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Joel S. Ross, MD |
MD FACP AGSF CMD CPI |
President and Founder |
Memory Enhancement Center |
of America, Inc. |
4 Industrial Way West, 2nd Floor |
Eatontown, New Jersey 07724 |
732.571.1535 |
« Protect Your Most Valuable Asset, Your Memory | Home | Why Alzheimer’s Disease, should be renamed Reagan’s Disease. »
Americas Seniors: The Overmedicated Society?
By Joel Ross | January 11, 2008
AMERICAS SENIORS:
THE OVERMEDICATED SOCIETY?
The value of a geriatric consultation
By Joel S. Ross, MD, FACP, AGSF, CMD
Geriatric Specialist
I saw an elderly patient recently who came for a geriatric evaluation. She had recalled how 15 years earlier I had cared for her husband, and said “you were so caring for my husband and I hope you can help me”. She sought my attention for a persistent weight loss problem associated with a decreased appetite.
Review of her medications indicated she was consuming each day over 14 different prescription medications prescribed by many different specialists.
Many of her medical concerns did not require medications, but rather a careful exploration of possible causes and then testing for certain diseases and if necessary removal of certain medications.
I removed 10 of her pills which had no clear medical reason to be continued and one week later her appetite came back along with several pounds weight gain. Today she is only taking 3 medications and is once again enjoying a good quality of life.
This one of but many examples of how the senior citizen is often overmedicated.
As Medicare recipients can see as many physicians as they feel necessary, they frequent the “specialists” again and again, with the result often of many medications prescribed with little time to explain the potential dangers of drug toxicity/side effects. Let’s look again at a typical geriatric patient who I saw recently:
She had back pain and visited first her general practitioner who prescribed physical therapy and an anti-inflammatory medication. Not happy with the pain relief she then sought an orthopedist who prescribed a narcotic for the pain. The pain continued and various x-rays, CT scans and MRI’s of the spine were done. She saw an advertisement for a pain specialist and made the appointment. She was given several shots in her back and still only moderate relief: however a narcotic patch was given.
She became lethargic and depressed and her family heard of a good neurologist who felt she was indeed depressed and prescribed an anti-depressant. She became dizzy while on all the pain medications and the anti-depressant and then sought a cardiologist. (All of these specialists were seen without the knowledge/endorsement/referral by her primary care physician). The cardiologist ordered an ECG, Echocardiogram and Stress Test. All were fortunately negative. Her depression worsened and she sought a psychiatrist who changed her anti-depressant medications and began two different medications for her fatigue and sadness. She started to become confused and was referred to see me by a social service agency, as there was concern she was developing Alzheimer ’s disease.
She came to my office with a very low blood pressure, very despondent and weak.
After a careful evaluation of her medical history, physical examination as well as neurological examination, it was clear she was overmedicated. All, yes all her medications were stopped and daily calls to my office concerning her condition were suggested. Each day her energy improved, the dizziness resolved and her mental status came back to her normal baseline. Her back pain is still mildly to moderately bothersome but she now can live with the discomfort and takes only acetaminophen (generic for Tylenol) 2000 milligrams per day.
I can go on and on about overmedication in the geriatric population I am asked to consult upon, but I only see the very tip of the ever-growing iceberg of “polypharmacy”. This means that there are too many medications being consumed by one individual and the likelihood of serious side effects becomes very real.
Americans consume over 50% of all prescription medications used in the entire world. Yes, the whole world!! Yet, Americans do not live as long as 7 other industrialized nations of the world. Where do we go from here?
I suggest there be an immediate stop to “direct to consumer advertising” by the pharmaceutical industry. Although education of the public is extremely important concerning medical conditions, from Alzheimer’s disease to ulcer treatments, the physician nowadays is bombarded by the patient often demanding a certain medication that they have seen on the TV, in a magazine or heard on the radio. We must get back to trusting our physicians who are far better able to weigh the benefits and risks of prescription strength medications for their patients.
As I had mentioned in an earlier editorial, there is a great need to study the safety and benefit of medications specifically in older patients. What may be helpful and relatively safe in younger patients may prove deadly in older patients.
Many conditions of older adults do not always require medication. Take the issue of elevated cholesterol: Individuals over age 80 have never been shown to significantly benefit from taking cholesterol-lowering medications. Although the cholesterol level will come down, it does not always translate into prevention of heart attacks (first or subsequent); nor reduction in first or subsequent strokes; In fact the many side effects of cholesterol lowering medications far outweigh any theoretical benefit in such older individuals.
What can the patient do to prevent or reduce the likelihood of a drug related side effect (also known as an “adverse drug reaction)?
- On your next visit to your doctor (s), bring any and all medications, both prescription and over the counter. Insist, yes insist your doctor justifies why each and every one of the medications still has a far better benefit for you than risk. If he/she cannot give you that time, find another doctor or request at the next visit a 20 minute meeting to discuss this very important, and potentially life saving issue of “polypharmacy”.
- Keep a very accurate diary of your symptoms, before, during and after any new medication is taken (this goes for prescription as well as over the counter medications). If a new problem/symptom/concern is noted shortly after a new medication has been taken, talk to that doctor or your local pharmacist for advice as to whether the new medication or new combination of medications can be playing a role in your new symptoms.
- Turn off commercials on the TV when they talk about prescription or over the counter medications. Ignore the newspaper advertisements about medications.
- Never stop medication unless suggested by your providing physician; this applies to both prescription and over the counter medications.
- Seek a board certified, fellowship trained geriatric physician to evaluate your medications if you were not satisfied with the visits to your other practitioners.
- Never take a new medication from a specialist without first having him/her get it approved by your primary physician. This could save your life!!
In summary, you must be the best advocate for your health. This can only be done by being very careful about taking “too many medications”.
Joel S. Ross, MD, FACP, AGSF, CMD
Geriatric Specialist
Long Branch, NJ
Topics: Clinical Research Study | 1 Comment »
February 26th, 2008 at 11:41 am
I am reading more and more about the statins prescribed for lowering cholestorol and a possible connection to memory loss. Is anyone doing research in this area. It seems to me that this exponential growth of the numbers of people who are suffering memory loss and the wide use of statins might have some connection. I’m sure no drug ccompany who makes statins would fund a study or if they did would release any negative findings [a sure segment for "60 Minutes].Have you noticed any correlation among your patients? I just read your report on your patient who was overmedicated and thats what triggered my question. I’ll be at the office tomorrow with Harold for his first open label infusion I wanted to get this question to you before I forgot.