Health Care or Mis-Care

[Although I know that most people prefer to watch inspirational videos rather than harsh ones like the one I am showing in the next frame, how our society treats the elderly needs to be looked at in all of its harsh realities.  So for the next few weeks to parallel the blogs I have been writing about the elderly, the video will remain.  Please do view it, because in order to change things, one has to confront square in the face what is or can be unpleasant.  Bear with me.  I promise the next video will be inspirational. ]

In my last two blogs,  I have been exploring anti-psychotic drugs and the elderly.  According to a research done by the University of Florida in 2010,  70% of those entering nursing homes end up on psycho-active drugs within three months of entering the home in spite of having no prior history of psychotic problems. Although dementia may occur in old age, more often than not, the delirious or dementia like behaviors are most likely caused by medication or the interactions of several medications the elderly person may be taking.  Benzodiazepines, opiates and tricycic anti-depressants are the main culprits.  These pills come in very many variations and are extremely prevalent in our society.  Today’s blog is exploring the effects that these drugs can have on older users.

AFFECTS ON OLDER PEOPLE

As one ages, The body’s ability to clear drugs decreases often because of a normal age-related decrease in kidney and liver function. This results in a greater accumulation of drugs in the body.

Secondly, Older patients are often prescribed multiple drugs at the same time. Due to complicated interactions between different drugs, side effects can become more prominent.

Last, Some research have demonstrated that neurotransmitters become naturally imbalanced as people age, increasing the brain’s sensitivity to drugs that have activity in the central nervous system.

With the regular use of anti-psychotic drugs in nursing homes, it is no wonder that the Rovner, et al study concluded that nursing homes were “de facto psychiatric institutions.”

Let’s look at the above facts in more detail:

Number 1.  When doctor’s prescribe medication, they often prescribe the full dose without recognizing that in an older patient, “the body’s ability to clear drugs decreases with age.” For example the equivalent dose of diazepam (a short-acting Benzodiazepine) in an elderly individual on lorazepam (a long-acting Benzodiazepine) should be up to half of what would be expected in a younger individual.  Giving full doses of these medications are sure to cause the side effects to increase in severity the more the drug accumulates in the system.

Paradoxically, an overdose of Benzodiazepines can cause the effects it has been prescribed to diminish, ie, anxiety, delirium, combativeness, hallucinations, and aggression.[ (Wikipedia)

Number 2: “Older patients are often prescribed multiple drugs” many patients do not realize that they are taking too many drugs or taking drugs that might interact with the other drugs in an adverse way. Sometimes they may have two prescriptions for the same drug under two different names, thus inadvertently increasing the dosage.

With the fact that “Some research suggest that neurotransmitters” change as we age affecting the brain’s sensitivity to drugs continues the argument that prescribing drugs to older patients has to be done with extreme care.

With all these factors at play, it becomes of utmost importance, then, that in-depth evaluations are done if and/or when an elderly person begins to manifest dementia-like symptoms.

Public Citizens points out:

“Because cognitive impairment caused by drugs is so frequently overlooked, it is important that when symptoms of confusion, altered concentration or difficulty thinking occur that you and your physician review any medications you are taking to determine if any of them might be the cause.

Fortunately, if the cause is a medication, your symptoms should go away or become less severe after stopping the drug, even if it takes weeks or months. (http://www.worstpills.org/includes/page.cfm?op_id=459)”

And Dr. Gary Oberlender, a Specialist in Geriatric medicines,  points out that

“Dementia as the cause of a senior’s cognitive decline should only be considered after a thoughtful and thorough medical evaluation has excluded a potentially reversible cause. The list of common causes of dementia in seniors is short. It includes Alzheimer’s disease, vascular dementia (stroke), Parkinson’s disease, Lewy body dementia, and alcoholic dementia.”

In recent months, the overuse of anti-psychotic drugs is beginning to be noticed.  In an article that appeared in The Telegraph, doctors can get up to five years jail time in the British Isles for prescribing these drugs to the elderly.  Here in the U.S., nursing homes are being forced to reduce their use of anti-psychotic drugs 

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