Estrogen in older women and the popular over-the-counter antihistamine, Benadryl, were among those on the list to avoid in the update of the 1997 Beers Criteria, published in the Dec. 8 issue of the Archives of Internal Medicine.
Nonsteroidal anti-inflammatory agents such as Motrin and Advil, or ibuprofen, made a second list of medications to avoid in older adults with certain medical conditions; nonsteroidals and aspirin, known to increase the risk of bleeding, were listed as potentially inappropriate for people with gastric or duodenal ulcers. Researchers also added to this list of conditions that increase patients' risk for adverse drug events; additions included cognitive impairment, depression, Parkinson's disease, anorexia, malnutrition and obesity.
"We realize that aging is an individualized process and there are some 65-year-olds who are healthy and do fine on these medications," said Dr. Donna M. Fick, a geriatric clinical nurse specialist and associate professor of medicine at the Medical College of Georgia in Augusta and principal author on the paper.
She and other geriatric practitioners also know that older people are at increased risk for medication-related problems, called adverse drug events, such as depression, confusion, falls and even death.
"I don't know that there is enough evidence to tell us exactly what the reasons are, but my theory would be because generally older people are on more medicines, because they have more chronic diseases, so it's an interaction of multiple diseases plus aging changes plus the drugs they take for those diseases," said Dr. Fick, who also directs MCG's Center for Health Care Improvement.