Should Geriatric Patients Use PPIs? New recommendations from the AGS
The American Geriatrics Society (AGS) is a non-profit consisting of over 6,000 health professionals committed to promoting the health and quality of life for our geriatric (aging) population. In 2015 the AGS updated it’s well respected list of Beers Criteria. The Beers Criteria lists medications that may be inappropriate for older adults (with the exception of those who are receiving hospice or palliative care).
One of the most recent additions to this list are Proton Pump Inhibitors or PPIs. Frequently prescribed for acid reflux, PPIs are also readily available over the counter so it makes monitoring their use in the aging populations somewhat difficult. With the enhanced risk of clostridium difficile infection, concern for increased bone loss and subsequent fracture as well as new information on increased rates of pneumonia, kidney disease, and dementiamake PPIs potentially risky.
Only your physician can accurately determine when the benefit of a medication outweighs the risk. However, according to an article written by Janna Hawthorne, PharmD, from the University of Arkansas for Medical Sciences, some conditions that may require PPIs include:
- Barrett’s esophagitis
- Erosive esophagitis
- Hyper-secretory conditions
- Those on a prolonged use of oral corticosteroids or NSAIDS
In these instances, your physician may determine that the benefit of PPI therapy outweighs the risk for your overall health.
If you are one of the 60 percent of the adult population that experiences acid reflux symptoms in your life, there are some safer way to treat the condition. Utilize all non-pharmaceutical methods to treat your condition including: avoiding foods that may trigger acid reflux, elevating the head of your bed at night, eating smaller more frequent meals, losing weight if overweight and quitting smoking may help to avoid the overuse of medications.
Should you still require PPI medications, it is important to be sure that your physician is aware of and approves of what you are taking. Taking the medication for the shortest duration possible that provides results and considering antacids or H2 blockers if an extended use is needed are all ways to further reduce the amount of PPIs taken. Talk with your physician about other alternatives if you are still experiencing symptoms beyond the generally recommended two weeks of PPI use.
Geriatric patients should also take a look at the amount of medications they are taking and insure that each physician that is prescribing medications knows their prescription history. Taking your current list of prescriptions and OTC medications with notes on how long you have been taking them can help your doctor assess whether any changes should be made.
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Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).