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Half of all adverse drug reactions within the US occur among older adults. 28% of all hospitalizations for older adults is because of problems with medicines. Adverse drug reaction is caused by the interaction of drugs with other drugs, alcohol, or even some foods such as grapefruit, and it seems that older adults are at special risk. What is the reason for this greater vulnerability? 

As we age, our metabolism changes. This can have a huge impact on the way in which our body processes drugs. A drug that you tolerated when you were younger may be much less tolerable in your middle or older years. And it’s not just about our metabolism. Many problems older adults have with drugs are related to overuse, underuse, or not following the guidelines that are related to the drug, i.e. storing the medicine out in the open when it should be kept in a cool, dry place, taking it on an empty stomach when it should be taken with food, taking it at the wrong time of day. The list goes on and on.

Underuse occurs when individuals split pills in half or in quarters, or skip doses because of the expense of the drugs. And it may not be just because of expense. I have an older sister who as a matter of course always took half of her prescribed dose of blood pressure medication. She also liked to mix up the blood pressure medicine with herbal remedies (God knows what the effect was on her body). Eventually she went off the prescription medicine in favor of her remedies. A year ago, she had a stroke and is still recovering from it. 

To guard against drug related problems, it is a good idea to learn all you can about any medicine you are required to take. Talk to your doctor and your pharmacist about any medicines that have been prescribed for you. It is also a good idea to fill all of your drugs at the same pharmacy, that way if there is a conflict between medicines, your pharmacist can alert you.                       

A new study shows that caregivers have a hard time falling asleep at night. It is believed this is because of the depression that most caregivers suffer from. 

As a caregiver for my mother during the several years she suffered from Alzheimer’s before ultimately succumbing to it, I can attest to the tremendous toll caring for a dementia patient takes. Although I wouldn’t have not been there for my mother, her illness sapped everything from me until in the end the only life that mattered was her life. My life became a shell, its only purpose to care for her. The unfortunate thing about this is that it left me with no inner resources. No wonder I became so overwhelmed by depression that sleep eluded me.   

Methadone, a drug that was once associated with heroin addicts is now widely prescribed by doctors and nurse practitioners to treat assorted pain complaints, and the group most likely to die from methadone use is the middle aged. This may be because the middle aged body has had time to accumulate assorted traumas that may be resistant to traditional pain relievers. It may be also that the middle-aged are less tolerant of pain.

Methadone is a synthetic form of opium. According to an article in the New York Times

It is cheap and long lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill seekers and badly prescribed by doctors unfamiliar with its risks, methadone is now the fastest growing cause of narcotic deaths. It is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.

Although misuse of methadone is one problem, a major problem is that many doctors are unaware of the risks associated with using this drug so overprescribe it, prescribe unsafe doses, or fail to properly monitor patients who are on the drug. Methadone use in conjunction with alcohol or sedatives may have a depressive effect on the central nervous system – the brain may forget to tell the heart to beat and the lungs to pump – therefore causing death.

Critics blame the insurance companies whose main concern is monetary cost for the increased use of methadone. For example, a one month supply of OxyContin may cost $500 compared to $35 for an equivalent supply of methadone. In these tough economic times that difference may push pain sufferers to use it over safer but more expensive drugs. Critics also blame the government for failing to recognize and confront the ignorance of physicians prescribing the drug.

Of course those most vested in current practices are the ones that are pushing back against any changes.

Reuters reports that people age 45-54 are more likely to die from prescription drug overdose than from motor vehicle accidents. Motor vehicle deaths were the No. 1 cause of accidental death, but now, according to the federal government, in 2007 nearly 7 million Americans abused prescription drugs. That’s more than cocaine, heroin, hallucinogens, Ecstasy and inhalants such as marijuana combined. This represents an 80 percent increase since 2000. 

One of the reasons ordinary Americans turn to prescription drugs is low social disapproval associated with its use, as well as the low risk of getting caught.     

Despite expectations that this would be the year in which the first disease modifying drug to treat Alzheimer’s would reach the market, that has not been the case. Just recently two widely anticipated drugs to treat Alzheimer’s failed clinical trials. That is according to the L.A. Times. 

The leading theory on Alzheimer’s is that it is caused by the sticky protein, amyloid beta. This protein clumps together in the brain and form plaque that kills brain cells.  With the failure of the latest drugs, it will be interesting to see if this theory continues to dominate research efforts.

At the same that efforts to find a cure are taking a setback, technology to detect Alzheimer’s is advancing rapidly. But there is no way to halt or reverse the disease. The five medicines currently available treat symptoms disease such as confusion and memory problems and not the disease. And their effect on the lives of Alzheimer’s victims is so minor that many find that the drugs are not worth the cost and side effects. 

Despite these setbacks, some researchers remain hopeful that a cure will be found. 

A new report by the US EPA shows that the poor, the elderly and children will suffer the most from global warming. The cause of global warming is the release of greenhouse gases in to the atmosphere from fossil fuel burning. Experts predict that by the year 2050 global temperatures will rise by about 2 degrees and by the end of the century temperatures will rise by about 7.5 degrees.

