You may be concerned about the financial judgment of an elderly client. He appears lethargic, confused, depressed — even has balance problems — and you’re worried about dementia. In fact, the problem may not be dementia but drug abuse, and the substances your client is ingesting aren’t illegal substances sold on the street but medicine prescribed by his doctor.

A recent CBC radio program, Seniors and Drugs: Prescribed to death, noted that drugs, not just old age, are killing Canadian seniors. On analysing Health Canada’s adverse drug reaction database, CBC estimated that about 3,300 seniors die in Canada every year as a result of bad drug reactions. Even though seniors make up only 13% of the population, they accounted for 44.4% of all deaths reported to Health Canada from 1999 to 2003.

While death is the extreme result, seniors are being hurt by the drugs they take. They consume 40% of all prescription medications taken in Canada, and experience more than a third of the reported negative side effects. Those percentages may be just the tip of the iceberg, as many reactions are not reported.

As a concerned advisor, you may want to alert your senior clients to potential problems before they become realities. An alternative, if you run a family practice, is to introduce the subject to other members of the family. Or you can make the topic of prescription drug abuse the subject of a group event such as a lunch-and-learn session, and invite a health-care professional to speak to the group.

“Prescription drug abuse is a real problem,” says Dr. P.K. (Chari) Rangachari, a medical doctor and a professor of pharmacology at the University of Calgary. “People are living longer. And the older they get, the greater the probability that they will need treatment. And as people age, their bodies metabolize drugs less efficiently. Their liver and kidney functions and their circulation systems start to decline.”

Toxic cocktails

The multiple prescriptions many seniors have can combine to form toxic cocktails.
“Older people are often seen by different medical specialists who don’t realize that other specialists are prescribing drugs for them,” Rangachari notes.

The problem has its roots in our “turnstile” system of medicine, he adds, which gives doctors little time with any one patient. In addition, few physicians keep electronic medical records because of their concerns about patient confidentiality. A recent survey by the Canadian Medical Association found only 3% of its members had fully electronic records.

“We need to educate physicians and medical students to be aware of the situation,” Rangachari says. “But the problem is probably too serious for physicians to handle alone. The best prevention is for the patient — or family — to become an active partner in his or her own health care. The volume of information that’s now available is allowing patients to take action on their own behalf.”

However, an individual has to be careful about what kind of information he or she is accessing. For example, a wealth of information about disease, medicine and health care is available on the Internet, but it may be misleading or misinterpreted. The objectivity of the information may also be questionable, especially if the site is run by
a provider of health-care products.

The best way for a patient to participate in health care is in conjunction with a trusted physician. The time has passed, he says, when doctors can take a patronizing attitude and assume they are the sole authority. “It makes good sense to engage the patient,” he adds. “The doctor may serve 300 or more patients, but the patient has only his or her condition to learn about.”

It is up to patients and their families, then, to open the lines of communication with their physicians. Gloria Gutman, director of the gerontology research centre at Simon Fraser University in Vancouver and president of the International Association of Gerontology, lists a number of issues seniors should bring up with their doctors:

> Senior patients should inform every doctor they see about all the medical prescriptions they have from other physicians and dentists.

> They should tell their doctors about all allergies and sensitivities.

> They should tell doctors about the non-prescription drugs, herbal remedies and vitamin supplements they are taking. “People buy laxatives, decongestives and stomach preparations, and these can be deadly when combined with prescription drugs,” Gutman says.