it up as a necessary annoyance—let your doctor know about it. It could be a sign of something serious.