The People's Perspective on Medicine

No One Is Watching Out for Older People’s Medications

A nursing home insider describes lack of oversight for older people's medications that can lead to confusion, dizziness and falls.
Senior sitting behind a lot of pill bottles holding his head in his hands isolated on white

As we get older, things change. We can see the gray hair cropping up, and try as we might, we can’t hide the wrinkles. (At least, not entirely.)

Interior changes aren’t so visible, but aging also alters our ability to metabolize medicines. Kidney and liver function may become compromised, so that doses should be lowered. Doctors need to take extra care with older people’s medications.

Drugs Upon Drugs:

Perhaps that is why older adults are more susceptible to some drug side effects. Too often, the response to that is a new prescription, so that a person may end up with drugs to treat side effects of medicines prescribed for a side effect. Some of these medicines may affect a person’s cognitive capacity.

Who Is Watching Out for Older People’s Medications?

Q. I work in dementia care. My co-workers and I are all alarmed about the medications given to elders.

In care homes, we all know that when someone gets a new medication, a fall may not be far behind. We are used to elders arriving on 10 or even 20 different medications, none of which have been reviewed before. We’ve even seen someone arriving with three different depression meds, started at three different time periods with none of them being discontinued.

Neglect of Older People’s Medications:

In the world of elder care, alas, we see disgraceful neglect in the world of medications. It would be a really good idea for a pharmacist to be required by law to review an elder’s meds.

A. We have long suspected that too many older people are overmedicated. Nursing home residents and patients with Alzheimer’s disease are especially vulnerable. Thank you for sharing an insider’s perspective.

The more drugs senior citizens take, the more likely they will experience fatigue, forgetfulness, confusion, dizziness and falls. Family and friends should be vigilant and request a review of all medications on a regular basis. To make this easier, we offer our Guide to Drugs and Older People, which lists a number of drugs that are inappropriate for people over 65, along with our Drug Safety Questionnaire, to be filled out by the prescriber or pharmacist.

Because the consequences of overmedication can be so serious, including confusion or falls, it is imperative that we find better ways to offer oversight on older people’s medications.


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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    Many nursing home patients have behavior problems compounded by the fact even though they have Alzheimer’s disease, they still do not want to be in there–but their families impounded them there. IF a nursing home inmate attacks staff or other inmates in that facility, they WILL be sent to a psychiatric facility for medications to control their behavior. However, if the inmate *again* attacks staff or other inmates, they will be once again sent to that psychiatric facility–nursing homes are not mandatory. They will REFUSE readmission if their behavior is not put under control. Another facility may or may not take them. Eventually they will burn all their bridges and nobody will want them. So it’s back to the family. While family likes to complain about the psychiatric meds, they should take care of their own kin and see how it’s like.

    Take an elderly man, weighs 200 pounds, tall and broad, and fat. Then take an elderly man, skinny, short, and a bit more active. Does the doctor write the same prescription for each?
    Or take these two patients: one has been on some kind of medication most of his life. The other has never taken anything but an infrequent aspirin. Doctor writes same prescription for both?? Does he?
    I know I can get by with 1/4 of the prescription daily amount that is written on the prescription pad. I am scolded about it though. The entire amount does crazy things to me.

    I worked where there was a man dying. The family was called and one of them was smart! He asked that his father be taken to a hospital in another town, so he was, and got a different doctor. The second doctor took him off almost all his medications. He said the man is dying from all this medicine. The patient pulled through and lived many many more years. I was there and I saw it.

    I had the same problem with my mother when I was her carer. I knew a new tablet she had been prescribed was giving her stomach problems but I was told it was impossible. Finally I decided to go over her Doctors head and went to the head of medicine. He was a very understanding gentleman and said while he could not find a reason for the side effects he had an elderly mother of his own and he knew it was causing my mother destress and wrote me a letter to give to her Doctor.

    At the time I thought how terrible it is to get elderly and be at the mercy of people who put everything down to age. Regarding medications I have always thought that everyone regardless of age should have long term medication reviewed regularly, even weight loss can affect the dosage, and certainly what suits you in your fifties will not do so in your seventies. Even change of lifestyle can affect the strength of blood pressure tablets. Also a lot of tablets have several E numbers in them and I personally had terrible upset stomachs from them and had to change my chemist in order to get the one that suited me.

