Don't make this mistake
It was the middle of the night and Judy Graham, a 67-year-old grandmother from Sydney, got out of bed to go to the bathroom.
All of a sudden, the dark room swirled around her. She crashed to the floor, smashing her jaw into the bedside table.
Waking up in a pool of blood as her worried husband, Roy, called an ambulance, Judy had no idea why she’d fainted.
She was healthy and active, though she’d recently seen her doctor for a new script for amlodipine to try to bring down her bothersome high blood pressure.
In the emergency department, the doctors were concerned that her blood pressure was abnormally low – just 105 over 68 (the Australian Heart Foundation recommends the top number, the systolic blood pressure, should be 120 for people of Judy’s age).
It was the low blood pressure that had caused her to pass out as she stood up.
Judy Graham had joined a very large group of older people whose medicines were doing them more harm than good.
Taking your meds
As you get older, your medicine cabinet can begin to resemble a pharmacy.
But today, many researchers are asking: do you – or do many people 55 and older – really need quite so many medications?
Professor Sarah Hilmer, a geriatric pharmacologist who works at Royal North Shore Hospital in Sydney, says that over-prescribing for older people is a major problem.
“There are two issues: medicines work differently in our bodies as we age – as we get older, our bodies generally have less muscle and more fat, we often shrink in size and our liver and kidneys don’t work so well, so we often don’t need the same dose as we did when we were younger.
“Also, we’re more likely to develop multiple diseases, each of which requires drugs that then might interact with each other,” she says.
Or the medication might not be right for you at all. Too often, doctors either don’t follow up to ensure that prescriptions are well-tolerated, or continue to refill old prescriptions without considering whether those drugs are still – or were ever – necessary.
Judy Graham’s blood pressure medication dose was adjusted right away, bringing her blood pressure to a healthy level without the dizziness.
But she’d broken her jaw and lost two teeth, and faced several weeks of painful recovery with her mouth wired shut.
As Judy learned, some of the most common medicines prescribed can also be among the most problematic.
Blood pressure medication
Combining medications to lower blood pressure and cholesterol does reduce deaths from heart disease, says a recent large global study.
In fact, more than one million Australians who are at high risk of a heart attack or stroke are not being prescribed these lifesaving medications, according to another recent study of older Australians.
However, people often continue to be prescribed high doses of medication even after their blood pressure reaches optimum levels.
And over-treatment, especially in older people, can lead to dizzy spells, confusion, falls, even severe kidney problems.
Older age can lead to a condition called ‘autonomic neuropathy’, explains Hilmer.
This means it’s more likely their blood pressure will drop when they stand up.
In fact, studies show that if you stop your blood pressure medications in older age, you have a 50 per cent chance of having normal blood pressure for up to five years.
One group is particularly at risk of adverse effects: people with diabetes.
Doctors are more likely to treat high blood pressure more aggressively in people with diabetes because they are more at risk of heart disease and stroke.
But a recent Cochrane Review, which is the gold standard of assessing the credibility of healthcare research, looked at all the evidence from around the world and found that lowering blood pressure too much resulted in a significant increase in the number of serious adverse events in people with diabetes.
Another Swedish study analysed cases in the national database of people with diabetes who were taking blood pressure medication.
Not all of them actually had high blood pressure. In such patients, the researchers found that taking blood pressure-lowering medications actually increased the risk of death from heart disease and stroke by 15 per cent.
“The ability to deal with drops in blood pressure seems to be impaired in people with diabetes,” explains chief researcher Dr Mattias Brunström.