University of California, San Diego
Special from Bottom Line's Daily Health News
November 25, 2004
A re you tossing and turning at night? Take a sleeping pill. Nervous around other people? Try an antidepressant. Balding? Have trouble in the bedroom? There are pills for just about everything these days.
Americans are overmedicated, and as a consequence, we suffer millions of avoidable side effects. To make matters even worse, one of the most vulnerable segments of the population
AN EPIDEMIC OF SIDE EFFECTS
To learn more about drugs and the elderly, I spoke with Jay S. Cohen, MD, associate professor (voluntary) of family and preventive medicine at the University of California in San Diego. Dr. Cohen is author of What You Must Know About Statin Drugs and Their Natural Alternatives (Square One) and Over Dose: The Case Against the Drug Companies (Tarcher).
He told me that drug reactions in hospitals lead to some 100,000 deaths a year, making them one of the leading causes of death in the country. Once hospitalized, older people face the greatest risk of a serious medication reaction or medication-related death. Although people over age 60 represent 19% of the population, they account for 39% of hospitalizations and a shocking 51% of deaths related to medication reactions.
DOSING DANGERS
In Dr. Cohen's view, dosage plays a major role in this problem. He points out that it is not medically rational to prescribe the same amount of medication to a young person the size of a professional football player as to a tiny 80-year-old grandmother
RESEARCH SUPPORT
In a recent study at Duke University, it was revealed that at least one in five older Americans take an inappropriately prescribed drug. At Duke University, researchers reviewed the 1999 prescription drug use of more than 765,000 people age 65 and over who were enrolled in a major medication benefits plan. They compared their medication use to the 1997 Beers Criteria, a compilation of drugs that are associated with thinking and alertness problems and that likely lead to an increased risk of falls (a major health problem in the elderly that can lead to broken hips, disability or even death). An update of the Beers list, reflecting recent findings, was published in the December 8, 2003, issue of Archives of Internal Medicine. Researchers found that 21% of seniors in the study filled a prescription for one drug of concern, and 4% filled prescriptions for three or more of these drugs.
The drugs of concern include mood-altering drugs, such as...
- hydroxyzine (Atarax)
- amitriptyline (Elavil)
- flurazepam (Dalmane)
- chlordiazepoxide (Librium)
- diazepam (Valium)
- doxepin (Adapin and Sinequan).
... and muscle relaxants including...
- cyclobenzaprine (Flexeril)
- chlorzoxazone (Parafon Forte)
- methocarbamol (Robaxin)
- metaxalone (Skelaxin)
- carisoprodol (Soma)
The most commonly prescribed drugs on the list were Adapin and Elavil.
WHY OLDER PEOPLE ARE MORE VULNERABLE
Given that there are many safer alternatives, observes Dr.Cohen, it is troubling that so many drugs are prescribed inappropriately for the elderly. He explains that there are several reasons why seniors are especially prone to side effects...
- Due to their diminished kidney and liver function, older people process drugs more slowly than younger people. This causes blood concentrations of drugs to reach higher levels and take longer to be eliminated.
- Most seniors have multiple illnesses. According to Dr. Cohen, 78% take at least one prescription drug and 60% take at least one nonprescription medication. The average older person takes three drugs daily. This means a greater risk for side effects and drug interactions.
WHAT YOU CAN DO
- Do your homework. Learn all you can about the condition you have, the medicine you take for it and the possible side effects (such as problems with thinking and alertness) and drug interactions. Ask your doctor and pharmacist questions, and carefully read the package inserts. You also can learn more about medications at such Web sites as MedlinePlus (www.nlm.nih.gov/medlineplus/druginformation.html) and PDRHealth (www.pdrhealth.com).
- Stress to your physician that you want to use the lowest effective dosage of medication. Older patients are hurt by the one-size-fits-all mentality of drug prescription, says Dr. Cohen. Newly introduced medications are typically offered at identical doses for young and old, well and infirm, large and small. However, in many cases, lower doses of drugs are safer and still effective for older people.
- Report side effects to your physician, and insist that he/she take your concerns seriously. A problem peculiar to older people is that their doctors frequently attribute side effects to illness or the effects of aging. If an older man feels that his focus is not what it once was or a senior woman thinks that her memory is vague or her balance is off, it is often attributed to old age. In many instances, however, the problem could be remedied by adjusting the dosage of medication. If your physician doesn't want to consider this, Dr. Cohen recommends considering changing physicians.
- All things being equal, ask for the drug with the longest track record for safety. With the blizzard of drug ads being directed toward consumers and doctors alike, it's tempting to think that the newest drug on the market is the best one. However, this is not always (or even usually) the case. Often, a medication that has been around for longer is just as effective, safer, less expensive and perhaps most important, has the longest track record of experience for side effects.
Well informed is well armed. Whatever your age, but especially if you are elderly, there are many steps that you can and should take to protect yourself from dangerous side effects and drug interactions. Daily Health News contributing editor Andrew L. Rubman, ND, notes that certain naturopathic interventions, such as increases in B vitamins and fiber, can improve the function of your liver and digestive tract, thus reducing risk for some side effects.
Source
- Jay S. Cohen, MD, associate professor (voluntary) of family and preventive medicine, University of California, San Diego. Dr. Cohen is author of What You Must Know About Statin Drugs and Their Natural Alternatives (Square One) and Over Dose: The Case Against the Drug Companies (Tarcher). Visit his Web site at www.medicationsense.com
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