Some Questions of Medication

As we grow older above the age of 30, we begin to lose a part of our “organ reserve.” In youth, our hearts van pump ten times the amount of blood required to sustain life, our kidneys can excrete six times the waste products that we produce in our bodies each day, and every other organ has similar reserve powers that fortunately are very seldom required. After age30, we begin to lose this reserve at a rate of 1 or 2 percent each year. We don’t even notice the loss, unless we are in a situation in which we really need it. Loss of reserve power means that it is more difficult to restore the equilibrium of the body after a severe insult to a body function.

As we age, our bodies detoxify drugs at a slower rate. In medical terms, the drug is metabolized more slowly. A little goes along way. In essence, we can get the same effect for a lower dosage; the regular dose of a drug can become an overdose. The first rule that a good doctor observes with an older patient is to keep the dose low.

Side effects of medications can simulate disease, and unwary doctors and patients often mistake a drug reaction for an underlying medical problem. A small dose of codeine may cause severe fatigue and sleepiness, a little digitalis may cause profound nausea and vomiting, a diuretic to remove fluid from the ankles may cause dizziness and kidney problems. The second rule that a good doctor observes is to suspect that the whole problem might be a minor drug reaction, cured simply by removing the offending drug. The largest problems come from the anti-inflammatory drugs, such as aspirin, naproxen, piroxicam, ibuprofen, indomethacin, and meclofenamate. These drugs frequently cause bleeding from the stomach and often cause hospitalization or even death. Older people are at three times the risk of younger ones.

Entirely new side effects can appear in the elderly. A sleeping pill may keep the patient awake. A tranquilizer may excite the patient or cause severe depression. These paradoxical reactions are not fully understood, but they are very common. Again, the good doctor and the thoughtful patient or relative will suspect the drug first.