Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, August 5, 1994 TAG: 9408050073
SECTION: EDITORIAL PAGE: A9 EDITION: METRO
SOURCE: JEAN HALEY
DATELINE: LENGTH: Medium
Older people have known about it a long time. So have their families. And so have a few voices specializing in geriatric medicine well over a decade ago. Not much came of their protestations, except to make some patients cautious, others skeptical and worried.
Now that the AMA has more or less officially spoken, maybe the professionals and paraprofessionals will listen and heed.
The likelihood that prescription drugs will be covered under national health-care reform legislation - whether it appears this year or later this decade - is one reason to take seriously implications of the AMA pronouncement. It would make sense to get a control on ``quality'' in the arena of prescriptions for the elderly before making drugs easier to distribute. The best reason, though, is what misuse of drugs does to patients. It's truly the most insidious kind of elder abuse.
Criticism has to be tempered: Some physicians, nurses, therapists and nursing-home administrators are knowledgeable about the potential danger of prescription drugs to elderly systems. They're aggressive in managing drug regimes and creative about finding other methods of treatment.
That's as it should be.
To get an indication of how long it takes for specialized knowledge to blend into the mainstream of a culture, however, consider what gerontologist and psychiatrist Robert N. Butler wrote about drug overuse in his Pulitzer Prize-winning book, "Why Survive? Being Old in America," in 1975.
``On an outpatient basis, general practitioners and psychiatrists find psychoactive agents an all-too-easy answer for the many complicated physical and emotional reactions of late life,'' Butler asserted. ``It is much simpler to give a pill than to listen to complaints.
``Often drugs represent the only form of treatment given to older persons,'' he added. ``An overall treatment plan that includes attention to diet, physical and social activities, psychotherapy and correction of living problems may be totally ignored.''
Who's listened?
James W. Cooper, a pharmacist, after extensively reviewing studies and drawing on his own 17-year practice, in 1991 published "Drug-Related Problems in Geriatric Nursing Home Patients." Cooper found such problems stretched far beyond long-term care facilities. They were a factor in more than half the nursing home admissions he studied, a third of patients over 65 hospitalized and more than a half of those using day-care or home-health services. In fact, Cooper's admonitions sounded remarkably like Butler's nearly a generation earlier.
``Drug therapy is the most frequently utilized treatment modality in the elderly,'' Cooper wrote. ``While other modalities of nutrition, psychosocial and physical activities play vital roles in the total (holistic) care of the patient, the likelihood of a drug causing problems that worsen the prognosis of the patient is greater than with any other modality of treatment.''
However, as the AMA publication noted, some of the most commonly used drugs are ``potentially inappropriate'' for old people. They include Valium, Librium, Darvon and Darvocet. Probably 6.6 million people 65 and over, the study indicated, are taking drugs that could be dangerous for them. Some doctors don't know enough about how drugs affect aging people, the study said, while manufacturers market their products aggressively.
What this means to ordinary people is threefold. First, don't let this research push you into quitting any medication on your own. It could cause severe withdrawal symptoms. Moreover, not all drugs and dosages are problems for all people. Talk with your physician.
Second, patients ought to take a conservative attitude toward drugs, especially if unexpected side effects show up. Talk with your physician.
Finally, mixing prescription drugs, inappropriate ones or dosages excessive for an elderly person can produce symptoms that mimic diseases. One is Alzheimer's disease. Families ought to review an elder's drug regime before accepting a diagnosis of Alzheimer's. Talk with your physician.
Jean Haley is an editorial-page columnist for The Kansas City Star.
The New York Times News Service
by CNB