Seeing grandparents (or parents) in their final years of life, one cannot help but notice the eagerness many MDs have to operate on them or prescribe baskets full of pills. Perhaps it has something to do with Medicare.
An editorial in the November 1993 issue of Canadian Family Physician shows some of the same concerns. It is appropriately titled, "Why are we still poisoning the elderly so often?" This is how the author began:
"The article by Bloom and colleagues (page 2337) makes for disturbing reading. The authors audited long-term medication use in a randomly selected cohort of 47 patients aged 65 and older who had attended a family practice teaching unit within the previous 2 years. Charts were reviewed for 'potentially undesirable prescribing' (PUPs) and 'potentially undesirable use' (PUUs) of drugs assessed during home visits by a trained nurse. There were 26 instances of PUPs in 21 patients and 39 PUUs in 22 patients. As the authors state, 'This is a discouraging finding in an academic teaching unit.' "Reading this article reminded me of the findings from a study of the medicine-taking habits of 800 elderly people in the United Kingdom. Twenty-three percent of patients had been receiving repeat prescriptions for more than a year without seeing their family physicians; doctors had not kept any notes on about 25 percent of the prescribed medicines their patients were taking; and 40 percent of sedatives, hypnotics, and anxiolytics had first been prescribed at least 5 years before. Overall, the authors estimated that nearly a quarter of the elderly people receiving prescribed medicine were taking some pharmacologically inappropriate medicine and a further two fifths of medicines were borderline. The results of this study prompted an editorial in the Lancet entitled, 'Need we poison the elderly so often?'"
The problems are not just limited to overprescribing:
"Not only do doctors prescribe inappropriately for the elderly, but they also give out fewer instructions with their prescriptions. In a telephone survey, 27.3% of patients aged 18 to 64 said that physicians had discussed side effects with them at the time they got their prescriptions. The comparable figure for those 65 and older was only 12.1%."
The elderly are supposed to be cared for, not drugged into a stupor (or out of existence). Your older patients need to be protected from this kind of treatment. Your younger patients may also have concerns about their parents or grandparents. As a DC, shouldn't you be talking to them about this problem?
