Red as a beet. Blind as a bat. Mad as a hatter. Dry as a bone. Hot as a hare.
If any of those descriptions suddenly fit an older person you care about, you may want to check their medications.
Your loved one could be taking a drug that contains diphenhydramine, which treats a range of conditions from allergies and anxiety, to itching and urinary incontinence. The brand name is Benadryl, but the drug also is in over-the-counter products with “PM” after the name and in prescription medications.
“A lot of people take these drugs and will be taking them for some time,” said Dr. Daniel King, a geriatrician with UR Medicine at Highland Hospital. “They can lead to subtle long-term cognitive effects. Increased confusion in the morning, certainly dry mouth is a common complaint particularly for older adults. They might not put cause and effect to the drugs.”
King said medical students learn the little ditty to spot the effects of these drugs, called anticholinergics.
The side effects are more pronounced among older people, which Jo Anne Leegant or Brighton learned when she went to New York City to spend a week with her aunt, who was about to turn 97.
Neither knew that the medication the elderly woman took to control itching could make her think that someone was making a delivery to her door at 5:30 in the morning.
Leegant said her aunt did not have dementia and was terrified that something was happening to her. A few days after her aunt stopped using the antihistamine, all was normal.
Leegant is past retirement age, the demographic most at risk. “It does make you wonder. It’s scary.”
King, Dr. David Gill of Rochester Regional Health, and Katie Niles, pharmacy and clinical wellness services coordinator at Wegmans, answered questions about anticholinergic medications:
What do they do? An anticholinergic blocks a neurotransmitter called acetylcholine. Sometimes that’s the point, such as when controlling urinary incontinence or treating depression. Other times, it can have an unwanted result that affects nerve and muscle function.
Why are older people more affected? There are theories, such as age-related changes in the brain and how drugs are processed in the body. Also, older people tend to have more prescriptions, which could compound the effect. Seniors also want to stay independent and may add an over-the-counter medication to take care of a problem they think is minor. Screening tools used in prescribing medications to older adults address the issue.
What are some unwanted effects? They can include blurry vision, delirium, flushing, dry mouth and constipation, or changes in regulating temperature. Other effects include increased risk of falls and temporary confusion. Studies are looking at the effect of long-term use on memory and cognition, including dementia.
What can family members do? Understand that anticholinergics can be in a variety of prescription and over-the-counter medications. If an older person is taking an allergy or sleep medication, be alert for changes in their behavior. Ask your loved one to find out from their doctors if all of the prescriptions are necessary, or if there are alternatives. Have prescriptions filled at one pharmacy, so the pharmacist has a complete record. Because of privacy regulations, over-the-counter medications purchased with a loyalty card won’t show up when a pharmacists does a medication review.