Common drugs risking ‘elderly people’s health’

A study of 13,000 people found that taking some common drugs could lead to an increased risk of mental decline and death for older people, because of the impact of the drugs on the brain.

The study also suggested that taking a combination of the drugs – as many older people, with complex health needs, do – increased the risk.

Experts at the University of East Anglia led the study. They found there were risks from over-the-counter and prescription drugs, including antihistamines, painkillers, blood thinners and eye drops for glaucoma.

The study involved people aged 65 and over from across the UK, and analysed over 80 drugs.

Well-known side effects

The researchers said well-known side effects of the drugs could have an impact on the brain. They analysed the drugs for “anticholinergic activity”, a potential side effect which affects the brain by blocking a key neurotransmitter called acetylcholine.

The drugs were ranked from one to three according to the strength of this activity, with drugs scoring one having a mild effect, two a moderate effect and three causing the most serious concern. Experts said the threshold for damage in patients was a total score of four.

Read more in our Q and A with a consultant on what the study means

Taking a combination of drugs increased the risks. So a patient taking four different drugs of low scores would still be at risk, the researchers said.

Some of the most risky drugs are commonly available, including the antihistamines chlorphenamine (used in the brand Piriton) and promethazine (used in Phenergan); anti-depressants amitriptyline (used in several brands) and paroxetine (used in Seroxat); and the incontinence drug oxybutynin (used in Ditropan). These were given a score of three on the researchers’ scale.

The blood thinner warfarin, heartburn drug ranitidine (used in the brand Zantac), painkiller codeine and timolol maleate eye drops were all mentioned as potentially harmful drugs by the researchers, who branded them a level one.

‘Consult doctor before stopping any medication’

One in five people taking drugs with a total score of four or more had died by the end of the two-year study. This was around treble the numbers taking no anticholinergic drugs – 7 per cent of this group had died by the end of the study.

For every additional point on the scale, the odds of dying increased by more than a quarter, or 26 per cent. High scores on the scale also affected cognitive function slightly, the research showed.

The study, published in the Journal of the American Geriatrics Society, forms part of a project hoping to uncover risk factors for dementia.

'More training needed'
"It's not a deprivation of the health care needs of the old. Often they have multiple and conflicting needs and there has not been enough work done," a spokeswoman for older people's charity Counsel and Care told Channel 4 News.

"Doctors and nurses are stretched for time and people do not always understand or are not trained in the different medication needs of older people, particularly in secondary practice, where many older people end up. 

"Counsel and Care would strongly push for better training and wholesale buy-in that older people's health and social care needs are of the utmost importance. Of course part of that is funding so there is the time and education to do this." 

Lead author Dr Chris Fox, clinical senior lecturer at Norwich Medical School, UEA, said the study was the first of its kind and showed: “a potentially serious effect on mortality.

“Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects.”

Dr Fox called for further research, adding: “In the meantime, I strongly advise patients with any concerns to continue taking their medicines until they have consulted their family doctor or their pharmacist.”