A Problem For Seniors––

When Good Drugs Do Bad Things

By Kaaren Valenta

Older adults now use an average of six different medications, not including herbal supplements and over-the-counter products like painkillers and cold medicines.

So it should not come as a surprise when seniors sometimes develop problems that are traced to their medications. In fact, according to an article published recently in the Journal of the American Medical Association, any new health problem in an older person should be considered drug induced until proven otherwise.

Dr Daniel E. Wollman, a Newtown resident who is a specialist in geriatric medicine –– and particularly the areas of memory and cognitive disorders –– says that older adults often encounter many problems when they are prescribed medications. Speaking at the Newtown Senior Center recently, Dr Wollman encouraged his audience to help him highlight some of their concerns.

“I’ve become very alarmed at the difficulty that older patients are experiencing,” Dr Wollman said. “Complicated regimens are often not clearly written out for the patient to understand. And there may be insufficient explanation or reinforcement about why a medication was prescribed.”

Taking the medicine incorrectly can be part of the problem, he said.

“Many pills look alike. They are not individually labeled. It’s not always obvious,” he said. “Drugs also have two names, a generic name and a brand name, and sometimes more. An older patient with declining eyesight is more prone to make a mistake, to misread the bottle label because they can’t read the small print.”

Sometimes a patient might see several different physicians –– perhaps a primary care physician, a heart doctor, a diabetes specialist –– and wind up with medicines that could react poorly together.

“The system doesn’t encourage easy enough communication,” Dr Wollman said. “If the patient is using the same pharmacy to fill prescriptions, the pharmacist should notice the potential for drug reactions. But if the person is going to different pharmacies, or getting prescriptions by mail, there is a potential for problems to occur.”

Clear and complete medication information also is often not available during emergency treatment. “Carry a list of the medicines you are taking and also your allergies,” Dr Wollman recommended. Include nonprescription medications, including salves and eye drops –– which some patients do not view as medications –– and herbal supplements, too, he said.

Dr Wollman said hospitals make every effort give the right medications, even using bar code scanners in veterans’ hospitals. “But when the patient is discharged, sometimes with seven or eight medications, how do we ensure that same level of safety in the house?”

Patients who are admitted to a hospital may be given a different medication than what they have taken previously because that drug might not be stocked by the hospital.

“Compare your original medication list with the new one and ask your primary care physician if you have any questions,” Dr Wollman said.

Adverse reactions are possible in the elderly because that age group may have less muscle mass, a slower metabolism, and greater sensitivity to drugs, many of which have dosages based on a 154-pound man of normal metabolism.

“There are also many people who because of their genetics require more or less than the standard dose,” Dr Wollman said. “And many of the medications used by children and adults without problems and available without a prescription, like Benadryl, aren’t tolerated by older people as well. The side effects get magnified and can be quire severe. One particular problem is dry mouth. Or it can cause confusion or delirium.”

Constipation is an under-recognized side effect of many drugs, he said. “Or patients may experience dizziness, nausea, itching, shaking, rash, dry eyes, difficulty walking, or a drop in blood sugar. Patients should be warned of potential side effects.

“Being able to predict side effects makes it easier to deal with them,” he explained.

When patients get a new prescription, they should ask their doctor what they should do if they happen to miss a dose. Some medicines, such as those for epilepsy, may have to be adjusted. Never “make it up” by taking a double dose.

“If you miss a dose of high blood pressure medicine and take a double dose to make it up, it could cause a drop in blood pressure,” Dr Wollman said. “You could fall and have a hip fracture, a real risk for the elderly.”

Also never abruptly stop a medication without speaking to your doctor first, he said.

“Never be wondering about your medications,” he said. “Speak to your physician, or a pharmacist, or a visiting nurse.”

Dr Wollman said the biggest problem seems to be communication.

“The theme I hear over and over is that doctors don’t listen to you,” he told his audience. “There should be equal decisionmaking power. You need to be a partner in your own health care.”

Dr Wollman is the founder and managing director of the Southern New England Memory Disorders Center in Newtown and recently also has become affiliated with the Jewish Home for the Elderly in Fairfield.

He is board-certified in internal medicine and geriatrics. As a 2002 John A. Hartford Academic Geriatric Fellowship scholar, he conducted research using magnetic resonance imaging (MRI) for the diagnosis of Alzheimer’s disease.

Dr Wollman is the recipient of many awards, including the prestigious St Louise de Marillae award from St Vincent’s, in exemplifying the philosophy, mission, and values of the health system. He has published many articles and spoken extensively in the fields of neuroscience, neuroimaging, models of health care, and Alzheimer’s Disease.

He graduated from the management and technology program at the University of Pennsylvania School of Engineering and Applied Science and The Wharton School. Throughout college, he worked extensively as a management consultant, then joined the accounting firm of Arthur Young. He applied for, and received, a National Institute of Mental Health scholarship, and pursued research in neurophysiogy. He completed studies in 1997 when he was awarded both the PhD and the MD degrees.

He did postgraduate medical training at the Department of Neurology at Yale University, the Department of Internal Medicine at St Vincent’s in Bridgeport, and most recently, the Department of Geriatrics at Mount Sinai School of Medicine in New York City.

Dr Wollman lives in Newtown with his wife, Dr Debby Pollack-Wollman, a sleep disorder specialist; and their daughters, Joanna and Caroline.