Medicines heal and hurt

Drugs: Chances for bad side effects and reactions increase with age.

Life After 50

January 13, 2002|By Linda Marsa | Linda Marsa,Special to the Sun

New medications introduced in the past two decades have enabled seniors to live longer, healthier lives. And people older than 65, though they constitute 14 percent of the population, now take more than a third of all the prescription medications dispensed each year.

But these medication advances are proving to be a double-edged sword. Because of seniors' high usage rate, greater frequency of multiple illnesses and diminished physical capacity, the elderly are at a much greater risk for disabling side effects and sometimes fatal drug reactions.

"We've known about this problem for a while, but we're only just beginning to identify effective intervention methods," said Dr. Jerry Gurwitz, a professor of medicine at the University of Massachusetts who has studied medication problems in the elderly. "And adverse events continue to be common."

Nearly 25 percent of all hospital and nursing home admissions result from older adults not taking medications properly. Part of the problem stems from the fact that the ability to process and tolerate medications weakens with age. Liver and kidney function diminish, and muscle and fluid levels decline, meaning drugs stay in the body longer.

Because people over 65 are more sensitive to drugs, their medication dosages must be closely monitored. Warfarin, for example, prevents blood clots and can reduce risks of stroke and heart attacks, but if dosages are too high, it can trigger cerebral bleeding and strokes.

What's more, the typical senior takes four to six medications, plus over-the-counter drugs. Of the nation's 1.5 million nursing home residents, the typical resident consumes 11 or more prescription medications.

As the number of drugs increases, so do the chances for adverse reactions. The antibiotic erythromycin, for instance, when used in combination with some cholesterol-lowering drugs, can cause a toxic reaction and even kidney failure. Also, combining certain antidepressants with hypertension medication can cause a sudden drop in blood pressure.

Often, the frailties we associate with old age -- confusion, memory loss, lethargy, depression, incontinence, slurred speech, loss of balance -- are actually side effects of medication. While there are no hard numbers on how often this is the case, experts say it is common.

"Typically, an older person will be out of it, and we just assume it's because they're old," said Dr. Jerry Avorn, an associate professor of medicine at Harvard Medical School in Cambridge, Mass. "But then we find it's the sleeping pill or antidepressant or tranquilizer that's causing the trouble."

Some HMOs for the elderly have installed computerized systems to flag potential problems with prescription drugs, such as possible interactions.

Many seniors may see several doctors -- their primary care physician and specialists -- who might not know what other drugs they are taking. And they may get their prescriptions filled at different pharmacies. Here again, this boosts chances of adverse reactions.

Even the sophisticated computer systems used by HMOs can't always improve compliance. Conditions such as congestive heart failure and high blood pressure, for instance, are well controlled by medication and reduce unnecessary hospitalizations. Yet some people experience unpleasant side effects from cholesterol-lowering drugs, and may stop taking them without telling their doctors.

Seniors also may have trouble reading labels and get confused about the proper dosages. Or they may forget to take their pills or double up on doses because they don't remember they already took them.

The solution, experts say, is to simplify medications: More is not necessarily better. Some drugs could be eliminated, while others can be used to ease symptoms of more than one illness.

"People need to gather up all their prescription drugs, and show their doctors and pharmacists what they're on," said Harold J. Washington Jr., a Los Angeles pharmacist and president of the California Pharmacists Association. "These professionals can work up a suitable drug regimen for the patient."

Linda Marsa is a reporter for the Los Angeles Times, a Tribune Publishing newspaper.

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