Medications can cause confusion in adults (65 years and older) due to decreased ability of the body to process and metabolize medications. As people age, their bodies become less efficient at breaking down and eliminating drugs, leading to a buildup of drugs in their bodies. Causing unwanted side effects, such as confusion, dizziness, and memory problems. Additionally, older adults may be taking multiple medications, and these may interact with each other causing further confusion in their central nervous systems. So we always remind older adults to talk to their doctor about any medications they are taking to make sure they are taking the correct dosage and to prevent the medications from interacting with each other. For all of the above mentioned and because this age group is the one that experiences the highest prevalence of problems related to exposure to potentially inappropriate medications and interactions between medications, the American Geriatrics Society created the Beers Criteria® where they classify the different groups of medications that may cause adverse effects in older adults.
The Beer Criteria includes 5 categories: I) Potentially inappropriate drugs; II) Potentially inappropriate medications that must be avoided in certain diseases. III) Medications that must be used with considered caution. IV) Combinations of drugs that can lead to harmful interrelationships. V) Medications that should be avoided or dosed differently for adults with poor renal functions.
Some of these medications would be those used for allergic processes or colds such as Antihistamines, one of the best known would be the 1st generation, such as Diphenhydramine. This medicine can make glaucoma worse in older adults. Caution is also recommended if you have or have had an enlarged prostate as it can cause urinary retention. In the respiratory system it can thicken mucosal secretion making it unsafe in patients suffering from Chronic Obstructive Disease. In pregnant women, these drugs can slow the production of breast milk. As a result of these and many more adverse effects, the use of normal saline solution (intranasal), steroids (intranasal) and second generation antihistamines such as Cetirizine are recommended in respiratory conditions. There is a group that, due to its common use, we cannot stop using Digitalis such as Digoxin, a medicine that is used in the treatment of congestive heart failure and atrial fibrillation. As older adults are the ones who suffer most frequently from these pathologies, they are the ones who are most exposed to their toxicity. There are several factors that make them more vulnerable, one of them is the decrease in kidney function that is affected with age. Comorbid conditions also favor susceptibility to the toxic action of said medication. Another important group are Antacids such as Cimetidine. Cimetidine is a medication used to treat heartburn, ulcers, and other gastrointestinal conditions. It is generally considered safe for use in older adults, but it can cause confusion in some cases. Common side effects of cimetidine include dizziness, drowsiness, confusion, and blurred vision. In rare cases, cimetidine can cause more serious side effects, such as temporary neuropsychiatric changes that are resolved with the use of physostigmine.
For all of the above, we make some of the many recommendations to take to prevent the adverse effects of medications in older adults. These would include physicians ensuring that the dosage of the drugs being prescribed is the correct dosage. That the medicine is appropriate for the age and state of health of the patient. In turn, verify that the older adult is taking their medications as prescribed and that they are aware of any possible drug interactions. Also, see that the older adult receives regular checkups and that any changes in their health or medications are discussed with their health care provider.
Bibliography
- Am J Emerg Med. 1991 Mar;9(2 Suppl 1):11-5; discussion 33-4.doi: 10.1016/0735-6757(91)90161-c.
- First published: March 1982 https://doi.org/10.1111/j.1532-5415.1982.tb01299.x Citations: 9
- N Engl J Med. 1978 Nov 2;299(18):992-6.doi: 10.1056/NEJM197811022991806
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