Global warming is expected to bring about worse heat waves, drought, worsening air quality and flooding. Accompanying these changes will be increases in the number of diseases spread by tainted food, bad water and bugs.  The elderly are considered to be at increased risk because of their already frail health and limited mobility.  

The L.A. Times reorted that 1002 preventable incidents happened in California between July 2007 and May of this year. Results are from a new California state law that makes it mandatory to report preventable incidents. The California legislation was passed in 2006.

These incidents are also known as “never events” because they never should happen.  They include bedsores, leaving objects in after operations, operating on the wrong patient, operating on the wrong body part, improperly connecting equipment, prescribing the wrong drugs, etc. They result in serious injury and death.

Preventable incidents, called adverse events, harm hundreds of patients in California hospitals each year. Unlike California, most states do not require them to be reported. Other states that require reporting are Maine, Massuchsetts, Pennyslvania, New York, Minnesota, Washington, Vermont.

The legislation requires California hospitals to inform state regulators of occurences of 28 types of dangerous mistakes. By 2015 the public health department is supposed to post the information on the internet, although officials hope to start publishing it sooner.

Some suspect the 1002 number may be low since hospitals typically underreport. becausethis number may be larger than the  reported by California. Dr. Donald Berwick, the president of the Institute for Healthcare Improvement, a Massachusetts nonprofit, said that “as many as 15 million patients each year are harmed in hospitals.”

Beginning in October of this year, Centers for Medicaid and Medicare has said they will stop reimbursing hospitals for eight kinds of mistakes. These include bedsores, objects left in patients, and infections acquired from surgery and from catheters.

Info from L.A.Times Hospital mistakes go public. 6/30/08

Obesity increases your risk of coming down with any form of dementia by 40%, according to one report. It increases your risk of coming down with Alzheimer’s by 80%. There is also a risk with being underweight since being underweight increases your risk by 40% of coming down with any type of dementia.

Another report claims that obesity is not related to cognitive decline. This report claims that “lifestyle guidelines such as increasing cognitive activity, cardiorespiratory fitness, and dietary recommendations are more important than those that focus on weight loss alone.”

Obesity is defined as having a body mass index (BMI) of 30 or more. Being underweight is considered having a BMI of less than 18.5.

As with any research information, the results in these studies deal with percentages. For example, the data in one report shows that there is an overwhelming risk of coming down with Alzheimer’s if you are overweight. My mother, who was neither overweight, nor underweight, nevertheless came down with Alzheimer’s in her late 60s. The other report claims that keeping mentally active may delay mental decline. My mother was obsessed with crossword puzzles until Alzheimer’s made it impossible.

I obtained the info claiming there is a relationship between obesity and dementia from the June 9, 2008 Los Angeles Times Health section. That edition was devoted to weight loss and problems related to losing weight. That were other worthwhile articles in that edition including report on the status of research to develop a weight loss pill, new type of weight loss surgery, and several weight loss stories.

Update. Dara Torres, 41 year-old female swimmer won first place in the 100 meter freestyle, winning a place on the US Olympics team. She beat out the younger and favored swimmers Natalie Coughlin and Lacey Nymeyeruntil.

Torres accomplishment gives hope to all of us middle-aged couch potatoes.

The New York Times recently reported that at age 41 Dara Torres, swimmer is expected to qualify at the Olympic trials next week. It will be her fifth time competing on an Olympic team. She’ll be the oldest female swimmer in the history of the Olympic Games. 
Dara Torres is doing something that most people think is impossible. But according to experts, although her achievements are unusual, they are not as unique as people think.

We assume middle-aged athletes cannot compete at a high level, but that may not be the case. In the Times was a quote from Michael Joyner, a competitive athlete and anesthesiologist at the Mayo Clinic who writes scholarly papers about aging and sports. Joyner said

 “Ted Williams hit .388 when he was 39. Jack Foster did very well in the Olympic marathon when he was 40. Karl Malone earned a triple-double in an N.B.A. game at 40. Jeannie Longo won a French time-trial championship in cycling at age 47.”

Our expectations about what middle aged athletes can and cannot do has to do with our own experiences as nonelite athletes. We notice that as we age our own sporting achievements fall sharply as do those of the people we know. This decline has to do with the fact that our bodies change as we age. Our body composition becomes more fat than muscle mass. Our aerobic capacity and strength also decreases. But the main reason according to experts has to do with a shift in our priorities. As a young high school or college athlete there is not the distraction of jobs or families. But as we grow older our priorities change so that it is on work and family.  Even elite athletes’ priority may shift from wanting to compete at a high level to simply wanting to stay in shape. Experts call this process “hypokinesis.” According to Joel Stager, professor of kinesiology at Indiana University, “A lot of what we assume is aging is just progressive hypokinesis.” Although there is some drop off in ability, its not as great as you might think. Athletes like Dara counter that decline by continuing to train at a high level.