Henry’s kitchen table is littered with drug paraphernalia. There are syringes, bottles, vials, nebulizers and a pill cutter. Henry is not a drug abuser…rather he is a senior citizen with a pill problem.
Despite appearances, Henry is entirely respectable. Like many older people, Henry is on so many different prescribed drugs it is almost impossible to keep everything straight.
He takes insulin and metformin for diabetes; digoxin, furosemide, warfarin and potassium for his heart; albuterol, prednisone, salmeterol and a triamcinolone inhaler for a breathing problem; omeprazole for heartburn; Mobic and amitriptyline for arthritis, back pain and fibromyalgia.
In addition to these 13 different prescription medicines Henry uses over-the-counter ibuprofen for inflammation, omeprazole for stomach pain caused by the ibuprofen and milk of magnesia for constipation brought on by the amitriptyline.
Henry complains that he is a walking drugstore. It’s hardly any wonder that Henry has a hard time dragging himself through the day. Some of these medications are inappropriate for older people, and Henry is in his 70s.
Part of the problem is that Henry has a lot of health problems. But his physicians have not coordinated his prescriptions and he has far too many. Side effects and drug interactions have turned Henry into a ticking time bomb.
Data show that more than one in six Medicare patients receives at least one inappropriate medication. Hundreds of thousands of older people are hospitalized every year because of adverse drug reactions.
Dizziness or unsteadiness caused by medicine is responsible for 32,000 hip fractures from falls. It is estimated that as many as 16,000 automobile accidents among elderly drivers may be due to drug-related impairment of vision, judgment or coordination.
Often, the most serious complications are indirect and hard to document. If Henry develops a bleeding ulcer because of the prednisone, Mobic and ibuprofen, will anyone recognize it as a drug-induced problem? Should Henry become a bit confused or have memory problems, will his doctors attribute it to the anticholinergic effects of amitriptyline and cimetidine or the vitamin B12 depleting activity of omeprazole and metformin?
As America ages, medical schools are not keeping up with geriatric pharmacology. Senior citizens are far more vulnerable to side effects from certain drugs, but most medical students are not taught about this problem. The average internist may not realize how many medications are inappropriate for people over 60.
What is the solution?
Older people and their families will need to watch out for themselves. Grown children must know more about their parents’ medications. It is no longer enough to ask mom and dad how they are doing and assume they can report accurately on their health situation. If dad falls and breaks a hip on the way to the bathroom at 3:30 in the morning, the whole family will be affected in a disastrous way.
People should NEVER be left in a hospital by themselves. Here’s just one example. J.D. posted this comment to our website:
“Based on my own recent experience being hospitalized, I feel sorry for any elderly person who does not have a family member to come and assist and advocate for them. The nurses come in to your room and feel they complete their duties by simply filling your stomach with the medication prescribed. They don’t seem to pay full attention to possible drug interactions nor do they realize the ill effects of taking too many pills on an empty stomach.
“Despite my requests to take my medications with a meal, I was instead given my meds several hours later, and in the end I wound up with three gastric ulcers.”
That is why we wrote a chapter titled “The Screwing of Senior Citizens.” In it you will learn about the Beers List of drugs older people should generally avoid. Your doctor may not know about Beers, but we provide you a detailed of drugs that can be disastrous if you are over 60.
Worried about your memory? Perhaps your medicine is contributing to the problem. Most physicians would flunk a test about which drugs have anticholinergic activity that can impact cognition. The list includes cimetidine, desipramine, digoxin, diphenhydramine, fesoterodine, hydroxyzine, meclizine, oxybutynin and tolterodine, to name just a few. You will also discover more details about our 10 Tips to Surviving Old Age in the book, Top Screwups Doctors Make and How to Avoid Them.
- See a doctor who likes older people.
- Find a good geriatrician.
- Ask about special dosing requirements
- Beware bad drugs.
- Avoid anticholinergic drugs if possible.
- Minimimize the number of drugs you take.
- Seek nondrug treatment when practical.
- Be assertive.
- Have an advocate.
- Stay active.
Following these tips could save your life or the life of a loved one!
Henry could be anyone over 60. He needs an experienced geriatrician to review all his medications. That person should spot dangerous interactions, such as that between prednisone, Mobic and ibuprofen.
With careful supervision, it might be possible for Henry to simplify his drug regimen and reduce his risk of serious side effects. We hope our chapter can help you or someone you love. You will find it in our book, Top Screwups Doctors Make and How to Avoid Them. Here is a link for more details.
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