Prescription Drugs Can Be Dangerous for the Elderly

Accidental overdose of an older patient often begins in good faith. The patient becomes ill and requires treatment, which at first is closely monitored. To prevent relapse, medication is continued. Time passes. A decline begins. Over a matter of weeks, for no apparent reason, appetite disappears and pounds are lost. Or fatigue sets in out of proportion to the passage of time. Or a bus ride is forgone for fear of falling down or losing bladder control. Or conversation becomes confused; senility has arrived with the change of a season.

Just as often, nobody thinks of reviewing the patient's drugs. Instead, the doctor may add a new drug to combat side effects not recognized as coming from another - for example, an anti-depressant to relieve the blues caused by a blood-pressure drug. Just because a drug has been taken comfortably for months or years does not automatically mean that it is innocent.

Another common scenario: The older person has been cheating, skipping doses of a drug when not feeling right, but then, after a decline, begins to get nursing care - and a full dose of medication, like it or not.

Most estimates are that people over 65 consume at least twice the amount of prescribed drugs as younger adults, not to mention over-the-counter medicine. Physicians who have been studying the question, recently observed that the elderly are being given too many drugs for maladies or malaise that may not respond to the pharmacy. Anti-psychotic or anti-depressant medication, for example, is not the solution for loneliness or depletion of resources.

The sheer statistical opportunity of the elderly to be poisoned is all too apparent. There also are features of the aging body that render it more vulnerable to drugs. After age 60, we typically start losing weight - not from the fat that has been building since our 20s, but from lean tissue.

The disparaging image of older people as ''drying out'' has a certain physiologic truth to it. Body water, the major component of lean tissue, diminishes. We become smaller vessels; thus the standard adult dose of a drug, diluted in a smaller volume of water, easily turns into an overdose.

Meanwhile, time chips away at the kidneys, which lose their reserve capacity to remove wastes and toxins.

Pediatricians and veterinarians routinely adjust drug dosage to the body size of their patients. Many physicians prescribing for older adults appear not to.

Sedatives, digitalis drugs, diuretics and anti-hypertensives appear to be the common prescription items making the most trouble for elderly people, along with drugs prescribed for psychiatric disorders - anti-depressants and the major tranquilizers. The latter can produce symptoms ranging from a mild dopiness to abnormal movements (resembling those of Parkinson's disease) to full-scale delirium.

Non-prescription items can be virtually as disabling. Antihistamines, for instance, often have not-so-subtle effects - unsteadiness and a tendency to fall - that persist long after the dose supposedly has worn off.

The least effective solution to prescription overdose is for doctors or patients to start blaming each other as, respectively, ''too aggressive'' or ''non-compliant.'' Any therapeutic measure reflects some kind of contract between doctor and patient, often tacit and unrecognized. When both parties perceive drugs to be beneficial, suspecting them of harm becomes less likely. But part of every checkup should be a routine review of all medications and, when symptoms develop, the review should take high priority.

For a patient to make adjustments of medication without consulting a doctor is highly unwise. To avoid the extremes of drug deprivation or overdose requires teamwork. The paper-bag exercise, which I gather has become popular in that small town in Normandy, and a certain respectful skepticism about the value of drug therapy are the patient's fundamental recourse.