Several articles I’ve been working on for my monthly newsletter, Biological Therapies in Psychiatry, made me think of aging as a key variable in therapeutics. Commonly prescribed psychotropic medications adversely affect bone health and may increase the risk of falls—a double whammy for fractures. Some psychiatric medicines increase the risk of bleeding, others the risk of venous thromboembolism. All of these hazards are even greater in the elderly—particularly in patients with medical illnesses and taking multiple medications.
The population is growing older. I am seeing more patients in their 60s, 70s, 80s, and 90s. And, miracle of miracles, I’m getting older! (Who knew?!) We can’t reverse the calendar. But we can factor a patient’s age, comorbid conditions, and other treatments into our therapeutic algorithms. Some of the approaches are decidedly low-tech.
Can my patient read the name and directions on a medicine bottle? (The print can be really teeny.) Does the bottle have a child-proof cap that’s hard for someone with frail hands or arthritis to open? Does the patient understand the nuances of how and when to take the tablets? Especially when there are multiple medications, advise about inexpensive pill containers, with the days of the week embossed in large characters on easy-to-open boxes. They come in many shapes and sizes and can be filled weekly by a patient or family member. Calendars and electronic devices also can provide mnemonic assistance.
Ask patients and family members about driving competence and safety. There are increasing numbers of electronic and mechanical devices in newer cars, which can enhance the safety of older drivers (and their passengers and others). And there comes a time to discuss relinquishing a driver’s license.
I think and ask about barriers, obstacles, and other tripping risks in the home—especially for paths likely to be trod after dark (like the route from bed to bathroom). What about risks for slipping in bathrooms?
Practitioners know to ask about other medicines a patient is taking. I cannot possibly be conversant with all current medications, but answers about their indications, adverse effects, mechanisms, and potential interactions are as near as my computer or smart phone. And I try to remember to ask about over-the-counter preparations, including dietary supplements—many of which can interact with prescribed medications.
We can’t turn back time. But we can remain aware of its effects and open practical conversations with patients and their friends and families.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry