Forgetfulness. Falls. Adding a new prescription or over-the-counter drug to address problems that are side effects of a previous drug. These are increasingly common problems, says a new book from Hazelden, because people are taking more drugs than ever before and not always aware of their side effects and interactions. This "polypharmacy" can produce everything from falls and accidents to behavior that is quickly termed dementia in the elderly, even when it is clearly from drug effects.
The problem is compounded by doctors not always aware of what other doctors are prescribing a patient and the addictive nature of many popular drugs today.
I recently interviewed Dr. Harry Haroutunian, whose new book, Not As Prescribed: Recognizing and Facing Alcohol and Drug Misuse in Older Adults, addresses these issues.
Martha Rosenberg: Your book discusses ageism that can lurk behind medical treatment of the elderly—the belief that a person does not have long to live, cannot live a quality life or even that they should be allowed to have their "comfort" when it comes to drugs like opioids or benzodiazapines.
Harry Haroutunian: People can do extraordinary things in their 90s. I have a colleague at the Betty Ford Center who has written two books about recovery and speaks in prisons about recovery and addiction at the age of 95. The later years can be more fulfilling than anything before them. I have seen my patients blossom when taken off harmful drugs and drug combinations. If Mom doesn't remember that you visited yesterday or that you rushed over to check on her because her phone went dead, she may not have declining memory issues at all; she may be suffering from drug side effects.
MR: In your book, you recommend a medical audit in which all the drugs a person is taking are put in a paper bag and brought to their primary doctor.
HH: Yes, and that includes over-the-counter drugs like Tylenol PM, Advil PM, Nyquil and anti-diarrheals, which can also cause confusion, memory loss, dry mouth and falls. Every time I go to my cardiologist, he does a medical reconciliation of all the drugs I am taking. If your older adult's doctor is not doing that, find a new doctor.
MR: Don't electronic health records automatically show one of a patient's doctors the drugs the patient's other doctors have prescribed?
HH: Not unless the doctors are in the same health-care system. HIPAA laws would not allow that information.
MR: The biggest problem with drug addiction is denial, and you say in your book the family can also be in denial.
HH: Yes. When it comes to a family member, denial can take the form of "not my mother," "these are prescription drugs" and "this can't be addiction." Remember, for the pre-WWII generation, there was huge shame and stigma around addiction, too.
MR: Another problem you raise is how to help a parent who you are supposed to respect and who once took care of you. It feels awkward.
HH: The key word is nonconfrontational, and being gentle. You can simply say, "Let's have a doctor look at all the medications you take to find out why you are so drowsy or forgetful." The whole family will be pleased, and the decision to admit the elderly person to a nursing home can be put off for years.
MR: You write in your book that drug-taking has become "normalized." What do you think about direct-to-consumer advertising?
HH: It is horrible. It gives people magical thinking and the idea that any problem can be fixed with a drug and there are no consequences regardless of the list of dangerous side effects. The ads allow the patient to feel "smart" by telling the doctor what he heard on TV, and then the doctor has to be smarter in what he chooses to prescribe.
MR: It is clear from your book that medications, not dementia or cognitive problems, may be causing many of the symptoms we see in the elderly, even landing them inappropriately in nursing homes. You are also no fan of opioids for chronic pain.
HH: If you took 100 patients who are on chronic pain medication and take them off the medicine and move them through three physical therapy pool exercises a day, a lot of them are going to feel better. The reason is the opioids are usually causing the pain through opioid-induced hyperalgesia. The patients' light-headedness and over-sedation will also disappear and their bowel functions will return to normal. These are wonderful changes to see.