Anyone who has ever driven an old jalopy knows that eventually things break down or wear out. Keep a car long enough and you will have to replace the fuel pump, hoses and belts, not to mention the transmission.
Older people sometimes need replacement parts as well. Hips and knees may give out after decades of hard wear. Sometimes the pump called the heart needs some extra support, and if the plumbing springs a leak, drugs like Detrol, Ditropan or Toviaz may be prescribed to help control incontinence.
The only problem is that unlike cars, people may react badly to some of these interventions as they age. Some of the most worrisome reactions are those that affect mental function. One reader shared her experience:
“I found that dosages or drugs that may be fine if you are 50 or 60 may be very dangerous as you get older unless the dosages or the drugs are changed. I was 70 when I was diagnosed with dementia by a neurologist (moderate dementia with Alzheimer’s symptoms). This was after a year of losing my memory and my sense of balance. I was so far gone that the diagnosis meant little to me, although it was crushing to my family.
“I was taking several prescribed antidepressants (Zoloft and Wellbutrin) plus Neurontin. My daughter, a nurse who had studied Neurontin, was convinced the problem was due to an interaction of Neurontin with the antidepressants.
“My doctor, a psychiatrist, reduced the Neurontin and I was better within a few days. By the time the Neurontin was phased out completely, I was back to normal. I suspect that many older people, especially in nursing homes, have similar problems that aren’t discovered.”
This reader may well be correct. A recent report points out that drug reactions account for up to 5 percent of hospital admissions; the rates are higher for older people (Archives of Internal Medicine, July 12, 2010).
The more medicines a senior citizen takes, the more likely there will be drug-induced complications. Symptoms such as dizziness, depression, drowsiness, insomnia, confusion, constipation and fatigue can be caused by medications that are supposed to be helpful. Sometimes a medicine is absolutely essential, but far too often the drugs that are prescribed may be inappropriate for older people.
The antidepressant amitriptyline is just such a drug. Except in rare circumstances it should not be given to seniors. Here is an example of what can happen:
“Thank you for your article on amitriptyline. My 85-year-old husband has been taking it for years, but within the past eight or nine months his memory has gotten much worse and he is easily confused. He went off the drug last month and is now just about back to normal.”
Amitriptyline is not the only culprit. In our recently revised Guide to Drugs and Older People, we list a number of medications that are often inappropriate for seniors.

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  1. Pat
    United States
    Reply

    Been on welchol for about a month, but gives me intolerable back pain and urinary incontinence. What is your thought?

  2. Shirley
    Reply

    Louise,
    My husband did not tolerate Crestor and Lipitor either, nor Welchol. He finally did end up with PRAVASTATIN. I’m not sure how it has effected him because he has so many meds also. He hasn’t noticed. But I changed his dosage from 40 mg to 20 and it works fine. I am using SIMVASTATIN, which I also changed from 40 mg to 20 mg. But if you do not want the STATIN drugs, which we really don’t, but are on anyway, try 400 mg of natural Vit. E or/and CINNAMON capsules. Another is RED YEAST RICE if you can afford it. IT WORKS! You can also just sprinkle a teaspoon of cinnamon on your foods, but you eventually get tired of it.

