Seniors’ Slippage May Be Due to Drugs

There was a time when people who managed to reach a ripe old age were respected, even treasured. They were revered for their experience and wisdom.
These days, though, we live in a youth-oriented culture. Even the practice of medicine is not set up to support seniors. There are too few geriatricians (doctors who specialize in treating older people). Those who do focus on the elderly are undercompensated, since Medicare often pays less than physicians would normally receive.
Perhaps that’s why the seniors are often mis-medicated. Long-term care facilities frequently put many residents on antipsychotic drugs, even though these medications may not help most older people. Studies show, in fact, that seniors on antipsychotics are at risk of dying sooner than they might without such medicine (BMJ, Feb. 23, 2012).
Some readers report painful experiences with older relatives taking inappropriate drugs. One wrote: “About a year ago, my mother seemed to be going downhill fast. She was showing signs of memory loss, confusion and depression. She was exhausted all the time and would often sleep through the day.
“Her balance was poor and she had a number of bad falls. In addition, she seemed to have become mean and bad-tempered. She was always looking on the dark side of any situation and seemed to remember only the terrible things that had happened in her life.
“At the time, she was taking flurazepam every night as a sleeping pill. I suspected that it might be causing her problems, so I talked to her doctor about it. He just smiled as if to say, ‘She’s 87 years old. What do you expect?’ I also talked to two pharmacists, neither of whom thought that this drug would be a problem.
“Then I read in your column that benzodiazepines (a class of drugs that includes Xanax and Valium as well as flurazepam) are inappropriate for elderly people. The list of side effects sounded just like Mother’s. I took her to another doctor.
“After she stopped taking flurazepam, she became a new person almost overnight. Her balance improved, along with her memory. She wasn’t exhausted all the time. She wasn’t depressed any more and was once again able to look on the bright side. She even started doing some simple exercises for the first time in her life. Thank you for giving all of us this important information.”
Benzodiazepines can cause unsteadiness and dizziness as well as confusion in older folks. Flurazepam, in particular, should not be prescribed to senior citizens. There are many drugs that are equally inappropriate for people over 65 such as amitriptyline, cimetidine, clonidine, nifedipine and oxybutynin.
Because many physicians and pharmacists are not familiar with the “Beers” list of drugs that older people should generally not receive, we have summarized it in our book, Top Screwups Doctors Make and How to Avoid Them. It is available in libraries and autographed online at PeoplesPharmacy.com. In addition we discuss medications that can rob older people of mental acuity and put them at risk for falls.
Just as parents and pediatricians need to take special care to protect children, doctors and family members need to be alert for medication hazards that could harm older people.