Many drugs that are over-prescribed are common ones, such as Valium, or dipyridamole, a blood thinner that the researchers of the study say is worthless except for those with artificial heart, valves. About 1.8 million Americans have prescriptions for dipyridamole; only 98,000 Americans, half of them older than 65, had artificial heart valves put in in 1987, the last year for which figures were available.
"There is a lot of concern in geriatrics about diazepam, for instance," says Johnson. "For example, the elderly may metabolize it differently than a younger person; it may stay around longer in their system. It may not be the best drug in that particular class for the elderly." If you believe that you are taking too many pills, make a list. You may feel foolish, but how could it hurt?
"Include over-the-counter medications; things like aspirin, cough syrup, sleeping aids-things you wouldn't think would be important-as well as alcohol," says Dr. Laura Duskin, a geriatric psychiatrist at Laguna Honda. "I would. It saves both you and the doctor time in the long run." Buy a medical guide or the Physicians Desk Reference to familiarize yourself with drugs, Duskin suggests. "It's your body."
Sometimes physicians aren't keeping as current as they need to be about the indications for various medications-why they are prescribing them in the first place. And sometimes, doctors are too quick to reach for the prescription pad, says Dr. Kathryn Borgenicht, a geriatrician at Laguna Honda. "We're a very medicine oriented society. It's important for the patient to recognize that medicines aren't always the answer; there are a lot of other kinds of therapies that are available that should be explored before you just reach for the next pill."
Some of the problem lies with the patient who may be seeing several specialists at once, without informing one what the other is doing. Some of the problem lies with physicians, who are either in too much of a hurry to take a thorough drug history or who are guilty of ageism, dismissing complaints of depression or grogginess-which could be side effects of too many drugs-just because the patient is elderly.
Do not stop taking any drug until you consult with your doctor. Don't be afraid to question your physician. Tell each of your doctors what the others are doing. And for yourself, take notes. Read the literature. Be informed. Many elderly patients are not used to speaking out about their health care, tending to take a passive role with their physician, so many questions about drugs do not get answered in the doctor's office. "Most patients, not just the elderly, forget about 60 percent of what the doctor said by the time they get home," says Dr. Mary Anne Johnson, medical director at Laguna Honda Hospital and Rehabilitation Center in San Francisco.
"There is the stress involved in seeing a doctor in the first place, people are preoccupied with what's happening to them, they don't hear everything they are told. This applies to all ages, not just the elderly. If you take home literature, at least you have something to refer to later on."
"The elderly must speak up," says Dr. Lawrence Feigenbaum, director of the UCSF-Mount Zion Center on Aging in San Francisco. "It's a simple issue of the patient bringing in their medications every time they go to the doctor. You show the physician the bottles and tell him or her exactly what pills you are taking. Sometimes the physician needs to be reminded."
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