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.
Like many older people, Henry has been prescribed so many different drugs it is almost impossible to keep everything straight.
He needs insulin and metformin for diabetes; digoxin, Lasix, warfarin and K-Dur for his heart; albuterol, prednisone, salmeterol, and triamcinolone for a breathing problem; esomeprazole for heartburn; and amitriptyline for neuropathy and fibromyalgia. In addition to these dozen different prescription medicines, Henry uses over-the-counter ibuprofen for inflammation and milk of magnesia for constipation.
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. Testimony before the Senate Special Committee on Aging detailed the extent of the problem over a decade ago.
Data have shown that more than one in six Medicare patients receive at least one inappropriate medication. In Henry’s case, amitriptyline can cause brain fog, confusion, dry mouth, unsteady gait and constipation and should rarely, if ever, be prescribed to someone over 65.
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. When an older person has a heart attack, it is frequently attributed to age or an undiagnosed heart problem. Ibuprofen, celecoxib, diclofenac, meloxicam and other NSAID-type pain relievers can all increase the risk of a heart attack. Rarely are older people warned about such a serious side effect.
As America ages, medical schools will have to improve the way they teach geriatric pharmacology. Older people are far more vulnerable to side effects from many drugs.
Until that day, however, patients will need to watch out for themselves. Often their grown children find they too need to know more about their parents’ medications.
We have prepared a Guide to Drugs and Older People that lists medications considered dangerous for the elderly as well as those that may contribute to confusion or falls. There is a section about avoiding overmedication so you don’t end up like Henry, a “walking drugstore.”
Here is a link to our Guide to Drugs and Older People.
Henry needs one physician to review all his medications. That person should spot medication mistakes such as amitriptyline or the scary combination of ibuprofen and warfarin that could lead to a bleeding ulcer. With careful supervision, it may be possible for Henry to simplify this drug regimen and reduce his risk of serious side effects.