LITTLE ROCK — As we grow older, the number of chronic medical problems coexisting increases astronomically. Patients frequently go from doctor to doctor to have their individual ailments addressed.
Medications are prescribed and keep mounting, until eventually the symptoms may well reflect the side effects of medications rather than the underlying illness.
Polypharmacy is defined as taking six or more medications, which may include prescription drugs, over-the counter medications, herbal remedies and multivitamin preparations. Take more than six medications and the side effect risk is 20 percent; take 10 or more and the chances of a serious side effect approaches 100 percent. The problem is aggravated by advancing age, which significantly affects the way drugs are metabolized and excreted.
Of all the medications overused in older people, none are more worrisome than narcotics for pain.
Drug addiction is frequently thought to be a problem of younger adults, but is increasingly seen in epidemic proportions among the elderly.
Once therapy is commenced with a morphine medication, such as oxycontin, the patient is usually on it for life.
Nothing is sadder than seeing a patient in his late 80s taking massive doses of oxycontin and oxycodone, almost always initially prescribed for chronic pain. As the patient becomes more tolerant to morphine, the need increases, the pain worsens and the dose is increased. And often managing these patients falls on the shoulders of a physician who did not prescribe the narcotics in the first place.
When a patient is at this very old age, the physician is placed in a hopeless situation. The patient complains of the most devastating pain, is desperate for narcotics, and even though it is obvious that dependency is present, the thought of denying drugs at this age seems cruel.
And for a person close to 90 or even older, admission to a drug rehabilitation program is almost certainly futile.
These patients present with the same drug-seeking behavior as a younger person. Often narcotics are prescribed by more than one physician; admissions to the emergency room are frequent because of severe pain(most often back); multiple CT scans and MRIs show significant chronic problems that have previously been treated by surgery and local pain therapy; it is obvious that pain medication is the only choice, and more narcotics are prescribed.
Just as serious is the overuse of tranquilizers, sleeping pills and antidepressants. It is all too easy for a physician to prescribe a tranquilizer for anxiety or a sleeping pill for insomnia. And once a person is on these drugs, stopping them is very difficult.
Particularly serious are Xanax and Ativan, which are prescribed for anxiety, and Ambien, a frequently used sedative. Often more than one tranquilizer and sleeping pill is prescribed that cause drowsiness - and lead to depression. As a consequence, antidepressants are added to the medication list.
Many of these patients also have pain and are often on either hydrocodone or a morphine derivative as well as other medications like gabapentin that partially relieve pain but also affect mood and sleep. From that point on, differentiating symptoms from drugs or disease becomes very difficult. And a symptom caused by a drug side effect can lead to prescription of more drugs.
No matter your age, there must always be a serious understanding of the devastating negative side effects of many powerful drugs. When used appropriately, narcotics are a godsend and improve the quality of life of patients with severe pain. And, of course, therapy to relieve serious symptoms should never be denied.
However, if multiple chronic diseases are present, nothing is more critical than having one physician in charge of all aspects of care.
The important role of the responsible physician must be to reduce medication use to a minimum while assuring that the patient achieves the needed relief.
Today overuse of medications and their side effects are as serious an illness as heart disease, cancer or stroke.
Once the age of 70 is reached, find one physician who truly coordinates care, questions the use of every medication and understands the key role of the pharmacist in providing you with key information on the upside and downside of all those drugs swallowed morning, noon and night.
Dr. David Lipschitz is co-director of the Healthy Aging Center at Saline Memorial Hospital. More information is available at: drdavidhealth.com
High Profile, Pages 43 on 11/04/2012