Rx: Not for the Elderly

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ething is wrong with the way drugs are prescribed to the elderly in this country. Every year, according to last week's Journal of the American Medical Association, nearly 7 million older Americans--about one-fifth of the population age 65 or older--are given medications that are rarely appropriate for people their age. Worse still, the same article reports, nearly 1 million swallow pills that an expert panel has determined senior citizens should probably never take.

How does this happen? Mix-ups, pill sharing and people using expired prescriptions contribute, but at least part of the problem is the way doctors are trained. Pediatrics is mandatory in all U.S. medical schools, but geriatric care tends to get glossed over. In pediatric rotations, I was told over and over that kids are not little adults. They are treated differently and get different drugs and dosages.

Not so the elderly. Seniors, despite appearances, are not just older adults. The human body goes through changes as it ages, externally and internally. The elderly often have less muscle mass, a slower metabolism and greater sensitivity to certain drugs. Yet the recommended dosages for most medications are based on a 154-lb. man of normal metabolism--with no allowance for age.

Case in point: propoxyphene (Darvon), which for the elderly offers no better pain relief than aspirin or Tylenol and is known to be addictive. Yet more than 6% of the seniors surveyed had been prescribed propoxyphene. Even more serious are a variety of modern tranquilizers and hypnotics, such as flurazepam (Somnol) and chlordiazepoxide (Librium). These medicines can lead to falls and hip fractures.

The most disturbing stories I've heard are from older patients who complain to their doctors about the adverse effects of their medication and are told that they are "just getting old." The fault is not always with the doctor, Dr. Arlene Bierman, one of the authors of the study, is quick to add. "Physicians want to give good care, and patients want to receive it," she says. But a situation that was already bad is getting worse as the population ages and new medications proliferate.

There is also an underlying problem with our medical system that Dr. Jerry Avorn, writing in an accompanying editorial, describes as the "triumph of habit over evidence." Doctors tend to write the prescriptions they're used to writing, rather than boning up on the latest drugs.

There is talk of instituting technological fixes--pharmacy-based warning systems or handheld devices that give doctors up-to-date drug lists. An enhanced focus on geriatric care in medical school would also help, as would annual medication reviews. But for now, seniors may have to fend for themselves. They should never change prescriptions without consulting their physicians, but they should feel free to question their doctors if they find themselves taking medications from the list of drugs to avoid.

Dr. Gupta is a medical correspondent at CNN. E-mail drsanjaygupta@hotmail.com