THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Monday, October 24, 1994 TAG: 9410240023
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: Long : 121 lines
They fill the compartments of the plastic container like brightly colored candy capsules. But they have names out of a chemistry textbook.
Capoten.
Furosemide
Alprazolam
Coumadin.
Twelve all together. Twelve medications that 80-year-old Roger Lapre must take every day. And for every medication, a different set of directions. One to be taken three times a day; one only after meals; one just before bed; one before lunch and dinner.
Lapre is not unique among the elderly. A recent study published in the Journal of the American Medical Association indicated that a quarter of Americans 65 and older receive at least one potentially inappropriate drug, and experts think the number may be as high as 50 percent. One expert calls it ``an epidemic of inappropriate . . . excessive drug prescribing for older Americans.''
To keep track of it all, Lapre's daughter, Alice Parrish, has devised an intricate system of charts, bright red post-it notes and stickers that tell her in plain English what each drug is for.
Lapre is lucky. He lives with his daughter in Norfolk and she manages his medications, watches for adverse reactions and gets him to the doctor for regular ``fine tuning'' of his drugs.
But before he moved in with Parrish in February, he would forget to take his drugs, take them at the wrong time of day, stop taking them if he ran out or take the wrong amounts.
He was confused, dizzy and forgetful, says his daughter.
``One time he was taking five fluid pills at once. He didn't realize anyone needed to check on him.''
When she took him to Norfolk internist Leslie B. Oppleman, the doctor took Lapre off several of the drugs, adjusted the dosages of others, and the effect, says Parrish, was amazing. ``People see him now and can't believe how well he's doing and how good he looks.''
``I think sometimes there's a tendency on the part of some physicians to take pity on some of these older patients and sedate them too heavily based on the fact they have multiple complaints,'' says Dr. John Franklin, director of geriatrics at Eastern Virginia Medical School. ``So they think the least they can do is make their life more comfortable with sedatives or drugs that relieve pain.''
Part of the problem is that many general practitioners and internists aren't familiar with the special needs of the elderly, Franklin said.
Older adults respond to drugs differently than a middle-aged person. They have a different proportion of fat-to-lean body mass, which affects how the drugs are distributed in their bodies. Their kidneys often don't work too well, resulting in a slower elimination of the drug that could build up to potentially toxic levels.
And they tend to overmedicate themselves using over-the-counter products. People 65 and older buy 40 percent of over-the-counter medications, even though they make up only 12 percent of the population.
``Many don't consider over-the-counter medications as drugs,'' said Patricia Williams, pharmacology professor at EVMS. ``They figure if they can get it without a prescription, it must be safe.''
But a remedy to relieve constipation, for instance, may cause an older person to excrete a prescription drug too quickly, so it doesn't have time to work. One for diarrhea could keep the drug in the body too long, where it could build up to toxic levels.
That's why EVMS requires its fourth-year students to take a two-week clerkship in geriatrics, one of only a handful in the country, which includes a course in medicating the elderly.
Students are sent to a pharmacy outfitted with special prism glasses that mimic the vision of a person with cataracts, and their fingers are taped together to duplicate the awkwardness of arthritis.
``So they can see how hard it is to read the instructions on the bottle, and even to open the bottle,'' said Williams. ``So then they understand why it's so hard for older people to keep track of and take all the different medicines.''
People 65 and older take an average of six to eight prescription drugs a day. Because they are often seeing several physicians for multiple problems, their doctors may not be aware of all the drugs they're taking, many of which may have harmful interactions.
Williams recommends what she calls ``the brown bag test,'' in which patients put all their medicines - prescription and over-the-counter - into a paper bag and take it to their primary doctor's office at least once a year.
Oppleman suggests they also keep a list of their drugs on a small card in their wallet, where it's available on an emergency basis.
Even if their medications are correctly adjusted, however, the elderly often can't afford to take them. Medicare, the government health insurance program for those 65 and older, doesn't pay for prescription drugs.
``It's just insane,'' says Oppleman of the government policy. ``They'd rather pay for acute care than preventive care.''
A monthly supply of Lapre's medicines, for instance, costs $458 - nearly his entire monthly income.
When he lived alone, says his daughter, he'd run out of a medicine, decide it was too expensive, and wouldn't refill it.
Oppleman tries to help by passing out free samples and writing letters to pharmaceutical companies asking for free or reduced-cost drugs for his patients. But that isn't enough, he says.
``The pharmaceutical companies need to offer a program for people 65 and older where, depending on income, they give them a discount.''
He also blames pharmaceutical companies and their direct advertising to consumers for part of the overmedication problem in the elderly.
``They pick up a magazine like Sports Illustrated and read about a medicine, then they come in and they want it. But they don't understand the side effects or contraindications,'' he said. ``They don't realize that every drug is a chemical that can hurt you.'' ILLUSTRATION: SOME TIPS
Gather all your medicines - prescription and over-the-counter - and
show them to your doctor at least once a year.
Keep a list of your medicines with you at all times, in case of
emergency.
LAWRENCE JACKSON/Staff
"People see him now and can't believe how well he's doing and how
good he looks."
Alice Parrish, on her father, Roger Lapre, whose medication was
adjusted to better suit his needs.
KEYWORDS: PRESCRIPTION DRUGS ELDERLY by CNB