Latest news with #polypharmacy
Medscape
3 days ago
- Health
- Medscape
Managing Weight in Older Adults Isn't About Weight at All
While weight loss is often the goal of weight management, weight management in older adults should go beyond weight loss to focus on functional health outcomes, comorbidity improvements, and harm reduction. Beverly Tchang, MD Weight management in older adults requires greater mindfulness and clinical nuance than in younger populations, owing to the increased risk of potential harm. Aging is commonly accompanied by a rise in medical complexity — older adults are more likely to live with multiple chronic conditions and to take several medications, which adds important layers of consideration when pursuing weight loss interventions. Over 50% of older adults have three or more chronic diseases. These overlapping conditions demand coordinated, multidisciplinary care. Within this context, clinicians must consider how meaningful weight loss might improve obesity-related complications, while also weighing the potential for unintended consequences that can arise from rapid or unmonitored changes in health status. Polypharmacy is a common concern in geriatric care and adds to the complexity of weight management. Among adults aged 65 and older with Medicare insurance, the median number of prescription medications was four. Older patients may be prescribed medications associated with potential weight gain, such as first-generation antihistamines or beta-blockers. Polypharmacy not only increases the risk of adverse drug-drug interactions but also necessitates vigilant monitoring during weight loss, particularly when medications are weight-dependent. A case report on thyrotoxicosis in the setting of 30% weight loss with tirzepatide highlighted the importance of adjusting weight-based medications like levothyroxine. Because obesity is the root cause or contributor to several other cardiometabolic diseases, obesity treatment has been demonstrated to improve several weight-related consequences. The Look AHEAD trial of adults with type 2 diabetes reported an average 8.6% weight loss and associated improvements in blood pressure, lipid profiles, and glycemic status. Obesity pharmacotherapy advances, which now grants access to 15%-20% weight loss thresholds, have been associated with de-escalation of antihypertensive and lipid-lowering therapies. In a secondary analysis of trials for semaglutide 2.4 mg, 34% vs 15% of participants experienced a discontinuation or dose reduction in their anti-hypertensive medication, while maintaining normal blood pressures. While such observational data is insufficient to establish recommendations, they implore attention: As weight loss is achieved, medication regimens should be regularly reviewed for potential deprescribing to reduce the risk of overtreatment, adverse effects, and polypharmacy-related complications. Beyond cardiometabolic disease, sarcopenia— the age-related decline in muscle mass and function — is another critical consideration. Clinicians should focus on evidence-based nutrition and physical activity recommendations demonstrated to preserve lean mass and function. Higher protein intake has been consistently demonstrated to preserve lean mass or improve body composition in the setting of weight loss. High protein diets (ie, greater than 0.8 g/kg/d) are commonly recommended alongside a progressive strength training program. In a weight loss study of adults with obesity, participants were randomized to a high protein supplement vs an isocaloric supplement and participated in a resistance exercise program 3 times/week for 13 weeks. While weight loss and fat mass loss between groups did not differ, those on the higher protein supplement (1.1 g/kg/d of protein) gained 0.4 kg +/- 1.2 kg of appendicular muscle mass while those on the isocaloric supplement (0.85 g/kg/d of protein) lost 0.5 +/- 2.1 kg ( P =.03). Similar studies focusing on resistance training have replicated these benefits across studies. A systematic review and meta-analysis of six randomized controlled trials that enrolled older adults with obesity compared weight loss via caloric restriction alone vs weight loss via caloric restriction plus resistance training; resistance training reduced 93.5% of the lean body mass loss associated with calorie restriction. Additionally, the strength-to-lean body mass ratio improved when resistance training accompanied calorie restriction compared to calorie restriction alone (20.9% vs -7.5%). However, muscle preservation is only half the story. Bone health is an equally important concern during weight loss in older adults. Rapid or sustained weight reduction can have unintended effects on bone density, which in turn can increase the risk of fractures. Few studies have examined the incidence of fracture rate after long-term and sustained weight loss. In the aforementioned Look AHEAD study of adults with type 2 diabetes, no significant difference in incident fracture rate was observed over a median of 9.6 years (373 participants randomized to intensive lifestyle intervention vs 358 randomized to standard diabetes education), but a composite of the first occurrence of a hip, upper arm, or shoulder fracture was found to be 39% higher in the intervention group. Long-term outcome studies examining risk of fractures with medical weight management have not been conducted, but the increased risk of fractures observed among individuals who have undergone bariatric surgery informed guidelines to recommend earlier, repeated osteoporosis screening and higher vitamin D supplementation to optimize bone health. Overall, obesity management in older adults requires a careful and tailored approach that is attentive to comorbidity management and that prioritizes risk mitigation. Increasingly, the effects of obesity on all aspects of a person's quality of life is being recognized, and patients should be informed on how weight loss may interact with coexisting medical conditions, medication regimens, and musculoskeletal health. Clinicians who treat obesity in older adults should be prepared to manage patients across these intersections, or coordinate care with registered dietitian-nutritionists, exercise physiologists, endocrinologists, and primary care professionals.
