Drugging the Elderly

Laura Newman couldn’t understand why her mother was having so much trouble walking. Lately, her mother had been complaining of fatigue and soreness. Was it all just a normal part of the aging process, Newman wondered? Or was her mother sick? Neither one, as it turns out. Laura Newman’s mother was on the highest dose allowable of simvastatin, one of the popular cholesterol drugs. She was suffering from rhabdomyolysis, a life-threatening illness that strikes a minority of high-dose statin users. And there was nothing in the woman’s medical history to justify such a huge dose—a dose usually reserved for post-heart attack patients. Laura Newman tells her mother's story in a just-released article in Scientific American. “As people age,” Rodney Hayward, professor of public health and internal medicine at the University of Michigan, told Newman, “the risks and benefits of people being on medicine change. Processing through the kidneys especially is increasingly less effective. You want to be aware of how many medications, and how many doses people are on, and reconcile that with the amount of benefit and risk.”

One huge problem is that people over 75 are systematically excluded from clinical trials.  And frankly, funding for pharmacology studies of aging populations is not traditionally considered a sexy research area. But it all results in a situation where, according to a study of elderly ICU patients cited by Newman, “85% were discharged with 1 or more potentially inappropriate medicines, with more than 50 percent in that group discharged with medications deemed more harmful than beneficial.” That’s not good. For the reasons noted above, doctors who care for the elderly “have little science to guide them,” Newman believes. The FDA is sitting on a mountain of proprietary drug safety studies, which, under present rules, neither doctors nor the public can get a look at. The elderly take more drugs than any other age group, and have more problematic drug interactions and side effects, yet it’s the least-studied drug population of all. “It will take a significant commitment for the federal government to marshall science and surveillance of drugs in this population,” Newman believes.