Ask the Experts: Concussions; Expired Drugs; Bronchitis

Q: A friend of mine suffered a concussion during a recent fall. However, since she didn’t lose consciousness, her condition was not detected in the emergency room and it took her son a day or two to realize all was not well. Can you clarify what the symptoms of concussion are so that my husband and I can stay alert for symptoms if we fall?

A: Unfortunately, concussion often goes undiagnosed when older adults are seen in the emergency department after falling. Some experts suggest this may be due to the association between concussion and high school/college sports—there is evidence that young athletes are more likely than older adults to be thoroughly evaluated for concussion after head injuries. Given this, it’s a good idea to familiarize yourself with common symptoms (also keep in mind that you can sustain a concussion even if you don’t lose consciousness after hitting your head, as happened with your friend). Concussion symptoms include headaches, confusion, dizziness, clumsiness, nausea, and vomiting. Some people also report increased light and sound sensitivity, problems with concentration, and an unusually irritable mood.
    You should report any falls you or your husband have to your doctor, even if you don’t seem to have sustained injuries. Also “fall-proof” your home if you have not already done so—for example, remove tripping hazards such as throw rugs, and ensure that stairwells are adequately lit. Another good preventive strategy is exercise that helps strengthen your leg muscles and improve your balance—tai chi is ideal. – Rosanne M. Leipzig, MD, PhD, Geriatric Medicine

Q: Is it safe to take medications that have passed their expiration date?

A: Very few drugs can harm you if they “go bad,” but you want your medication to be 100 percent effective and safe. The effectiveness of medications that have expired can’t be guaranteed, especially if they haven’t been stored as directed. Unfortunately you can’t tell if a drug has gone bad except for aspirin, which smells like vinegar when it degrades. However, I wouldn’t recommend that older adults rely on their sense of smell where aspirin is concerned, as age can diminish your ability to distinguish smells.
    I advise all of my patients not to use medications after the expiration date. Prescription medications are dispensed in 30- or 90-day supplies, and the pharmacy cannot give you a drug that will expire during that time. If you haven’t used up the drug within one year of the dispensing date, discard it and get a new supply if you still need it. Nitroglycerin sublingual tablets (used to treat angina) are only good for three to six months after the bottle is opened. I tell patients to make a note on the calendar or set a reminder on their smartphone for when to throw out the open bottle and get a new one.
    Over-the-counter drugs also have expiration dates and I recommend you check them. Twice a year (when the clocks change is a good time), I would suggest going through all the medications in your home and throwing out the expired ones. If you have any questions about the safety or effectiveness of any drug, ask your pharmacist—he or she is a great source of information about your medications.
-Judith Beizer, PharmD, Geriatric Pharmacology

Q: Is it possible to catch bronchitis from somebody? My sister has it and I want to make sure I don’t become ill too.

A: Bronchitis itself isn’t contagious. However, the viruses that it develops from—including the common cold and flu—are contagious, so if you were to catch the underlying virus that caused your sister’s illness, it is possible you also may develop bronchitis. Take protective measures to stay virus-free (see our page 3 article for tips, and also consider purchasing some surgical face masks). Bronchitis can cause serious complications (including pneumonia) in the elderly, so if you should develop signs of bronchitis yourself—such as a nagging cough with sputum (mucus) production, fatigue, shortness of breath, and chest discomfort—contact your doctor.  -Patricia Bloom, MD, Geriatric Medicine

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