Senior Health

Use of Ritalin, Other Stimulants Can Raise Heart Risks for Older Adults

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News Picture: Use of Ritalin, Other Stimulants Can Raise Heart Risks for Older AdultsBy Amy Norton HealthDay

ADHD medications are increasingly being prescribed to older adults, and they may cause a short-term spike in the risk of heart attack, stroke and arrhythmias, a large new study suggests.

Stimulant medications, such as Ritalin, Concerta and Adderall, are commonly used to treat attention deficit hyperactivity disorder (ADHD). But they are also increasingly being prescribed “off-label” to older adults, to combat conditions such as severe drowsiness, appetite loss and depression.

The new findings add to evidence that the drugs can pose heart risks.

Researchers found that on average, older adults starting on a stimulant showed a 40% increase in their risk of heart attack, stroke or ventricular arrhythmia within 30 days.

Ventricular arrhythmias are rhythm disturbances in the heart‘s lower chambers, and some can be fatal.

In the study, stimulant users had double the risk of dying within a month of starting a stimulant, compared to older adults who were similar in terms of health but not using a stimulant.

The absolute risks were relatively small, said lead researcher Mina Tadrous, an assistant professor of pharmacy at the University of Toronto.

Over one year, 5 out of 100 stimulant users had a heart “event,” the study found. That compared with between 3 and 4 of every 100 non-users.

And the increased risk appeared limited to the first 30 days of use, Tadrous said. Over the longer term — six months and one year — stimulant users were not at greater risk of heart trouble.

Why? It’s not clear, but Tadrous said it may be because of monitoring.

Doctors have long known that stimulant medications can raise blood pressure and heart rate. In fact, the drugs carry warnings about those effects, particularly for people with established heart disease.

So doctors and patients are likely checking for red flags — a spike in blood pressure or symptoms like chest palpitations — and if they come up, the drug may be stopped, Tadrous explained.

Over the longer term then, older adults who remain on stimulants may be those who are less likely to have heart and vascular side effects.

For the study, Tadrous and his colleagues looked at data on more than 30,000 adults over 65 living in Ontario, Canada. The group included more than 6,400 patients who started a stimulant prescription between 2017 and 2019. Researchers compared each of those patients with four others who were similar in terms of health and demographics but were not prescribed a stimulant.

The stimulant medications included amphetamine, dextroamphetamine (brands such as Dexedrine and ProCentra), methylphenidate (Ritalin, Concerta and other brands), and lisdexamfetamine (Vyvanse).

On average, older adults prescribed stimulants were 40% more likely to land in the emergency room or be hospitalized for a heart complication within 30 days.

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The sharpest increase was in the risk of ventricular arrhythmia, which was three times higher compared with other older adults.

For patients already on stimulants, Tadrous said the lack of longer-term excess risks could be seen as reassuring.

But, he said, doctors should remain “vigilant” in monitoring blood pressure and other markers of heart health in those patients.

Dr. James Kirkpatrick is chair of American College of Cardiology’s Geriatric Cardiology Section Leadership Council.

He said the lack of longer-term risks was the most interesting finding from the study. It’s not clear why that is, Kirkpatrick said, but he agreed that patient monitoring might explain it.

Kirkpatrick, who was not involved in the study, noted that for some older adults, the symptoms for which stimulants are prescribed can be so debilitating, the potential for heart effects could be worth the benefits of treatment.

“Individual patients have individual needs,” he said. “It’s always about balancing the benefits and risks.”

Older adults already on a stimulant should not stop taking it on their own, Kirkpatrick advised. If they have concerns, he said, they should talk to their doctor.

Kirkpatrick agreed that ongoing monitoring is important. And ideally, he said, older adults should regularly have a medication “review” with their doctor, to talk about which drugs they still need and where a change might be better.

The findings were published Oct. 25 in JAMA Network Open.

More information

The American College of Cardiology has more on the safety of stimulant medications.

SOURCES: Mina Tadrous, PharmD, PhD, assistant professor, pharmacy, University of Toronto, Canada; James Kirkpatrick, MD, chair, Geriatric Cardiology Section Leadership Council, American College of Cardiology, Washington, D.C., and professor, medicine, University of Washington Medical Center, Seattle; JAMA Network Open, Oct. 25, 2021, online

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Language Can Make the Difference Between Home, Hospital Care: Study

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News Picture: Language Can Make the Difference Between Home, Hospital Care: Study

It helps to speak English if you’re a home care patient in the United States.

A new study of home health care found that patients who speak a language other than English have higher rates of hospital readmission.

Readmission rates among New York City patients whose first language wasn’t English were highest among Spanish and Russian speakers. They were lower among Chinese and Korean speakers, according to the study published online recently in the International Journal of Nursing Studies.

“Language preference as a social determinant of health is not a new factor in health care delivery,” according to lead author Allison Squires. She is an associate professor at New York University’s College of Nursing, in New York City.

However, “our research suggests that patients with language barriers in home health care may be particularly vulnerable to poor outcomes,” Squires said in a journal news release.

For the study, the researchers analyzed data on more than 87,000 patients in New York City who were getting home care after being discharged from a hospital. The team focused on the five most common languages spoken by the patients: English, Spanish, Russian, Chinese and Korean.

The risk of hospital readmission within 30 days was somewhat higher among patients who preferred a language other than English (20.4%) than among English-speaking patients (almost 18.5%).

