How Changing Prescription Habits are Affecting the Elderly

The way doctors prescribe drugs is changing. Seniors who previously have been on prescription drugs for years may find that doctors are suddenly less inclined to prescribe them; meaning they must find a way to stop taking drugs they've relied on.

As long ago as 1990, studies have warned that seniors were becoming overly reliant on benzodiazepines. In 2008, nearly nine percent of seniors aged 65 to 80 were prescribed the drugs. Benzodiazepines (or benzos) are drugs commonly prescribed for anxiety and insomnia. They are the most widely prescribed antidepressant medications in the world. Common benzos include Valium, Lorazepam and Xanax. For some time now, studies have warned that "Despite their wide therapeutic range, elderly patients are particularly prone to adverse reactions to benzodiazepines.” Side effects and adverse reactions to benzos include:

• drowsiness
• light-headedness
• confusion
• unsteadiness
• dizziness
• slurred speech
• muscle weakness
• memory problems
• constipation
• nausea
• dehydration
• blurred vision

The side effects of benzos are known to be more severe in older adults. The way the drugs affect people differs as they get older. As well as being more susceptible, most of the effects of benzos relate to physical problems that seniors are already more likely to have. Unsteadiness may be a relatively minor side effect to a young person, but to a senior who is already at a higher risk of falls, it could cause serious health implications.

Seniors are prescribed more drugs than any other section of the population. They makeup 12 percent of the population and account for 34 percent of all prescription medicine use. Because they take so many prescription drugs, seniors and their caregivers must take even more care that what they are taking doesn’t interact with their other medications. Seniors may have more than one doctor, a primary care physician and a cardiologist for example, and might take five or more medications every day, and drug interactions can cause real problems. At least 15 percent of seniors suffer a medication problem each year. Benzos interact negatively with opioids, which seniors are often prescribed for pain. In 2015, 431 seniors died from taking benzos, two-thirds of which were due to a reaction with opioids.

The seniors who are taking these drugs are likely to be on them for the long term. Thirteen percent of those on benzos take them from one to five years, 19 percent for five to ten years and over 25 percent end up taking them for over a decade. Often with benzodiazepines, the patient starts on a lower dose, but as the body starts getting used to the drug, the symptoms return and the dose is increased. The longer a person is taking the drug, the more likely it is that the dose is the highest permitted dose.

There is a high prevalence of long-term drug use among seniors, of drugs that are more likely to cause adverse side effects. Seniors are also likely to be on other prescription drugs, which can interact with this long-term medication. The issues that this can cause are apparent. Maybe your mom started on a prescription drug in her 40s. At that time, doctors were happy to keep prescribing it, and she stayed on it for a prolonged period. But now she is a senior and is at increased risk of severe side effects. Suddenly, the possible side effects of the drug are too risky, so her doctor, maybe a new one now that her long-time doctor has retired, decides to cut back, but after 20 years on the drug, that’s an enormous request.

As much as 25 percent of those who take benzos may be considered dependent on them. Benzodiazepine withdrawal can cause a withdrawal syndrome that comes with distressing side effects including:

• sleep disturbance
• irritability
• tension
• panic attacks
• tremors
• sweating
• loss of concentration
• nausea
• weight loss
• heart problems including palpitations
• headaches
• muscle pain

Many more severe side effects are possible from withdrawal from high dosage, including seizures and psychotic reactions. Some studies indicate withdrawal can be even worse for seniors, with symptoms including:

• confusion
• disorientation
• hallucinations

Withdrawal can last from a few days to several months, as much as ten percent of people might feel withdrawal symptoms years later.

Finding a Good Solution

Most medical professionals, including those at the Department of Veterans Affairs, believe "tapering" holds the answer to weaning seniors off prescription medications they have been taking for some time. Patients take somewhere between six to 12 months gradually lowering their doses and detoxing until they are eventually free of any dependency.

Withdrawing from a drug that's been legally used for a long time can be a stressful and distressing time for anyone, especially a senior who is already dealing with constant change as care needs evolve. If your loved one must stop taking a prescription drug he or she has been taking for some time, it may be that a professional caregiver can offer support.

While caregivers cannot administer prescription drugs, they can help your loved one by monitoring when to take the medication and reminding the person of the new routine, particularly if your loved one has been entrenched in an old routine for a long time. The caregiver may also be able to help with the symptoms of the withdrawal. For example, if your loved one becomes confused and disorientated, the caregiver can be there to reassure and make sure your loved one is not in any danger of harm. Importantly, when your loved one is with the professional caregiver, you can be free from worry, safe in the knowledge that he or she is in good hands. Without a caregiver or companion, your loved one will be tasked to handle this extremely difficult situation alone.

For more information on how to help your loved one with a prescription drug routine, read this article.