Newest drug problem may be prescription medication
August 1st, 2006
By Laurel Harper
A rising incidence of drug abuse is occurring among the nation’s elderly—but they’re not buying crack on the street corner.
The problem doesn’t lie in the legality of the drugs they are taking. (Most are doctor prescribed or are everyday, over-the-counter (OTC) or herbal remedies.) The problem lies in how many medications they consume and how those interact.
Polypharmacology—the use of multiple drugs—is at the top of a list of concerns the University of Louisville Department of Family and Geriatric Medicine is tackling through a comprehensive education program that targets doctors, physician organizations, hospitals, nurses and U of L medical students and residents. A multidisciplinary advisory committee is creating the two-year program to educate health-care providers about ways to manage the chronic diseases that may lead to multiple drug prescriptions, teach the side effects of common medications and more.
The program is being funded by a gift from Jean Frazier, whose experience with an elderly friend being improperly medicated prompted her to do something.
“Almost everyone has a story about a mother, a father, an uncle, aunt or sibling who has suffered from over-or mis-prescribing prescription drugs,” Frazier said.
Drs. James O’Brien and Toni Miles certainly have firsthand knowledge of the problem.
O’Brien, who also holds the Margaret Dorward Smock Endowed Chair in Geriatrics, and Miles, the Ole A., Mabel Wise and Wilma Wise Nelson Chair in Clinical Geriatrics Research and one of the country’s top gerontologists, are heading the project.
Miles led the first community-based study to demonstrate an association between multiple drug use and a higher death rate for the elderly. The results, published in the Journal of Gerontology, showed that older people who took more than four medications had a 27 percent higher risk of dying during the study period.
One of her studies followed 3,000 elderly Mexican-Americans in five Southwestern states for 10 years.
“We literally went into their homes and asked them, ‘Show us your pills’,” Miles said.
What they saw was everything from OTC and herbal remedies to prescriptions that cause adverse reactions when taken together—and even leftover medications passed along by well-meaning neighbors and friends.
The problem isn’t confined to any particular demographic, she said. “It is just across the board.”
O’Brien, who chairs the family and geriatric medicine department, sees the same thing in his own practice. That’s why he asks his patients to bring in everything—from their prescriptions to nasal sprays and laxatives—so he can see what they’re really taking.
“People have literally dumped bags full of medications on my table,” he said, noting that many times multiple medications can be the result of the patient’s different health-care providers not being aware of what the others are prescribing. That is one of the issues the program will tackle.
Miles and O’Brien also are concerned with how medications affect an aging body with a slowing metabolism.
In her Southwest research, Miles found that many of the people were on medications that were potentially toxic because they were totally inappropriate for patients’ physiologies.
“There’s a whole class of drugs that shouldn’t be used in the elderly,” she said.
Valium is a good example. Studies show that a dose in a 20-year-old takes 20 hours to be eliminated from the system, while in an 80-year-old that same dose requires 80 hours. The elderly also should use caution when taking some everyday drugs, including Benadryl and Advil.
The polypharmacology program will focus primarily on Louisville, but it also will reach out to the state, Miles said. Along with an educational conference—the first was held this past June—other activities include community-based education and Living Well workshops to educate patients about the appropriate use of medications.