    I think the onus should be on the Chemists as they are the experts and they are dispensing these very dangerous drugs. Care homes are a disgrace nowadays with good ones few and far between. These homes really need to be monitored very closely as not all people are lucky enough to have relatives to check on them. Some hospitals too often overlook the obvious, I remember when my late Mother was in one an elderly lady was brought in from a care home for treatment, she seemed in a lot of distress, I asked a nurse was she alright and was told she moans and moves like that all the time because of dementia. However the following day the lady seemed worse and I watched her closely and came to the conclusion that she was in terrible pain and it seemed to be her back. I must add here she was deaf and blind, I mentioned it again to a nurse to no avail so luckily enough her family visited that afternoon and I mentioned it to a relative and advised her to ask for a Dr. The outcome was the poor woman’s back was covered in infected bed sores.

    The Dr himself treated her and I’m glad to say that night the moaning and agitation put down to dementia stopped. We all have a duty to be alert and speak up for the vulnerable in society.

    Sadly, it’s all true: older adults are taking way too many medications! Many of these meds would not be necessary if they were instead guided towards steps to a healthier lifestyle.
    Adding to this problem is the fact that many of the meds taken have disastrous interactions with each other. As a certified drug and alcohol specialist and gerontologist, I’ve been studying this for some time and astounded with the depth of this problem in our country. The big pharmaceutical companies have nothing to gain by advocating for safety and health, in fact it runs counter to their methods of amassing huge profits.

    The good news is that there is far more awareness of this vast problem, and people are looking for solutions. more on this later…gotta go!

    I’m not bashing doctors, on the contrary, but we do need to be trusted and heard and that includes listening to our concerns, complaints, and requests, from healthcare providers and physicians., and family members. We elders do take care of ourselves but we completely trust professionals to our other health needs and for someone to suggest otherwise is a blow to our integrity and intelligence. We don’t suddenly stop. However, some do become lax just due to general aging. I’m pushing 70. I DO take care of all of my responsibilities and my partners (he suffered a brain injury & is partially paralyzed on one side). I also advocate for other seniors plus care for other members of my family. It would help if assistance were offered by other family members when elders are or could be in need of minor care. And above all, respected and looked up to, not down upon because of age!

    I’m 80+ years old, and it’s been my experience that doctors have given (or tried to give) me too much medication too quickly. None of them seem to realize that old people’s bodies are as you say, different, and the side effects can be worse than the original problem.

    The last time I was in the hospital, one of the nurses called my daughter and asked “How can we get your mother to take her pain medication?” because I refused it when I felt I didn’t need it– and it was prn! The net result of all this is that I now turn to Dr Google for advice and avoid flesh-and-blood MDs as much as possible.

    In the past year Dr Google diagnosed my diverticulitis and designed a diet for me, and I’m doing nicely thank you. I shudder to think what I would have had to go through if I had consulted my geriatric specialist.

    It’s a well know fact that medicines affect something look at the pamphlet that comes with medicines you take. I’m so glad that I don’t have to take any medicines. It scares me when I see people that have to take so many medications.

    It’s not only medications that we should worry about. Last Feb. I went to the ER, diagnosed with diverticulitis. I was given 2 antibiotics. One was Cipro, the other began with an M. I was to take them for 10 days. I quit after 5 days because from 8 a.m. to noon, I was having 6 to 7 bowel movements. I called my personal care physician, and he agreed with me. The antibiotics were just too strong for my delicate 86 y.o. intestines. Since that time, pardon the expression, my stool hasn’t been the same. Doctors must be aware of the patient’s age before they prescribe strong antibiotics.

    My husband was in a beautiful, expensive rehab facility after his stroke. They assured me they would give him personal care, not to worry. After only five days, he was hallucinating and had nightmares, became psychotic, fearful, combative, spoke inappropriately to the nurses, etc. I didn’t even know this person.

    When the psychiatrist came (that I asked for), he said “your husband is on NINE different medications! Three would be more than enough.” I took him home and got rid of everything but his blood pressure meds. Then he got better. My point is: You, or your loved one, must be diligent at all times, and take charge of your care. Ask questions!! Don’t just rely on the health care workers to make the right decisions. They are most often overworked and take the easy way out. And if you are not comfortable with the doctor, by all means try some one else. They are not gods!!!

    Thank you for this article about “no one looking out for old folks medications”. My elderly mom had started falling so often that my siblings and I were seriously considering nursing home care. My brother gathered all her medications and took them to her doctor. A review of the meds showed that mom was on 6 different blood pressure medications. Every time her medications were changed, the old one was not discontinued. Neither her doctor nor the pharmacist had caught this. It has now been over a year since mom’s medications were corrected. She is now 92 years old. She has not fallen even once since the adjustment to her meds. She is still living at home.

