How we take medications, how much, and how often, changes as we age. Learn what you should consider asking your doctor and what symptoms to look out for that may give you clues that they are now doing more harm than good.
As we age our metabolism changes. It slows, and our digestive tract absorbs nutrients differently.
Our hydration and water needs change, and we can easily become dehydrated. In addition, our livers don't function as well, our kidneys don't work as efficiently, and our hormone levels change, reduce, or increase and things just don't work the same. Our bodies are slowing down.
All these changes mean our bodies absorb and utilize the medications we have been taking for years, differently. And that's when good medications turn bad.
What should we do?
It may be time to adjust the dosing or even the type of medication to be at the best therapeutic levels for our changing bodies. Too much can become toxic to your body and can start doing the opposite of what it's supposed to do. For example, the blood pressure pill you've taken for years may not be working as well, and your blood pressure is creeping back up. You may need to increase the dose or add other types of anti-hypertensive drugs to the mix.
Another factor is how the effectiveness of your medications may change and interact with other medications, supplements, and even the things you eat. Three medication group types that require reviewing regularly are anti-anxiety, anti-depressant, and antipsychotic. Let's talk about that now and review an example.
Steve has bipolar disorder and just turned 70 years old. He's been on lithium for 15+ years and his lithium blood levels have constantly been in the perfect range. His symptoms have been very well controlled. Over the past year he very slowly and gradually started to struggle with more depressive episodes, his concentration started declining, he was constantly sleepy, his mental acuity was diminishing, and he eventually started having trouble finding words. On the surface, this could easily be ignored as just getting older or maybe even thinking it's the start of dementia. His slight hand/finger tremor (a side effect of lithium) had turned into a heavy tremor. His wife Jane, a nurse, was concerned. The increased tremors are signs of potentially serious lithium toxicity.
Steve hadn't had his blood lithium levels monitored or assessed by his provider for several years because they had been so consistent in the past. He assumed everything stayed the same.
On his RN-wife's insistence, Steve visited his doctor where he was able to report his symptoms. and Jane reported the pertinent symptoms she had observed, objectively. His doctor duly ordered a blood test to check his lithium levels and other tests to check for any other potential changes to kidney, liver, and systemic changes that might indicate anything else or be adding to the problem.
The tests showed his lithium levels were very high, getting to dangerous, toxic levels. As a result, his doctor put him on a gradual and controlled, lithium dose reduction, while Jane monitored for any adverse behavioral changes. His PCP referred him back to a psychiatrist to continue the careful dose reduction and review his mental health needs.
After about 6 months of gradual and controlled reduction, the "old Steve" returned. His tremor dissipated, and his concentration, memory, and mental clarity all returned. His depression receded and his mental fog lifted. Both his physical and mental energy improved dramatically.
Important: Do not ever do a sudden reduction or stop any medication without consulting a doctor first! It is highly dangerous to self-diagnose, treat or suddenly stop a medication.
Steve is a great example of how medication needs can change as we age. In my experience as a nurse working with seniors over the years, I have seen this true example play out time and time again. As nurses and doctors specializing in gerontology, we know to monitor for behavior or physical changes as part of a senior's aging wellness and chronic disease management care plan.
These signs and changes can be so subtle, happening so gradually over time that we miss seeing them; we accept them as a part of aging, and even maybe early signs of dementia. Even though Steve's wife is a nurse, she didn't immediately recognize what was happening until she stood back, put her impartial objective thinking nursing hat on, and realized how much he had changed.
This is a typical example of why regular medication reviews are so important, yet are often overlooked.
But of course, not everyone has a nurse specializing in senior care as their spouse. So what can you do?
Medication review
If you are caring for a loved one, or have seen changes that make you concerned that something isn't right or are wondering if it's early dementia - encourage them to make an appointment with their primary care provider to review their symptoms and medication. Accompany them if you can. Write a list of symptoms or changes you've observed and talk about them or ask if these mental changes could be due to medications. Always ask!
What to expect at your doctor's appointment
Your doctor will review your chart, medical history, and current medications and ask you about what symptoms you are experiencing. Be honest and as detailed as possible. Try to be objective rather than subjective.
Your doctor will order blood tests, a panel of tests that will give them a body systems overview.
They will do a quick, simple mental health assessment and evaluation right there and order blood screening tests like they did with Steve. If you are on any antipsychotic, or antidepressant medications, they will review those and order levels to be tested if appropriate. Your doctor will be screening for toxicity caused by the medication.
What to tell the doctor
Take a list of questions you want to ask with you.
Be honest about your concerns.
Be very detailed about the signs you are seeing.
Bring medications with you, and tell them what you are taking, how much, and how often.
Whether you take them before, after, or with food.
Be objective in your descriptions of symptoms where possible providing measurable facts, - i.e., "instead of sleeping 7-8 hours a day with no mid-day naps, I'm now feeling more fatigued and sleepy despite sleeping 10-11 hours a night, and needing a 1-2 hour mid-day nap."
How can Karen help?
Steve is fortunate. He has his own, personal nurse advisor and coach - which happens to be me (I'm his wife!)
I will always tell you to make an appointment with your primary health provider to discuss your concerns.
As your private, nurse advisor, advocate, and coach I help you prepare for your doctor's appointment. I provide background education and information and co-create your list of symptoms and questions so your 20-minute appointment with your doctor is productive. I can also accompany you if you wish, in person or virtually.
To book a 30-minute free discovery call to learn how I can help you with your senior healthcare needs and questions, Schedule below.
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