Language barriers between patients and providers can hinder effective communication, and negatively affect quality of care and patient safety, the study authors noted.

This may be especially true in home health care, where it may be more difficult to provide interpreter services. Many home care patients don’t have high-speed internet access, or sometimes even a phone, which limits access to video or phone interpreter services.

There are ways to reduce the risk of hospital readmission among home care patients with language barriers, according to the researchers.

They include improving translation capabilities, and using health care teams that speak the same languages as their patients.

“Ensuring that patients have clinical interactions in their preferred language across the care continuum is important, as it can increase access to care at the earliest stages, reduce the risk for readmission, and improve care transitions throughout the health care system,” Squires said.

More information

HealthinAging has more on home care.

SOURCE: International Journal of Nursing Studies, news release, Oct. 27, 2021

Robert Preidt

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Almost 1 in 3 U.S. Seniors Now Sees at Least 5 Doctors Per Year

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News Picture: Almost 1 in 3 U.S. Seniors Now Sees at Least 5 Doctors Per YearBy Amy Norton HealthDay Reporter

TUESDAY, Nov. 2, 2021 (HealthDay News)

Nearly one-third of older U.S. adults visit at least five different doctors each year — reflecting the growing role of specialists in Americans’ health care, a new study finds.

Over the past 20 years, Americans on Medicare have been increasingly seeing specialists, researchers found, with almost no change in visits with their primary care doctor.

On average, beneficiaries saw a 34% increase in the number of specialists they visited each year. And the proportion of patients seeing five or more doctors rose from about 18% in 2000, to 30% in 2019.

Is the trend good or bad? “It’s probably both,” said Dr. Michael Barnett, the lead researcher.

On one hand, he noted, medicine has grown by leaps and bounds in recent decades — yielding a deeper knowledge of various health conditions and more options for diagnosing and treating them.

“There are a lot more things that a specialist can do now, and that’s good,” said Barnett, a primary care doctor and an assistant professor at the Harvard T.H. Chan School of Public Health in Boston.

However, managing all of those medical appointments, various prescriptions and information from different providers can be “maddening,” Barnett pointed out.

“If nothing else,” he said, “transportation to those appointments is a big issue for older adults.”

So the broader question of how all this specialist care is affecting older Americans’ quality of life is a complicated one, according to Barnett.

What is clear, he said, is that the American health care system is “very specialist-oriented.”

Back in 1980, Americans aged 65 and older mostly saw primary care providers. About 62% of their medical appointments were with a primary care doctor, while 38% were with specialists, according to Barnett’s team.

But by 2013, those figures had flipped.

That makes the United States different from many other developed health systems in the world, which put more emphasis on primary care. And, the Harvard researchers said, studies suggest those systems provide better care at lower costs.

The new findings — published Nov. 1 in the Annals of Internal Medicine — are based on claims data from Americans on Medicare between 2000 and 2019.

Over time, the average beneficiary saw more specialists and had more visits to specialists, the investigators found. But there was no real change in their number of annual visits to primary care providers.

By 2019, Medicare recipients saw two specialists, on average. But many saw more: That included the 30% of beneficiaries who saw five or more doctors.

Alice Bonner is a geriatric nurse practitioner and senior advisor to the nonprofit Institute for Healthcare Improvement.

She agreed that the trend toward more — and pricier — specialist care is neither good nor bad, but more complex than that.

“It could be that it’s helping people, or it could be that it’s wasteful,” Bonner said. “It’s so dependent on the individual situation.”

One question, she noted, is whether older adults are becoming “more assertive” in asking to see specialists. Visits to a busy primary care provider can be brief, Bonner pointed out.

“If people are not having their concerns addressed,” she said, “they may seek care elsewhere.”

Like Barnett, she said that seeing multiple doctors can add a layer of complexity that burdens older adults — from transportation to managing medications.

“It’s not uncommon for patients to be on nine or more medications,” Bonner noted.

Ideally, health care should be helping older adults live not only longer but better, and understanding “what matters” to any one patient is key, according to Bonner.

“Most older people tell us they don’t want their lives overmedicalized,” she said. “If they’re busy traveling from doctor to doctor, they may have less time for doing what matters to them.”

Barnett made a similar point, saying primary care doctors should “help patients do what matters most to them.”

In some cases, Barnett said, that might mean “pulling back” on some specialist care — though, he noted, the general culture of the health care system is to add care rather than take away. So patients may need to ask.

“It’s always reasonable for patients to ask their primary care doctor whether any care they’re receiving is still necessary and needs to continue,” Barnett said.

Specialist care also adds complexity to the job of primary care providers, who are supposed to be coordinating it all, Barnett pointed out. In the current system, that may or may not be happening smoothly.

Since doctors are mainly paid per service they provide during an office visit, any time spent coordinating patients’ care is uncompensated. That system, the researchers said, is a “disincentive.”

More information

The U.S. Department of Health and Human Services has advice on choosing health care providers.

SOURCES: Michael Barnett, MD, assistant professor, health policy and management, Harvard T.H. Chan School of Public Health, Boston; Alice Bonner, PhD, RN, senior advisor, Institute for Healthcare Improvement, Boston, and adjunct faculty, Johns Hopkins School of Nursing, Baltimore; Annals of Internal Medicine, Nov. 1, 2021, online

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Exercises for Seniors: Tips for Core, Balance, Stretching See Slideshow