    I think the fewer the drugs the better. I prefer to use diet, exercise, etc. as ways to control blood pressure, cholesterol, etc. I take a multi-vitamin and some herbs. I was on Lisinopril because my blood pressure was a little high, but it made me cough so I quit. I take one cayenne capsule twice a day as a way to control my blood pressure. It’s working for me.

    When my father had some health issues two years ago, I suspected that his medications were not being overseen adequately. I got the list of the seven medications he was taking and I researched them, made bubble maps of possible side effects for each drug, and then created a spread sheet. Yes, it was a bit of work, but extremely revealing.

    Potential side effects:
    For all seven of them were dizziness, and weakness (he had fallen twice).
    Five medications were fast heart rate, nausea, and blurred vision.
    Four medications were confusion, headache, shortness of breath, bruising easily, and swelling in hands and feet.
    Two medications were slow heart rate, uneven heart rate, lightheadedness, skin rash, depression, fatigue, and elevated blood sugar.
    There were many other side effects listed for just one medication he was taking.
    I won’t even go into possible interactions I found between the medications with each other, food, alcohol, and tobacco.

    At that time he was diagnosed with dementia, heart problems, diabetes, high cholesterol, stomach problems, and hypercalcemia. He changed doctors and medications. With proper oversight many of his diagnosis and most side effects have faded away.

    It’s scary to think that some doctors are not thoroughly reviewing their elderly patients’ meds. It also concerns me that we, the elderly, do not take more responsibility for our own health. Eating the right foods, exercising, strength training, balance training, getting adequate sleep – these are so very important for maintaining good health. How often do people just go for the quick fix – pills? We need to ensure people are educated about all the factors that impact quality of life, and we need to stop relying on our doctors as the ultimate authorities. Even good doctors cannot be aware of everything. We are primarily responsible for safeguarding our health.

    Most people do at one time or another fall off track with personal healthcare though usually those misdeeds are minor and easily retracted via attention given and dedication to oneself. Elders main misgiving is neglect by others leading to loneliness and seclusion … We’re still the same people with the same feelings but we may require more attention to overall personal detail but when friends and or family members shy away because one member isn’t able to keep up due to various reasons not just health, those seniors get left out and or left to themselves. It’s a shame we think they’re ok in those situations but tend to think they’re senile if they suffer minor or serious illness or other health concerns we are not aware of. Funny how we tend to catagorize the elderly.

    I think that older people’s medications should be monitored by a pharmacology expert but not necessarily the person’s doctor. I just had a dreadful experience with a doctor who, when I walked into his office to get my two prescriptions renewed, told me that I should have gotten a letter from Medicare saying that no one over 65 should be given clonidine and that Medicare would not allow him to write a new prescription for clonidine for me.

    I have taken a combination of Norvasc and clonidine for 17 years after spending three months in and out of the hospital before my doctors finally tried clonidine and found that it worked. I know the implications of the drug and I am careful with it and respectful of it. If I were past 80 and had mild dementia, I would agree that I should be given something else. But I am still capable of managing my medications.

    The doctor refused to try to taper me off of the drug. He refused to say that he could put me in the hospital and try something different. He suggested lisinopril with my record of severe reaction to ACE inhibitors right there in front of him. My initial fear turned to anger, and I fired him on the spot.

    When we got home, my husband and I got on the phone to Medicare, to Silver Script, to our Employees Retirement System of Texas who underwrites the Humana MA PPO that we have and to Medicare Rights. We learned that no such “letter” was ever sent to anyone. That Clonidine may not be smart for some older people, but it has not been banned. That I should have been given a transition prescription for both medications while I try to find a new doctor. Etc.

    In other words, this doctor lied and also refused care and transition prescriptions, putting me in very real danger. I ended up getting a two week refill at a local urgent care center. But I am really, really angry. This is the second time a Baylor doctor or his staff have created this kind of issue for me. Clonidine cannot be stopped point blank without the danger of a possible stroke or heart attack, not to mention less threatening but nonetheless bad withdrawal issues.

    My reactions to drugs of any kind have always been pretty negative. Contrast dye caused a cardiac arrest. Levaquin caused days of hallucinations and five different cardiac arrhythmias, one of which is still with me. ACE inhibitors cause a dreadful cough. I lost five years of my life to a beta blocker years ago and don’t want to risk that again. Norvasc and clonidine have been the only combination that will control extremely labile blood pressure, and while I tried to take the generic form of Norvasc, that wouldn’t work either.

    I have to have name brand Norvasc and a clonidine tablet that is made by one particular manufacturer. So, I don’t take much in the way of prescription drugs. Have never had a flu shot because of certain allergies, but , at age 73, I have never had a cold or the flu either.

