Drug Abuse Among Elderly Legal--and Deadly

At 80 years of age, Rae Spanover looks forward to every Monday--her day off. She is one of a growing number of nursing home residents around the country who once a week takes a “drug holiday” from many daily medications and she says it feels great.

“On that day, I feel better. My stomach doesn’t get upset. My head doesn’t bother me. I feel very good that day,” said Spanover, who has remained active in her Bronx, N.Y., nursing home with the aid of a walker.

Millions of elderly Americans daily take myriad drugs that may linger and build up in their systems or react dangerously together. Spanover was lucky in this regard.

Her daily drug habit did not lead to fainting spells, disorientation or death, as overuse and bad combinations of drugs have for countless numbers of the elderly.

Adverse Reactions Possible

Symptoms that might be blamed on old age, such as delirium and confusion or sudden changes in behavior or appetite, really may be the result of an adverse drug reaction, said Dr. Geraldine Lanman, director of geriatric programs at Long Island Jewish Hospital in Brooklyn, N.Y.

The physical deterioration that accompanies advanced age may account for why the elderly, who make up just 12% of the population, use 30% of the prescription drugs sold annually. But while consuming more drugs, the elderly are less able physically to handle the effects of long-term and multiple drug use.

Diuretics, sedatives, heart and pain medications are among the most commonly used drugs among senior citizens. Over-the-counter drugs like antihistamines and decongestants, even aspirin, also pose hazards for some of the elderly.

“The elderly can suffer toxic reactions to normal doses of prescribed medications because of physician error or ignorance about prescribing for elderly patients,” Lanman said.

She said most drugs are tested and labeled with younger people in mind. As the body ages, metabolism slows and body mass often decreases, so lower drug dosage may be appropriate.

“Put that together with being on quite a number of medications--and the data suggest the average elderly person takes anywhere from 10 to 15 different medications a day if you include over-the-counter treatment and you can end up with adverse reactions,” she said.

“You have be be very cautious about what you are using and stay in touch with your physician.”

Check With Physician

She joined other experts in advising that anyone who uses medications regularly should bring all their pills, prescription and non-prescription, to his or her physician to make sure the drugs are compatible for them.

At the Daughters of Jacob Nursing Home, residents such as Spanover are offered, after consultations with their physician, the option of taking a weekly drug holiday from non-essential medications.

Since the program began five years ago, it has gained popularity and has been adopted by other nursing homes around the country, according to pharmacy director Murray Zarfes. He said some residents are clamoring for two weekly drug-free days.

The drug holidays, which do not suspend life-sustaining drugs such as insulin and antibiotics, have psychological as well as physical benefits, Zarfes said.

“We want people not to be tied to their drugs, he said. “The holidays are making them feel they are a whole person. They don’t need to be medicated all the time. They can engage in activities without thinking: ‘Oh, it’s one o’clock. Time to get my medicine.’ ”

The drug-free day allows residents more time to secrete drugs that accumulate in their systems and in some cases create a hangover effect.

Suggestions for Avoidance

“We want to make sure people are not overmedicated,” said Zarfes. “We don’t want people sitting around half-asleep.

Experts offer these suggestions for avoiding adverse drug reactions:

- Keep your doctor informed of all medications you use, both prescribed and over-the-counter drugs, even common drugs you have taken for years. Inform your doctor of changes in your well-being and any changes in the drugs you use.

- Request simple, written instructions for your drugs.

- Ask about possible side effects.

- Alert your doctor to your history of adverse drug reactions, allergies, kidney or liver problems.

- Use one pharmacy so it can monitor medications.