Seniors' Big Drug Problem

Misusing medications is a leading cause of death among the elderly

The doctors thought Alice Stora was dying. And maybe she was. But it wasn't a disease that was killing her. It was the cocktail of prescription drugs she was taking. Stora, 88, living with relatives in Florida, was bedridden and often incoherent. Her weight had dropped to 88 pounds, and doctors said she had just a few months to live. Last May, a son and daughter-in-law, Carl and Inda Stora, brought her to Monroe, N.Y., to live with them. They found she was taking a dozen different prescriptions. Her new doctors eliminated many of the medications, scaled back others, and changed her diet. Now Stora is up and around, and writing letters to friends. She has regained almost 20 pounds.

Stora was a victim of a silent epidemic that afflicts millions of seniors. Everyone knows the benefits of pharmaceutical drugs. But many of those same medications are inappropriate for seniors or can be deadly if taken improperly or in combination with incompatible remedies.

Such adverse reactions are increasing as the elderly use more and more drugs. Today, 40% of seniors take five or more prescription drugs a week, and 12% take more than 10, along with vitamins, herbal supplements, and over-the-counter pills. The result: Medicines themselves have become the fifth leading cause of death among seniors. Top gerontologists now consider drugs the prime suspect when a patient has new symptoms. "This is a major issue," says Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School. He estimates that drug-related injuries among seniors number as many as 2.3 million each year -- nearly 200,000 of them fatal or life-threatening.

The problem is especially serious when it comes to sedatives, antidepressants, and antipsychotic drugs, as well as pain medications -- all commonly prescribed for seniors. And because frequent drug reactions include falling, dizziness, and confusion, many doctors simply write off these dangers as a consequence of growing old. Or they mistake them for symptoms of other diseases and prescribe still more drugs. The more meds seniors take, the more likely they'll get into trouble. Some take the wrong doses, some take their meds at the wrong time of day, and some stop using medicines that they do need.

COORDINATING CARE

A huge part of the problem is lack of knowledge and communication among health professionals, patients, and families. Because seniors commonly suffer multiple illnesses, they see many doctors. They may also buy drugs from several sources -- the local pharmacist, mail order, or online. That means that seniors, or their adult children, need to take a bigger role managing medicines. "Assume that doctor A is not talking to doctor B," says Nancy Fiedelman, a McLean (Va.) geriatric care consultant. "You have to take responsibility."

To start, make a record of all the drugs a senior is taking. "Keep a list of the name of the drug, the dosage, and how often they really take it -- not just what it says on the vial," says Diane Crutchfield, a Knoxville (Tenn.) consulting pharmacist. "And note the pharmacy, the doctor's name, and phone number." Also keep track of over-the-counter drugs, vitamins, and herbals. They may seem benign, but some, such as Benadryl, can be very dangerous for seniors. So can combining anti-arthritis medicines such as Celebrex with pain relievers such as Motrin or Advil.

You should also find out all you can about each prescribed drug. Ask the doctor what the medication is for, whether there are alternatives, what are the side effects, and how the medication reacts with other drugs. You can also check Web sites for information. Another good resource is the pharmacist. Get as many medicines as possible from one source. And choose a pharmacist who is attuned to seniors' needs, such as a certified geriatric pharmacist. Make sure each of the senior's doctors has the list of drugs. The best will ask patients to bring their medications with them during an initial visit. But in today's world of in-and-out medicine, many doctors won't take the time. If your elderly relative is seeing several doctors, ask one to coordinate care. An internist or gerontologist is best suited for this overseer role. Specialists should know to contact that doctor when they change meds.

If you don't think the physician is on top of things, you can retain a geriatric care manager, who can coordinate and monitor all aspects of elder care. One source for such help is the National Association of Professional Geriatric Care Managers (caremanager.org). Or you can hire a consulting pharmacist (ccgp.org), who will review medications and work with your doctors to manage them. Expect to pay $100 to $150 an hour for a care manager and $60 to $120 an hour for a consulting pharmacist.

Whoever you pick, stay involved. "Somebody needs to be monitoring this," says Susan Johnson, a Bethesda (Md.) care manager. Inda Stora says she learned that lesson, too. "I'm always asking questions," she says. That has made all the difference for her mother-in-law.

By Howard Gleckman

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