Health In many studies, the over-prescribing for seniors has been the focus of significant concern. Drugs that have been used traditionally to prevent or treat common conditions in the older population are now being shown in some circumstances to have little or no effect in promoting health and, in some cases, are interacting with other drugs or causing side-effects worse than the condition they are trying to prevent or treat. This over-prescribing has been especially noted in the health care of seniors, especially those in nursing homes. For example, it was reported in an article in the Canadian Medical Association Journal last year that a study in 2013 showed that publically funded drug plans in Canada spent an estimated $419 million on inappropriate prescriptions and $1.4 billion on indirect health-care costs. A major example is the over-prescribing of benzodiazepine drugs, commonly used for anxiety, insomnia and other psychological indications. These drugs, commonly prescribed for the elderly, can greatly increase the risk of falls, fractures, motor vehicle accidents, hospitalization and mortality. Although experts warn that they should be limited to a one- or two-week prescription, patients quickly become dependent on their effects and the drug is continued indefinitely. Many of us are on drugs purported to prevent certain conditions and remain on them long after their usefulness has subsequently not been proven. In a number of large studies, there is abundant proof that the statin drugs (e.g. Lipitor, Crestor, Zocor) play a very significant role in persons younger than 70 years of age in reducing the risk of cardiovascular events such as heart attack and stroke. The same studies are unable to show any benefit in those over 70 years of age with no history of cardiovascular disease. Recognizing the known potential side-effects of these drugs, major medical bodies are now recommending that such drugs no longer be prescribed for those over 70. Likewise, ASA (Aspirin) in a dose of 81 mg. was often recommended to prevent the onset of heart attacks and strokes in persons without any evidence of such disease. Now, the evidence-based research shows that such benefits can only be proven effective in prevention for persons known to have cardiovascular disease. Recognizing the potential side-effects such as gastrointestinal bleeding, most clinicians no longer recommend Aspirin for primary prevention. Another drug which is very effective and has gained enormous popularity is the class of drugs called proton pump inhibitors, ppi, (e.g., Nexium, Prevacid, Pantoloc, Losec). These drugs are used to reduce the production of stomach acid and are commonly prescribed for treatment of heartburn, hiatus hernia, ulcers and gastoesophageal reflux disease (GERD). It is estimated that more than four million Canadians are now taking this drug and, although it is very effective, unfortunately its long-termuse has now been proven to be associated with an increased risk of developing fractures, pneumonia, c difficile infection, lowmagnesium levels and chronic kidney disease. Patients are advised to use as low a dose as possible to prevent symptoms, stay on the drugs for only a few weeks ‒ thereafter using safer methods to control symptoms such as diet and antacids. Even daily vitamin consumption has been re-evaluated. When I walk down the vitamin aisle in the drug store, I wonder “who needs all this stuff?” Most clinicians now do not recommend vitamin supplements as being necessary inasmuch as so much of our food is fortified with vitamins. Vitamin D remains the debated one because of its possible role in reducing the risk of certain cancers and, because it is inexpensive and safe, many doctors still advise its addition to the dietary and sun sources. Even supplemental calcium ‒ especially for postmenopausal women ‒ has been shown recently to be ineffective in preventing fractures, including hip fractures. PAINLESS EYE INJECTIONS treating Macular Degeneration Diabetic Retinopathy & other diseases of the eye (239) 324-4888 Toll Free (855)MALKANI Sunil M. Malkani, M.D. Retina Specialist & Surgeon 3 Convenient Locations Naples Fort Myers Port Charlotte www.mrcmd.com SunilM.Malkani,M.D. *Will provide paperwork for your insurance CSANews | FALL 2017 | 35
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