    I lost a good friend several years ago, and when she died she was taking 21 prescription medications. My husband’s brother died the same way. Another friend’s husband bled out from blood thinners. My husband takes nine prescription medications. I keep an eye on them and told him that he is now being given meds to counter side effects of other meds. Not good. I lead a “Seniors Coalition” here in Dallas and one of the things we are working on is partnering with pharmacologists at Southwest Medical School to monitor the meds of older people for safety and efficacy.

    Its doubtful that Medicare would say that. A Medicare Advantage Plan might though and that might have been the case. I use to review statistically which physicians prescribed which drugs, how often and for whom.

    If a physician/drug fell “out-of-range”, exceed some limit or deviated too often from the formulary, they could be reprimanded, even have their capitation terminated.

    Your only alternative would be to find another plan and/or another physician more suited to your needs.

    My sister suffered from liver and kidney failure and when I visited her weeks before she died she was still taking 7 separate medications one being 500mg of Tylenol as well as blood thinners, 2 separate diabetis drugs, BP medications and I can not remember the other 2 but all I could think of is there is no wonder why she is suffering from liver and kidney failure and how long she had been on the medications She was at home but a nurse came to her house daily to administer her drugs , she was 75 years old!

    I have witnessed this problem first hand. Many nursing homes are guilty in over medicating patients with drugs that cause major problems. I personally fought one who insisted that my mother needed a certain drug. They gave it to my mother without my approval or knowledge. I noticed my mother could not function and was fast loosing her cognitive functioning. l

    Thank you for this warning. Too many elders are taking too many medications.

    Right now I am not on any medicines after what I’ve been through, especially with statins. I’m 69 and I hate to take meds if I don’t have to for the very reasons you mention in the article. It is a vicious circle of prescription drugs. I was full of pain and so crippled up after being on various statins for a while, especially Lipitor that I could barely climb stairs and holding onto things to get up from a sitting position.

    So I started taking Advil which brought it’s own set up side affects such as high blood pressure, falling down all of the time because my mind was telling me to pick up my left foot but it wasn’t happening which cause me to trip. And now I have plaque buildup on my arteries. I also read where too much Vitamin C can cause a buildup of plaque. Maybe 600 mg of Calcium with Vitamin D isn’t too much for some people but can very well be too much for someone else. Meds and Vitamins affect each person differently.

    Doctors are really scary and we have to take action for ourselves. Look how many people die each year because of doctors giving meds that shouldn’t be given.

    I agree, It is the same in UK. my wife had Alzheimer’s and I could cope until she lost the use of her legs. I put her into what I thought was the best nursing home.
    I visited her every afternoon and but one Monday morning found her crying and said the staff did not have any medication for her and showed her the blister pack, She then noticed that they had not given her the nights be fore’s medication.
    Needless to say I had plenty to say to the Manager. Every week for the four weeks my wife was in there a problem with medication. some times it was an overdose .I naturally moved her to a different home.

    I am 86 years old and have too frequent urinary infections. Or are they really infections? Doctors disagree. Results from urine specimens give a small degree of indications that infections are there. Some doctors offer antibiotics (which wipe out the good results I get from probiotics for IBS. ) Other doctors say they do not.

    I have seen four Urologists recently. The last one I saw, who belongs to a large group of supposedly well qualified Urologists, after looking at the results of several lab tests, said I had not had infections. He said I had an overactive bladder. He prescribed a medicine for it and declared, before I even asked, that this medicine had absolutely no side effects. Not so! I looked it up on National Library of Medicine and Mayo Clinic. These sites indicate that no research has been done on the elderly. Both named several side effects, some immediately dangerous.

    One common side effect is that it raises blood pressure. My blood pressure normally runs from 160’s to 180’s over 80, has for 20 years and, in a doctor’s office, it can go as high as 200. Doctors scare me! I am taking 20 mg daily of Lisinopril. This doctor did not take my blood pressure nor did he ask for a list of medicines I am taking. He gave me an ample supply of the medicine to reduce an overactive bladder and called in more to my pharmacist.

    I asked my pharmacists to not fill the Rx currently, but to put it on file. I think people over 85 are written off by younger doctors and other younger people. It sounds “so old” to them. We are out here and this seems, to us, the most important years of our lives. We gain wisdom from our view at the top of the mountain connected to our past years–a fuller picture. We know our cells are dying and we are feeble and worn, but, as long as we keep our minds, there is great meaning and joy in our lives. In 1985, when she was over 90, I asked my aunt, “What is the best way to stay healthy?” She said “Stay away from doctors.” I can’t say she was far from wrong.

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