Yahoo
18-05-2025
- Health
- Yahoo
Boomers have a drug problem, but not the kind you might think
Baby boomers – that's anyone born in the U.S. between 1946 and 1964 – are 20% of the population, more than 70 million Americans. Decades ago, many in that generation experimented with drugs that were both recreational and illegal. Although boomers may not be using those same drugs today, many are taking medications, often several of them. And even if those drugs are legal, there are still risks of interactions and side effects. The taking of multiple medications is called polypharmacy, typically four or more at the same time. That includes prescriptions from doctors, over-the-counter medicines, supplements and herbs. Sometimes, polypharmacy can be dangerous. I am a geriatrician, one of only 7,500 in the U.S. That's not nearly enough to accommodate the surging number of elderly boomers who will need medical care over the next two to three decades – or help in dealing with the potential problems of multiple drug use. We geriatricians know that polypharmacy isn't always bad; multiple medications may be necessary. If you've had a heart attack, you might be on four medications or more – beta-blockers, ACE inhibitors, statins and aspirin, for instance. And that's appropriate. But about half of older adults take at least one medication that's not necessary or no longer needed. Doctors need to periodically reevaluate to make sure each medication is still right for the patient and still the correct dose. During treatment, the patient's weight may fluctuate, either up or down. Even if it stays the same, body composition might change; that occurs as people age. As a result, one may react differently to a drug. That can happen even with a medication a person has been on for years. Polypharmacy often means higher health care costs and more drug interactions. Patients are more likely to miss medications or stop taking them altogether. Sometimes, physical activity diminshes; falls, cognitive impairment, malnourishment and urinary incontinence increase; there may be less ability to do daily tasks. Those on five or more medications have a much higher incidence of having an ADE – an adverse drug event – compared to those using fewer meds. Making matters worse, the symptoms of polypharmacy are sometimes masked and taken as signs of aging. Studies have suggested solutions, with better coordination among care providers being one. Making the pharmacist an integral part of routine care is another. The increasing use of electronic patient records helps. So do smartphone apps, sometimes an easier way for patients and providers to connect. But so far, there's no magic pill, and as researchers and clinicians investigate improvements, much of the burden remains on patients and their families. There are steps you can take to stay safe, however. Regularly clean out the medicine cabinet and get rid of expired medicines or those you're no longer taking. Either throw them away or ask your doctor or pharmacist about the best way to dispose of them. When seeing the doctor, bring in the meds you take and review each one in detail. Make certain you need to continue taking them all and verify the right dose. You can also check the PIMs list, also known as the Beer's List. Published by the American Geriatric Society, it's an index of medications potentially harmful to the elderly. Some are linked to increased risks of side effects, and not a few are sold over-the-counter without prescription. That includes medicines containing antihistamines like diphenhydramine, or Benadryl. In the elderly population, Benadryl carries an increased risk of dizziness, confusion and urinary retention. Medicines that are part of the NSAID family (nonsteroidal anti-inflammatory drugs) are also on the list. In some elderly patients, they can cause high blood pressure or kidney failure. Commonly used medicines in the NSAID family are those containing ibuprofen or naproxen. Just because a medicine is on the Beer's List doesn't mean your doctor was wrong to prescribe it, or that you should stop using it. Instead, use the medication with caution and discuss with your doctor to make sure you need it. Determine with your doctor the lowest useful dose, monitor for side effects, and speak up if you have any. As a geriatrician, I see patients in an outpatient setting, either as their primary care provider or as a specialist consultant. We review medications at every visit: the list, the dose and how often the patient is taking it. A true and accurate medication list is the critical first step in geriatric care. This is especially important during care transitions, such as when a patient is coming out of the hospital or nursing home. Particularly at that time, we find out if the patient is using the medication as prescribed, or taking it more frequently or less or not at all. Which leads to my final piece of advice: If you've strayed with your meds, one way or another, know that we doctors don't judge or punish patients. Just tell us the truth. That's all we want to hear. Then we can move forward together to find the best regimen for you. This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Laurie Archbald-Pannone, University of Virginia Read more: To tackle gendered violence, we also need to look at drugs, trauma and mental health Do we really need to burp babies? Here's what the research says What are heart rate zones, and how can you incorporate them into your exercise routine? Laurie Archbald-Pannone is affiliated with American Geriatrics Society.
