When Edmund visited Peggy in a nursing home, her senility kept her from recognizing him. But one day he stopped by in the morning instead of the afternoon and the elderly woman was surprisingly lucid. Was it a rare coherent period for an Alzheimer's patient or something else?
That story line about overmedication of the elderly is from the soap opera "All My Children," but it is a scenario that is often played out across the country. Too much medicine or the wrong combination of drugs can cause elderly patients to be sick or seem senile say the specialists who treat them.
Dr. Peter P. Lamy of the University of Maryland's School of Pharmacy estimates that 10 to 20 percent of all emergency room admissions of the elderly are due to overmedication and that 10 to 15 percent of the senior citizens diagnosed for dementia, vascular dementia and Alzheimer's disease are really victims of over-medication. Approximately 10 percent of all senior citizens in hospitals and 50 percent of all elderly outpatients are being overmedicated, he says.
Dementia is a general term for mental deterioration. It has many causes and may or may not be reversible. Vascular dementia is a form of mental impairment due to blood flow to the brain. Alzheimer's is an irreversible disease in which brain cells are damaged or die, leading to severe dementia.
Anyone can be a victim of over-medication, but the elderly are particularly at risk. Many pharmacists and geriatricians - doctors who specialize in the elderly - say over-medication of the elderly is the country's "other drug problem."
The results of over-medication can be far-reaching. A recent Vanderbilt University study indicates that certain tranquilizers, such as Valium, can make a senior twice as likely to fall and possibly break a bone. Depending on what medicine is taken, over-medication can also lead to kidney damage, liver damage, stomach damage, incontinence, bleeding, Parkinson's disease, dizziness and misdiagnosis for senility, vascular dementia and Alzheimer's.
The average older person takes more than 15 prescriptions per year, according to a 1989 report submitted to the House Select Committee on Aging by U.S. Health and Human Services Department Inspector General Richard Kusserow.
"There are a number of people we've made senile due to drugs. There's no question about it. The goal should be to take as few drugs as possible," Dr. Lamy says.
Over-medication can occur innocently in a variety of ways - from a senior citizen seeing doctors who aren't aware of medicine other doctors have prescribed to possible over-medication in a nursing home.
"The people working in the industry are all good-intentioned people, but sometimes the results are less than satisfactory to all concerned," says Dr. Toshio Tatara, director of the National Aging Resource Center on Elder Abuse in Washington.
Which is one of the points the "All My Children" story tries to make - that the over-medication of the character Peggy Moody, played by Anne Meara, is about overworked people making a mistake, not about evil nurses or doctors. The fact that Peggy is a Medicare patient without family to look out for her makes it even more realistic.
Medicare patients are often treated by different doctors. If Doctor A doesn't know what Doctor B prescribed, Doctor A could prescribe something that counteracts the first medicine or has a negative effect. Most pharmacies have a computer tracking system that can catch this, but only if the patient goes to the same pharmacy consistently.
Over-the-counter medicines also can cause complications. A non-prescription sinus medicine or stomach remedy that worked successfully at one time won't necessarily be safe when taken with an arthritis medicine, a diuretic or a blood thinner.
"These [over-the-counter] medicines have a great potential to do good, but there's a potential for harm if used incorrectly," says Ray Bullman, deputy executive director of the National Council on Patient Information and Education in Washington.
Also, as people age, their bodies work less efficiently. This can be especially true of the liver and kidney, the organs that clean the body of toxins. A dosage that worked for a 65-year-old patient might be too much for a 75-year-old.
And, patients and doctors can fail to monitor side effects properly. Frequently lack of energy, inability to concentrate, sleeplessness, stomach upset and incontinence are wrongly attributed to old age rather than drug side effects or interaction.
"Don't ascribe anything to aging," Dr. Lamy warns older people, "particularly if you're prescribed a new drug or new dosage. Call somebody [such as your doctor],"
Health-care providers have also been cited as part of the over-medication problem. The U.S. Health and Human Services Department study reported that doctors themselves may lack enough education to deal with the elderly.
Dr. Kusserow told the House committee that most medical students have had only one pharmacology class and that fewer than 2 percent have been required to take geriatric medicine courses. This is contrary to pediatrics and obstetrics, which are required courses at almost all medical schools.
"Of the 126 U.S. medical schools, 17 require a special course in geriatrics and 112 include geriatrics as part of a required course, but that could be a one-day lecture on geriatric medicine, it could be a weeklong session - there's no standard on how much geriatrics education that would include," says Patricia Miller, director of the American Geriatrics Society.
