The Nation's Other Drug Problem

OVER-MEDICATED ELDERLY:

March 16, 1993|By Beth Hannan | Beth Hannan,Contributing Writer

When Edmund visited Peggy in a nursing home, her senility kept her from recognizing him. But one day he stopped by in the morning instead of the afternoon and the elderly woman was surprisingly lucid. Was it a rare coherent period for an Alzheimer's patient or something else?

That story line about overmedication of the elderly is from the soap opera "All My Children," but it is a scenario that is often played out across the country. Too much medicine or the wrong combination of drugs can cause elderly patients to be sick or seem senile say the specialists who treat them.

Dr. Peter P. Lamy of the University of Maryland's School of Pharmacy estimates that 10 to 20 percent of all emergency room admissions of the elderly are due to overmedication and that 10 to 15 percent of the senior citizens diagnosed for dementia, vascular dementia and Alzheimer's disease are really victims of over-medication. Approximately 10 percent of all senior citizens in hospitals and 50 percent of all elderly outpatients are being overmedicated, he says.

Dementia is a general term for mental deterioration. It has many causes and may or may not be reversible. Vascular dementia is a form of mental impairment due to blood flow to the brain. Alzheimer's is an irreversible disease in which brain cells are damaged or die, leading to severe dementia.

Anyone can be a victim of over-medication, but the elderly are particularly at risk. Many pharmacists and geriatricians - doctors who specialize in the elderly - say over-medication of the elderly is the country's "other drug problem."

The results of over-medication can be far-reaching. A recent Vanderbilt University study indicates that certain tranquilizers, such as Valium, can make a senior twice as likely to fall and possibly break a bone. Depending on what medicine is taken, over-medication can also lead to kidney damage, liver damage, stomach damage, incontinence, bleeding, Parkinson's disease, dizziness and misdiagnosis for senility, vascular dementia and Alzheimer's.

The average older person takes more than 15 prescriptions per year, according to a 1989 report submitted to the House Select Committee on Aging by U.S. Health and Human Services Department Inspector General Richard Kusserow.

"There are a number of people we've made senile due to drugs. There's no question about it. The goal should be to take as few drugs as possible," Dr. Lamy says.

Over-medication can occur innocently in a variety of ways - from a senior citizen seeing doctors who aren't aware of medicine other doctors have prescribed to possible over-medication in a nursing home.

"The people working in the industry are all good-intentioned people, but sometimes the results are less than satisfactory to all concerned," says Dr. Toshio Tatara, director of the National Aging Resource Center on Elder Abuse in Washington.

Which is one of the points the "All My Children" story tries to make - that the over-medication of the character Peggy Moody, played by Anne Meara, is about overworked people making a mistake, not about evil nurses or doctors. The fact that Peggy is a Medicare patient without family to look out for her makes it even more realistic.

Medicare patients are often treated by different doctors. If Doctor A doesn't know what Doctor B prescribed, Doctor A could prescribe something that counteracts the first medicine or has a negative effect. Most pharmacies have a computer tracking system that can catch this, but only if the patient goes to the same pharmacy consistently.

Over-the-counter medicines also can cause complications. A non-prescription sinus medicine or stomach remedy that worked successfully at one time won't necessarily be safe when taken with an arthritis medicine, a diuretic or a blood thinner.

"These [over-the-counter] medicines have a great potential to do good, but there's a potential for harm if used incorrectly," says Ray Bullman, deputy executive director of the National Council on Patient Information and Education in Washington.

Also, as people age, their bodies work less efficiently. This can be especially true of the liver and kidney, the organs that clean the body of toxins. A dosage that worked for a 65-year-old patient might be too much for a 75-year-old.

And, patients and doctors can fail to monitor side effects properly. Frequently lack of energy, inability to concentrate, sleeplessness, stomach upset and incontinence are wrongly attributed to old age rather than drug side effects or interaction.

"Don't ascribe anything to aging," Dr. Lamy warns older people, "particularly if you're prescribed a new drug or new dosage. Call somebody [such as your doctor],"

Health-care providers have also been cited as part of the over-medication problem. The U.S. Health and Human Services Department study reported that doctors themselves may lack enough education to deal with the elderly.

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