  3. Cadge
    Reply

    My husband just turned 63 and is having serious short term memory problems and inability to finish sentences and pronounce words. He had a closed-head brain injury during a hit-and-run car accident 10 years ago, but was not rendered unconscious. He started having hand tremors about a year ago, was diagnosed with Essential Tremor and was put on 25 mg. Primidone.
    He has since increased to taking 25 mg. Primidone twice a day due to increased tremoring. The tremors are currently under control. He is a builder in So. Calif., and thus has also been out of work for 1-1/2 years. Thus, the neurologist has him on 10 mg. Atalopram Hydrobromide (Celexa) for depression (lack of drive, inability to concentrate/focus, sleeping long hours). He started having what appeared to be TIA’s, where he would have lapses of inability to speak (he described it as “can’t get the words to come out of his mouth”) so he was put on Plavix, with no improvement. (Family history of strokes.)
    He has since been switched to 200/25 mg. Aggrenox, twice a day for the “TIAs” and has improved, but is still having trouble forming words on a daily basis (although it’s not an issue of getting the words out now, but rather of slurring the words when he does speak). The neurologist recently put him on Simvastatin to bring down his cholesterol numbers, but he had a bad reaction, so he has been taken off that and will be starting Niacin this week.
    I have had suspicion that the medications were causing some of his problems, and this morning I read the article you published in the Daily Bulletin. We recently decreased the anti-depression meds to half on our own, and that has helped some of the problem, but he had a bad reaction when we tried to take him off totally.
    Where do we even begin to get a second opinion on the medications he’s on? I feel the doctors see a new problem and “throw” a new medication at the problem to solve the problem, but I wonder if it’s making other things worse, or even creating some new problems. Is there a pharmacologist who can look at the drugs he’s on and make a determination if the mix of chemicals is doing more harm than good? Help!

  4. Louise
    Reply

    My husband has taken Lipitor for 15+ years. Only the last 5 years has he experienced any of the side-effects we read about in Lipitor. We stopped taking it last year for about 3 weeks. Routine doctor apt. had been scheduled at end of the 3 week period. Blood test before doc apt showed his cholesterol had gone up to 276. It had been down to about 180. Doctor could not understand why the increase until I told him we had cut out the Lipitor.
    He said “If my patients would listen to me and quit doing what the Greadons told them we’d all be better off.” Because my husband has diabetes (type 2) brought on by brain tumor surgery in 1995 our doctor said it is important that he be treated as if he has already had a heart attack. (He has not, but has had a small stroke.)
    The doctor we see now is not the one who originally put my husband on Lipitor, but both of the docs believe that Lipitor (statin drugs) are “the best think since sliced bread”. So…………what are your suggestions as effective alternatives?

  5. Greg Pharmacy Student
    Reply

    In elderly people we learned in pharmacy school that a new symptom should be considered a drug adverse reaction unless it was ruled out.
    Interestingly a simple urinary tract infection can also mimic dementia. I think you have mentioned this on your site before.

  6. MMS
    Reply

    My husband was given Motrin for pain and it caused hallucinations. The Aleve did the same thing. My daughter noticed the effect and demanded it to be stopped. The hallucinations stopped and have never returned.

  7. sdw
    Reply

    My elderly mother was diagnosed with Alzheimers and could barely recognize me or carry on a conversation. Another doctor diagnosed her with having low vitamin B and after about 3 months of megadoses of B vitamins, she could carry on a conversation and was seem to shake of many of problems of Alzheimers for a couple of years.

  8. DB
    Reply

    My 80 year old mother was having mild symptoms of dementia and Parkinson’s. Her memory was failing, and she was getting confused easily. She was also starting to have tremors and shaking in her hands. I suspected she was being over-medicated because every time she went to the doctor he would give her another drug to take, but never take her off anything.
    I finally insisted that my mom go to a different doctor, and sure enough, that doctor immediately said my mom was being very over-medicated. Not one of the specialist she was seeing ever mentioned she was taking too much medication, until her new primary care doctor told us. So now, months later, we have her medications straightened out, she is doing much better.
    Memory and all cognitive functions have improved and the tremors and shaking have stopped. She’s back to exercising, driving, and all the other activities, she didn’t have the energy to do before. I would highly recommend anyone with an elderly parent having signs of dementia, have their medications evaluated by a different primary care doctor. If no other reason than to confirm that what your doctor is doing is the right thing.

  9. S.H.
    Reply

    When I was 54, I was put on Crestor, then LIPITOR; within weeks I could not finish sentences. It was awful; you don’t have to be OLD to have dementia symptoms caused by meds; when I would stop the lipitor (after suspecting it) I got better; then, when I started back on it, I was right back where I was before: not being able to finish sentences with short term memory problems; I finally quit the stuff; by the way, I ached all over and my bones ached, also. (MY family Dr. told me that he could not tolerate statins, either.)

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