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Our elderly are adrift in a sea of drugs Add to ...

The quirky, popular syndicated column Straight Dope recently examined the legend that the "Eskimos" put their old people on ice floes and set them adrift. Author Cecil Adams said "senilicide" (the killing of old people) did occur during severe famines, but the last recorded case was in 1939, and even before that it was a rarity.

"The common perception of taking granny out to the nearest ice floe and setting her adrift is wrong."

But the common belief that granny is a lot better off today than in the mythically cruel Arctic of old may be equally wrong.

In fact, there is ample evidence that senilicide is more common in our wealthy, modern Canadian society than it ever was in Inuit society. We don't set our elders adrift on ice floes, but we do the modern equivalent: We drug them into icy oblivion.

Overmedication of seniors is an ever-worsening epidemic.

Troubling information emerged recently that Ontario nursing homes are relying heavily on drugs to control patients with dementia. The study, conducted by the Institute for Clinical Evaluative Sciences, found that one in four newly admitted nursing home patients was prescribed anti-psychotic drugs within a year. Almost 10 per cent of them received excessive doses.

Patients in hospitals and nursing homes are chemically restrained -- sedated if you prefer -- to protect them from harming themselves. But the practice also occurs because of understaffing and our disdain for aging and the elderly.

Mundane, everyday overprescribing is just as troubling. Almost 88 per cent of Canadians over the age of 65 have taken a prescription drug in the past month.

It is virtually unheard of for a senior to leave a physician's office without a prescription. They are prescribed blood-pressure medication, cholesterol-lowering drugs, arthritis drugs, diabetes drugs and anti-depressants in dizzying numbers.

Once a person is admitted to hospital, the number of drugs prescribed increases. A recent study found that, after hospitalization for a heart problem, elderly patients leave the facility with, on average, eight prescription drugs. Another research paper showed that one in three seniors is improperly prescribed drugs.

While drugs have benefits, they also have side effects, particularly when they interact, when they are taken in the wrong doses, or when the wrong drug is prescribed. About 10 per cent of all admissions to hospital among seniors are due to reactions to drugs.

Misuse of drugs also occurs frequently in hospitals. A new report on "adverse events" (also known as medical errors) found that between 9,250 and 23,750 Canadians annually die as a result of these avoidable errors in hospitals.

Most of the deaths were among seniors -- the principal clientele of hospitals -- and a significant percentage were drug-related.

Of course, all this prescribing is well-intentioned -- but so was setting people on an ice floe. It does not excuse the dreadful outcomes.

Dr. Michael Rachlis, a University of Toronto professor and author of the book Prescription for Excellence, estimates that at least $1-billion a year is spent on prescription drugs for seniors that they should not take.

The World Health Organization, in a report, estimated that up to 50 per cent of prescribing worldwide is irrational -- useless, unneeded, wrong dose, harmful. In Canada, that works out to $8-billion a year in unnecessary spending, and related harm.

Aside from the obvious waste of money in a cash-strapped system -- money that could be better spent providing seniors with services they desperately need, such as home care -- there is very little tracking of the appropriateness or inappropriateness of prescription drugs.

Take, as an example, drugs to treat osteoarthritis, a common condition among seniors. About one in three seniors takes daily painkillers for arthritis pain. One in five takes a new class of drugs called cox-2 inhibitors. While these drugs are much more expensive, there is little evidence they work any better. In fact, according to a recent study, again by ICES, these drugs are associated with a higher risk of heart failure than traditional painkillers. And this is not an isolated finding. Earlier research found that diuretics (known as water pills) costing only pennies were just as effective in treating high blood pressure as fancy new heart drugs called ACE inhibitors, which cost hundreds of times more and have markedly more side effects.

There are virtually no cost-benefit analyses done on prescribing practices, and very little follow-up on how individuals -- and seniors, in particular -- fare. Without this information, without these checks and balances, our elders are being cast adrift, not on an ice floe, but in a pharmacological haze.

Follow on Twitter: @picardonhealth

 

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