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.
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