"There's also a shortage of trained geriatricians, who are the specialists," she says. "We get calls from all over the country from people, [saying] 'I need a geriatric specialist and there isn't one within 200 miles,' Even if a senior citizen has a knowledgeable doctor, they may be afraid to ask questions. "They're still from the days when the doctor knew best and you didn't question what the doctor said. What a good doctor will say is, 'Ask questions, do reading, do your homework,' " Ms. Miller says.
Another way for the elderly to keep track of their medications is through the Brown Bag Network, an umbrella term for a 'f nationwide program that includes Maryland. Clinics, hospitals, HMOs, pharmacies and senior centers "set out a day when they ask seniors to clean out their medicine cabinet, put [the medicine] in a brown bag and bring it in," says Leonard Genova of the Food and Drug Administration's state office.
"They'll have a pharmacist on staff there looking at the medications [people] bring in to see, one, if they're expired; two, if [the people] still need to be on this medication. [The pharmacist] will ask them questions they can take back to their physicians and get verifications," he says.
But above all, physicians agree the elderly have to take control, either by themselves or through their families, and stop taking medicine passively.
"Senior citizens must pay attention. They have to become an active participant in their health," Dr. Lamy says.
Ms. Miller agrees. "Be prepared to go to a doctor with the list of the drugs you're taking, questions about what kind of interactions can occur, because ultimately, you're your own responsibility," she says.
TAKING MEDICINES SAFELY
The Brown Bag Network, a program that helps the elderly keep track of their medications, will be offered from 9 a.m. to noon tomorrow at North Parkville Health Center, 9512 Harford Road, and from 1 p.m. to 4 p.m. tomorrow at the Galleria Health Center, 1407 York Road, Lutherville. Call (410) 528-7071 or (800) 326-4472 for appointment.
For more information on how to take medicine safely:
* The National Council on Patient Information and Education has these free booklets: "Get the Answers," "Medicines: What Every Woman Should Know," "Alcohol and Medicines: Ask Before You Mix," "Have Your Medicines Had a Check-up?" and "Medicine: Before You Take It, Talk About It." Send a business-sized, self-addressed, stamped envelope to: NCPIE, 666 11th St. N.W., Suite 810, Washington 20001.
The Food and Drug Administration has a number of free brochures including "Food and Drug Interactions," "Know the Right Way to Take Your Medicines" and "Some Things You Should Know About Prescription Drugs." Call Leonard Genova at (410) 962-3731 or write him at 900 Madison Ave., Baltimore 21201.
The American Association of Retired Persons has two free booklets and one book. For "Using Your Medications Wisely" (D317) write to the National Institute on Drug Abuse, Information Systems, P.O. Box 2345, Rockville 20847-2345 or call (800) 729-6686.
* For "Getting the Most From Your Medication" (D12038), write to AARP Fulfillment, 601 E St., N.W., Washington 20049.
* "The AARP Pharmacy Prescription Drug Handbook" is in bookstores for $17.95 or through the AARP Pharmacy for $12.95 plus $1 postage. Call (800) 456-2277.
* Joe Graedon and Dr. Theresa Graedon of "The People's Pharmacy," a syndicated newspaper column, have a brochure on medicines that may make people appear senile. To order a copy of "Graedons' Guide to Older People" send $1 and a business-sized, self-addressed, stamped envelope to Graedons' People's Pharmacy, No. O-31, P.O. Box 52027, Durham, N.C.
WHAT YOU CAN DO
* Make sure every doctor you see knows about all the medicines you're taking, including non-prescription drugs.
* Talk to your doctor and pharmacist.
* Don't expect a pill for every symptom.
* Don't blame new problems or symptoms on old age, particularly if you're taking new medication. Ask your doctor or pharmacist if it could be a side effect or drug interaction.
* Find a good pharmacy -- independent or chain -- and stick to it.
* Follow the instructions for your medicine exactly. Check the medicine before you leave the pharmacy to see if there are any warning labels, such as "take with meals," and make sure you understand them. If not, talk to your pharmacist.
* Read the fine print on the over-the-counter medicine you take -- it is important.
* Make a medicine I.D. card, which lists all your medicines and the dosage, conditions you're being treated for, allergies, your name, address, and your doctor's and pharmacist's names and phone numbers.
* Find a system that helps you remember to take your medicine, such as keeping your medicine next to an alarm clock set for the time of your next dose.
* If the Brown Bag Network is being offered near you, take advantage of it.
* If you have a friend or relative you think could be overmedicated and his or her doctor isn't responsive, find a geriatrician.