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Archive for Sunday, September 4, 2005

Martin: Speak up about prescriptions’ side effects

September 4, 2005

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A litter of cats was born in my basement. They've grown from blind lumps the size of gherkin pickles to scampering attack kitties.

When they wear out their mother and me, we steal upstairs.

The two of us have our habits. When I settle in a chair, the cat settles in, too, as if movie watching were also her favorite thing.

Pets make us aware of patterns - theirs and ours alike.

I think about this as Sally Rigler, a research faculty member in the Center on Aging at the Kansas University Medical Center, tells me about another human pattern that's rooted in habit. It came from a study of drugs used by more than 3,000 Medicaid recipients in Kansas.

Rigler and her colleagues report in the latest issue of the Annals of Pharmacotherapy that many elders habitually take what are, for them, inappropriate medications, given the side effects.

They may have taken the meds for years. Their doctors may have prescribed them for years. Everyone's comfortable with the arrangement, Rigler says, even though alternatives might be better.

There were three kinds of elders in the study. Some were in nursing care facilities. Some were at home, but frail and receiving services there. A third group was less challenged by disease and infirmity than the other two.

The drugs deemed "inappropriate" appear on lists constructed by Mark Beers, Rigler says. Beers, a geriatrician, and other experts worked up lists of drugs whose effectiveness hadn't been studied, whose side effects outweighed their benefits or that simply weren't well-tolerated.

Rigler's study focused on Medicaid claims made by Kansas elders between May 2000 and April 2001. During that period, 21 percent of the healthiest group had used at least one "inappropriate" drug, 38 percent of those in nursing facilities and 48 percent of the frail elderly living at home.

Among painkillers, propoxyphene was the most common inappropriate drug. It's an ingredient in a medication called Darvocet. Propoxyphene can cause grogginess, confusion and dizziness in older patients.

Another medication used for pain, amitriptyline, was also near the top of the list. Once again, sedation and confusion were among the problematic side effects, Rigler says. So were blood pressure and heart-rate changes.

Among antihistamines, the most common inappropriate drug is diphenhydramine, which is found in many over-the-counter cold products and sleep medicines. It can cause sleepiness, dry mouth and confusion in older folks.

These drugs may be older and cheaper than their alternatives, but costs aren't necessarily why elders take them.

Rigler says, "It may often be more a matter of prescriber and patient habit."

She suggests that older patients question doctors carefully about potential side effects of their medications.

They're often reluctant to do that, though. In fact, that reluctance is another habit that's hard to break.

Nesting with a cat in the lounge chair, taking propoxyphene for an ache, not asking questions - all of these are habits, some with benefits, some with risks.

We humans boast about our freedoms, but as animals, it's the patterns, the repetitions, that we love.

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