(Part 2 of 4)
In this video, geriatric psychiatrist Marc E. Agronin, MD, shares guidelines for appropriately prescribing psychotropic medications for older adults. Dr. Agronin is the senior vice president for Behavioral Health and chief medical officer for MIND Institute at Miami Jewish Health in Florida.
Dr. Agronin presented "The Top Dos and Don’ts in the Psychopharmacologic Treatment of Geriatric Patients: Focus on Dementia and Late-Life Depression and Anxiety" at the virtual Psych Congress 2020 conference.
Read the transcript:
If you're working with older adults in prescribing psychotropic medications, keep in mind the term “potentially inappropriate prescribing.” What this refers to is to make certain that if you're going to prescribe a psychotropic, you keep several important guidelines in mind.
Make certain you have a clear diagnosis for the medication. You want to make certain that you're staying within standard guiding guidelines for dosing of the medication, and be mindful of the fact that the person may have underlying medical conditions or other medications they're taking that can interact one way or the other with these medications.
You want to make certain if there's underlying hepatic, or renal, or cardiac issues, that these are taken into consideration, and that you're not using medications that could potentially have impact on these physiologic changes, especially without getting other specialists involved who can help advise you.
Make certain that the medication is being monitored closely. I often see instances where individuals are put on a medication for good indication, but it's not followed over time, and so it might not be titrated appropriately or on the right time frame.
Make certain that there's efficacy before you make a change or add on another medication. Sometimes, the patient simply is not taking the medication, or they're not taking it correctly, or because there's neurocognitive impairment, they don't know how to take it correctly, and so when you see lack of effect, it might really just refer to lack of adherence or lack of appropriate use of a medication.
In addition to this, the Beers Criteria has been around since 1991. These were developed initially by a geriatrician, Dr. Mark Beers, to make certain that certain medications that are higher risk in older individuals are either not used, or used judiciously.
I would point to a few major categories that we really focus on in late life. Any medications that are either anticholinergics or have some anticholinergic impact. Often, it's not a single medication but an aggregate. They can lead to classic anticholinergic effects, such as dry mouth, orthostasis, even confusion in some individuals.
Antihistamines, I would add, that are in over-the-counter sleeping pills people take, these can increase their risk of oversedation, of falling, of confusion.
Benzodiazepines are used often as sedatives, as sleeping pills. They can serve a role, especially in acute management of anxiety disorders, but in line with all the principles that I just outlined, the concern may be that if they're not monitored very closely, they're not paired with other more appropriate medications to be used for sleep or anxiety, you can end up getting someone in a situation where you're actually getting a greater risk of issues or side effects, rather than the efficacy of the medication.
Those are some of the main considerations to keep in mind. With those guidelines, you will be able to safely and effectively treat older individuals with psychiatric conditions.
More with Dr. Agronin: Adjusting Psychopharmacologic Treatment for Geriatric Patients