Drugs Slow Elders' Recovery

These reports are of high interest to me because they relate to a situation in my own family. It is highly important to understand that as you age your ability to metabolize drugs and other substances, as well as clear their metabolites through your liver and kidneys becomes impaired.
In my mother's situation she was - for the last six years of her life - grossly over medicated, and that list of drugs included several that the research showed definitively that they should not be administered to the elderly, and especially not to elderly women.
Regardless of the data presented, neither the care center or my brother, who had POA, made any effort to act for the best interest of my mother's health and quality of life.

Sedating Drugs May Slow Elders' Recovery By Ed Susman, Contributing Writer, MedPage Today, January 15, 2010

Elderly patients sedated with morphine or haloperidol (Haldol) were less likely to to be discharged to their homes than patients given other sedatives, according to research presented here.
MIAMI BEACH -- Elderly patients sedated with morphine or haloperidol (Haldol) in surgical intensive care units were less likely to to be discharged to their homes and more likely to be discharged to a nursing facility than patients given other sedatives, often resulting in a poorer quality of life, researchers reported here.
Patients who received morphine were 2.57 times more likely to be discharged to a nursing home, rehabilitation center, or a skilled nursing facility (P=0.029), Carrie Miller, MS, CRNP of the Hospital of the University of Pennsylvania in Philadelphia, told attendees at the annual meeting of the Society of Critical Care Medicine.
Patients who were given haloperidol were 12.46 times more likely to be discharged to one of those facilities rather than to their home.
Similarly, the risk of having a significantly reduced function from baseline admission was five times greater if the patient had received haloperidol (P=0.044) and 2.76 times more likely if the patient had received morphine (P=0.011), Miller said.
"While older adults frequently require medications to treat pain, anxiety, and delirium, little is know about the effects these medication have on older adults' functional ability or quality of life," Miller said.
To shed some light on the question, she and her colleagues evaluated 114 patients in three surgical ICUs. Mean age was about 75, some 60% were men, and 85% were white. Overall, 37% were undergoing general surgical procedures, while 35% had undergone vascular procedures and 16% were trauma patients.
Patients' level of consciousness and delirium status were assessed daily and information about medication use was gleaned from the ICU flow sheet and the computerized administration record.
The most frequently used narcotic in the surgical ICU was fentanyl (Duragesic), administered to 77 patients; the most frequently used sedative was midazolam (Versed); and the most frequently used antipsychotic was haloperidol.
Miller and her colleagues noted that use of propofol (Diprivan) appeared to be associated with better outcomes as far as discharge to one's home was concerned.
They noted that there was "considerable discrepancy" between medication usage and dosage recorded on the patients' flow sheet and medication administration record. "Researchers and clinicians should consider that administered prn medications may not always be recorded on the nursing flow sheet," they concluded.
The study did not control for confounding variables such as the severity of illness or comorbidities that may have affected outcomes, Miller said.
"This is an interesting study," said Suzan Streichenwein, MD, a private practice geriatric psychiatrist in West Palm Beach, Fla. "It would be valuable for future studies to include the severity of illness or more specific details about the type of surgery relative to the dosages of morphine used and its influence on the discharge functional outcomes.
"Tests diagnosing mild cognitive impairment and/or dementia preop versus postop as well as the time period under anesthesia in relation to outcomes would also be helpful," said Streichenwein, who was not involved in the study.
Streichenwein told MedPage Today that other possible confounding factors require further studies in this area.

None of the clinicians had relevant financial disclosures.
Primary source: Society of Critical Care Medicine
Source reference:
Balas M, et al "Narcotic, sedative and antipsychotic medication use in older surgical intensive care unit patients" SCCM 2010; Abstract 1000.
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