Friday, June 24, 2011

Chronic pain, seniors and medication

On the one hand we read older adults are overmedicated, now we read that chronic pain isn't being managed. I have written much about the myths of pain management. I fought for months to get adequate pain meds for my father.

On the one hand we find that depression, grief, sadness and isolation in those in long-term care, retirement homes, or isolated in their own homes without transportation. It is my contention that it is undiagnosed pain that confounds some.

June 22, 2011

Seniors overmedicalized, experts say

Still others say that the pharmaceutical industry plays a role. “Doctors are influenced [by pharmaceutical marketing] usually without knowing it,” says Dr. Joel Lexchin, professor of health policy at York University in Toronto, Ontario.  Lexchin adds that his studies link marketing with decreased quality in prescribing patterns and increased costs for patients, including seniors (PLoS Med 7(10): e1000352. doi:10.1371/journal.pmed.1000352).

Lexchin argues the aging process itself often leads to unnecessary interventions. *Normal reactions associated with aging, such as depression or grief or even sadness and isolation associated with being cooped up indoors during the winter are often inappropriately characterized as medical conditions, he says. “Doctors don’t have a lot of time to spend with each patient, nor do they often have access to the kind of resources like social workers and community workers that could prevent the use of prescription medications.”

More insidiously, Lexchin argues that the elderly in long term care homes are often drugged so that they are more manageable in a resource-constrained environment. He cites as evidence a study that found about a quarter of adults who enter a licensed nursing home in the province of Ontario were prescribed an antipsychotic drug in their first year, despite never having been on a neuroleptic (J Am Geriatr Soc. 2004; 52:749-55).
*Normal reactions to aging do NOT include clinical depression. This is not true for all seniors. This is a gross misstatement. I cannot accepts that this is normal.
Doctors definitely do not spend much time with their patients in long-term care and retirement homes. It is a shameful part of our healthcare system.

Little Progress Seen in Treating Chronic Pain

Many factors influence patients' experience of pain, including cognitive and emotional elements, history, and pathology -- all of which need to be addressed for successful pain control.

After age 75 or 80, the arterial walls are less elastic and therefore a higher blood pressure is often necessary to pump blood to areas where it’s needed, he says. “By medicating to lower blood pressure, I run a high risk of creating circulatory insufficiency.”

I blame the lack of geriatricians, unfamiliar with the complexity of senior health issues. For example, side effects for these seniors, who are often left out of clinical trials. Pharmaceuticals control clinical trials. Subjects are controlled for only one morbidity. This means they do not test for contraindications and yet many of our seniors have comorbidities. Also, many seniors are given prescriptions to offset other prescription.

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