Overdosing The Elderly

By Christine Gorman

Doctors call it the brown-bag test, and a growing number of them administer it the first time they meet with someone over the age of 65. The idea is for patients to empty the contents of their home medicine chest into a bag and bring it into the physician's office to show which drugs they have been taking. The results can be horrifying. Although most older Americans are taking fewer than five prescription drugs, it is not uncommon to find people who are swallowing three times that number. Often the person is being treated by several doctors, who may not know what drugs the others have prescribed. Or a husband may be taking his wife's arthritis pills because they work for her. But with each new medication, the chance of triggering potentially dangerous side effects increases dramatically.

Even more frightening, a significant proportion of the prescriptions are for one of 20 different drugs that older people generally should not be taking at all. According to a study of 6,000 people published in last week's Journal of the American Medical Association, 23% of Americans ages 65 and over are using medications that are notorious for triggering insomnia, fainting spells or even amnesia among the elderly. Says Dr. David Himmelstein, a physician at Cambridge Hospital in Massachusetts and one of the study's co-authors: "It's a sad commentary on the prescribing practices of many doctors in this country."

Part of the problem, say Himmelstein and others, is that doctors do not get enough training in geriatrics. Over the past several years, researchers have documented that tranquilizers such as Valium and Seconal linger an exceptionally long time in older people's bodies because their kidneys and livers work slowly at eliminating the drugs. The buildup can lead to confusion and memory loss. Unfortunately, those symptoms may be dismissed as signs of aging rather than of drug use.

Nor is the trouble limited to just the 20 drugs cited in the study. Some of the medications that are generally considered to be safe for the elderly become dangerous if they are used at high doses or for long periods of time. "Plenty of existing drugs that are not on the list can cause all kinds of problems," says Dr. Judith Ahronheim, who specializes in treating older patients at the Mount Sinai Medical Center in New York City. In addition, she says, "there are many other newer drugs that might be potentially harmful for older people."

Even so, the experts advise older people not to panic and take themselves off medications they suspect might be causing side effects without first consulting their doctors. Some drugs can trigger withdrawal symptoms unless a person is gradually weaned from them. Nor should the study's conclusions be read as an indictment of all medications. Some conditions, such as depression, are actually undertreated in the elderly. Fortunately, many drugs are safe for older people to take. What is needed is a more judicious approach to their use and a better understanding, on the part of both physicians and of their patients, about what these medications can and cannot be expected to do.

CHART: NOT AVAILABLE

CREDIT: TIME Graphic by Joe Lertola

CAPTION: RX FOR TROUBLE

With reporting by Lawrence Mondi/New York