Rattling with pills as you grow older

As you peer into your medical future among the nasties lurking for you will be lots of pills. Fifty percent of people over 65 are on five or more drugs – the medical version of five-a-day – unless of course you have read ‘The 10 Secrets of Healthy Ageing’, my new book written with Patrick Holford which has lots of ways to avoid the polypharmacy that is otherwise a likely fate.

Just what is involved was highlighted in the New York Times health blog yesterday which detailed the daily pill consumption of the writer’s 92-year-old aunt. There were twelve in all. One one for low thyroid, two for high blood pressure, an anti-depressant for depression, one for possible Alzheimer’s, another anti-depressant for night time anxiety attacks, one for an eye condition called macular degeneration, a multivitamin, Vitamin C, calcium with vitamin D, low dose aspirin, a lutein supplement (an antixoidant linked with eye health), and a “stool softener” – constipation is common problem.

Not surprisingly there were problems with this massive intake. She had to be taken off one  antidepressants because it lowered her sodium levels, she got an extra blood pressure drug which left her totally disorintated and unable to stand up.She was admitted to hospital, collapsed had seizures, was given more drugs. About a third of elderly Americans on drugs suffer adverse side effects every year.

An expert on drug side-effects  in the elderly – Dr Dee Mangin, Director of Primary Care Research at Christchurch School of Medicine in New Zealand., has found that reducing drug intake can often result in a dramatic improvement  – there are more details in the book. She has found and that patients are, understandably, much more concerned about side-effects than doctors.

Older perople get more drugs becasue they are more likely to get sick – that’s obvious. But as experts in geriatric medicine accept this is an area where good evidecne can be thin to non-esxistatnt. Thre are two reasons for this:

Firstly because drug trials are usually done on younger and healthier patients so you can’t be sure they will work on older frailer ones whose systems are running down. Secondly subjects  in the trials nearly always get just one drug at a time, so again you don’t know it will have the same effect in an elderly patient already on ten other drugs..

A more fundamental problem is that drug prescribing has to follow the guidelines for each condition. So if you have a heart condition you get these drugs, arthritis these ones, sleeping problems these ones and so on. It’s a system that begins to breakdown in the elderly because it produces this multiple drugging or polypharmacy.

‘Following official guidelines which results in multiple drug taking,’ writes Dr Mangin, ‘is probably one of the greatest but most invisible threats to health in the ageing population.’

And there is yet another issue here. Doctors frequently warn about taking supplements or even over-the-counter medications because they could interfere with the action of prescribed drugs. They very rarely discuss or warn about the possibility that drugs can affect the availability of vitamins and minerals.(More in the book)

The one interaction that is relatively well known is that statins reduce the availability of an antioxidant and enzyme called Co-enzyme Q10 that is vital for energy production and the proper functioning of muscles.   But there are plenty of other ones that could have been affecting the 92 year old aunt.

The beta blocker she was taking for blood pressure could also reduce availability of CoQ10, as do antidepressants while the anti-anxiety drugs makes less melatonin available. Two of the effects of lowering both Coq10 and melatonin are increases risk of memory loss and disrupted sleep – both problems the aunt was taking drugs for.

The best way of avoiding polypharmacy is to reduce your chances of developing the big chronic killers that have so many drugs lined up to treat them, as the book explains. It also provides a guide to the drugs to avoid and the minerals and vitamins you need to make sure you are getting enough of.