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HealthScout News Service

   The more medications the el-derly ingest, the less knowledge they have about what they're taking. And that lack of aware-ness can have potentially disas-trous consequences.

    Only 15 percent of elderly pa-tients interviewed in an urban hospital could correctly list all their medications, dosages, fre-quencies and side effects, ac-cording to a report in the June issue of Annals of Emergency Medicine. And those who took more than three medications a day were the least likely to know what each drug was for:

   "Our study reflects poor com-munication between health-care providers and elderly patients, the complexity of modern medi-cal regimens and the passive role the elderly are taking in their health care," says Dr. Joel Bart-field, co-author of the study and an emergency-medicine professor at Albany Medical College in New York.

     One of Bartfield's primary concerns: Emergency-room per-sonnel could unknowingly give an elderly patient a drug that reacts badly with prescription medicines he might be taking.

    Between January and March 2001, Bartfield and Dr. Michael Chung, the study's lead author who was then a senior resident at Albany Medical Center,

questioned patients over 65 who  came into the center's emergency room. The doctors excluded those who were disoriented, severely ill or un-able to identify their pharma-cies, but allowed the rest the option to participate

   Of the 77 patients they inter-viewed each was taking an av-erage of just less than six prescribed medications. Collec-tively, they recalled 359 drugs. Buy when the researchers phoned the patients' pharma-cies, they learned that 458 pre-scriptions had been filled. Only 32.5 percent of the group knew their dosages.

   Despite the makeup of the study sample, Barfield believes age wasn't the pivotal factor. He believes a younger population group taking multiple medica-tions would also experience in-formation overload.

   Still, it's senior citizens who usually confront this conun-frum. The older people get, the more daily drug cocktails be-come a fact of life, even for the healthy. Physicians frequently prescribe medications for pre-ventative reasons - to ward off osteoporosis, control cholest-erol counts or lower blood-pressure levels, for example.

   Because it's a challenge for any patient to keep track of such complex regimens, doctors and pharmacists should pre- empt the inevitable confusion, Bartfield advises.

    "I think that all health-care professionals who deal with pa-tients have a responsibility to educate them about the pills they're taking," he says. "When they come into an emergency room, we need good informa-tion about what they are al-ready on. And then it's our job to make sure that additional medications that might be indi-cated aren't going to interact in an adverse way with what they are already taking."

   Each year, approximately 100,000 Americans die from ad-verse reactions to drugs, ac-cording to a 1998 report in the Journal of the American Medi-cal Association.

   Without greater understand-ing and knowledge of the risks related to mixing medications, the numbers are likely to climb, says Bartfield.

   "Considering a large number of elderly people go the emer-gency departments with ad-verse drug reactions, and they are the fastest-growing age group, this could become a major public-health problem," he adds.  

   Dr. Jerry Gurwitz, a geriatrician and professor of medicine at the University of Massachusetts, believes the problem is proba-bly greater than the study suggests.

    "They excluded a lot of pa-tients from their sample, and you can only expect the situa-tion to be even  more  problema-

tic with patients who are grave-ly ill or have memory problems," he says.

   Gurwitz, whose primary area of research is in improving drug safety for the elderly, says peo-ple should carry written records of their medications and do-sages with them.  These should include explanations of each drug's purpose.

 "Doctors need to help their patients update their lists on every visit and request that they always bring in their medi-cation, whether they're going to their physician's office or to an emergency department,"Gurwitz says.

   Bartfield agrees that a more standardized approach to pa-tients' medication would help health-care professionals - pharmacists, private practition-ers and emergency-room physi-cians - prescribe the appropriate treatment.

   But he also recommends that people play amore active role in their own health care.

   Older Americans still harbor a "doctor knows best" attitude, he says. Many ask few quest-ions and take little responsi-bility for their medical treatment.

   Better-educated consumers, he says, will translate into fewer adverse drug reactions.

-Times Picayune, July 2002