March 11, 2017

The Over-Medicated Elderly: A MISDIAGNOSIS DILEMMA

When Mom complained, repeatedly, how badly her knees hurt, I encouraged her to consult a specialist. After several months of noninvasive procedures that failed, her doctor recommended knee replacement surgery. Mom would eventually require help around-the-clock with everything from dressing, meals, household chores, and rehabilitation, as well as help to care for my already dependent dad.

As elderly family members grow ill or disabled, significant challenges arise for the people who love them. Today, more senior Americans choose to stay in their own homes with adult sons and daughters assuming the responsibility of their care as health further deteriorates, or the need for critical medical procedures develops. With this responsibility, caregivers often discover a disturbing dilemma facing their aging parents: over-medication.

When I volunteered to assist Mom through her recovery, I had no idea Dad’s health would soon spiral out of control. His medical conditions consist of diabetes, depression, hypertension and dementia. After arriving home with Mom from the hospital, Dad almost collapsed in the bathroom, unable to move his feet. Complaining in a mumbling tone, he said, “I don’t know what I am supposed to do. I can’t move my feet.”

At the ER they discovered an overdose of insulin and lithium in Dad’s blood, and admitted him overnight for observation and to regulate his blood sugar. Before Mom’s surgery, she had written out a schedule for Dad to follow for taking his medications; however, without her there to assist him, he mixed up the medications and the dosage.

I soon became caretaker to both of my parents. I would wait in the emergency room and doctor’s offices to talk with doctors, nurses, home health care, physical therapists, social workers, and more. Suddenly, I needed to learn and understand every medical condition to help make sure they did the right things at home. Overwhelmed, and surprised at the number of pills they both took, I thought, do they really need all these pills? No wonder Dad got so confused about his medications. I immediately set to work by creating a chart to track his medications. The list contained three different diabetic meds (which made his blood sugar read consistently too low) along with three hypertension medications and three depression meds. No wonder Dad constantly fell asleep, even sitting in his chair!

Medications raise significant concern for elderly patients, especially when multiple prescriptions present an array of side effects. In 2016, CNN reported how studies point out “An aging body tolerates and metabolizes drugs differently than it did when we were young.” And many clinics schedule patients in 15-minute intervals, leaving very little time to collaborate over symptoms and possible medication side effects. According to a recent AARP Bulletin story by Richard Laliberte, “wrong diagnosis” is the number one harmful health care error resulting from doctors inaccurately prescribing medications based on a narrow focus of symptoms. Many elderly patients do not speak up to question a diagnosis, nor do they anticipate the potential for such.

Even a correct diagnosis may produce medication error. Laliberte further explains how “drug blunders” make up the sixth harmful medical error. Mistakes happen anywhere within the multiple step processes of administration which research reports “missteps contribute to 700,000 emergency room visits and 120,000 hospitalizations a year.” These studies support the alarming dilemma of over-medicated issues in the care of elderly patients.

Mom had her own medication issues, struggling to deal with pain while healing from her knee surgery. Her pain regimen caused nausea, constipation, and fatigue. To combat these side effects, she took additional pills – three different medications for constipation alone. She also took health supplements and other prescribed medications due to high blood pressure and the loss of her thyroid from cancer.

We have fallen into an epidemic of over prescribing medication as a quick fix for every complaint from our health, and our looks, to our aches and pains, as we get prescribed a pill—and a pill for every side effect, a phenomenon termed “polypharmacy.” Polypharmacy effects cognition and mental deterioration, which can mistakenly yield diagnoses of depression, dementia and even Alzheimer’s disease.

Research studies recommend that patients keep a medical history and review the side effects of each medication they take. Patients and their families are encouraged to question doctors about prescribed medications, and ask if they really need them. As a patient or caregiver, make sure to ask questions. If you don’t get answers, find other ways to get them, either with online research, by asking more questions, or seeking a second opinion. A doctor who will listen and collaborate will provide better management for your health and the health care of your loved ones.

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