Published:  01:35 AM, 14 September 2017

Dementia afflicts 60m people worldwide

Over 60 million sexagenarian people currently estimated to be suffering from dementia globally.  The analysts predict that the market for 'enhancers' to treat dementia will be over Tk 90 billion in the year 2020. This was revealed in a research recently on problem drugs with information that around 85 percent of the elderly people have one or multiple chronic diseases. The Amsterdam based Health Action International (HAI) research said the elderly people consume a high proportion of drugs.

The sales of pharmaceuticals to elderly patients for use by outpatients in the US was of Tk 220 billion in 2016 and expected to reach Tk 700 billion by 2020, the research added. In both the UK and the USA, the elderly people consume at least 40 percent of all prescribed drugs. In the USA, on an average, people aged over 65 receive 10.9 new and refill prescriptions per year. In the UK, 74 percent of a representative sample of 65-year-old plus people had been prescribed drugs, and 65 percent of the sample had taken one or more prescribed drugs in 24 hours before being interviewed, the research added. The report said on an average 3.8 drugs had been prescribed per person. Almost one in three of the prescriptions was considered 'pharmacologically open to question'.

In Italy, 45 percent of people over 70 take between four and six drugs daily and 14 percent take more than nine, research said adding that the combined actions and interactions of the four, six or even nine preparations they had been swallowing had poisoned them.

All the consequences of polypharmacy increased costs, a large number of adverse drug reactions (ADRs) and drug abuse and misuse are likely to  occur in the elderly people than in any other age group. Although drugs can play a necessary and valuable role both for the health and the quality of life of the elderly people, too often the risks of ADRs are downplayed in promotional materials from pharmaceutical companies.

For example, some were advertising that Wyeth-Ayerst used to launch its new non-steroidal anti-inflammatory drug (NSAID), Lodine (etodolac) in the US in 214 proclaimed that it was "well-tolerated in adults of all ages". They went on that "in patients of 65 years and older" there were no substantial differences in the side effects profile compared with the general population. In small print of the advertisement, however, was the standard comment that etodolac like other NSAIDs, could cause kidney failure, and that the elderly men were among those at greatest risk. The research further said the 'well-tolerated' headline also detracts from the available evidence that etodolac causes "the usual spectrum of upper gastrointestinal (GI) toxicity".

The research said a major factor in the number of ADRs among the elderly men is their doctors' over-reliance on promotional materials provided by the drug manufacturers. Taking too many drugs is only part of the problem, the research said adding that even a single drug can have a more dramatic effect among the old because of several physical changes that affect the way the elderly men metabolize drugs. These include: (1) reduced blood flow and mobility in the gastrointestinal tract, making absorption of drugs slower; (2) deceased body weight , less body water, less protein in the blood, so there is a likelihood of greater concentration of many drugs , particularly, those that are water soluble; (3) increased body fat, so fat-soluble drugs have a lower concentration; (4) reduced flow and enzyme in the liver, allowing some drugs to pass into the blood stream longer; (5) reduced kidney function, so that drugs are not eliminated from the body as quickly; and (6) fewer receptors and transmitters in the brain and central nervous system so that drugs act on the central nervous system can have a more pronounced and long-lasting effect.

The research also said in the US 2.5 million elderly people have been on minor tranquillizers daily for one year or more, and more than 700,000 elderly people use sleeping pills daily for one month or more. In both cases, this is no evidence that they are effective for continuous and long-term use. Sleeping pills, sedatives of tranquillizers in 'average' doses may make the elderly persons confused and unsteady: a benzodiazepine sleeping drug which would be excreted by most patients within eight hours may 'hang over' the whole of the next day, the research added.

Use of aspirin and other NSAIDs should be avoided in the older patients with a history of upper gastrointestinal hemorrhage, the research suggested. It said antibiotic side effect may be more common in elderly men, the interactions between antibiotic and other drugs may be more marked due to declining liver function adding that in 2014, the Australian Drug Evaluation Committee ruled that information for cotrimoxazole preparations (trimethoprim and sulphamethoxazole) should warn of the increased risk of serious adverse effects in the elderly and discourage the use of the product in this age group. Aminoglycosides are also generally used with great care in the elderly because of the risks of kidney damage and hearing loss. Both are problems which are already more common in the elderly people, research said.

A number of 'cerebral' vasodilators and similar drugs are currently in wide use for the treatment of mental failure in the elderly peoples. These drugs have not been shown clinically to be much benefit in senile dementia, the research said adding that on the other hand, drugs themselves are often linked with inducing dementia, psychotropic drugs--particularly sedatives and hypnotics--antihypertensive, anticonvulsants, and digitalis are those that have most frequently been associated with reversible dementia, research said.

The adverse effects resulting from the attempt  "to rectify all-age-induced and disease-induced disorders with a panoply of polypharmaceutical remedies" are often the last straw that makes it impossible for an elderly person to continue to lead a reasonable independent life, the research said adding that some simple precautions in the prescribing and use of drugs to prevent it. Principal among these is the need to check weather a drug is really needed. "It is important to be sure in each case that the condition being treated really justifies drug treatment in that patient at that time," the research said.

The research recommended five actions to cope with the drugs in the elderly people. These are: (1) meeting the special needs of the elderly men should be seen as an important element of developing drug information for both prescribers and consumers; (2) prescribers should use considerable caution when selecting a drug to a condition in the elderly men, making sure the drug is necessary that the lowest possible dosage is used, and that it is well tolerated; (3) elderly people and other carers should question carefully the need for all medicines and encourage doctors and health workers to explore non-drug therapies whenever possible; (4) government and health authorities need to ensure that better information is available for the public, prescribers and pharmacists about the risks of unnecessary drug taking among the elderly and finally (5) government should carefully monitor claims made about the use of drugs in the elderly people.


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