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Is Grandma drugged up?

  • Story Highlights
  • Every year, 38 million older Americans suffer drug complications, research says
  • Certain sleeping pills can make an older person more likely to fall
  • A doctor or pharmacist can review medications and check for interactions
  • Ask your doctor whether there are alternatives to your medications
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By Elizabeth Cohen
CNN Medical Correspondent
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ATLANTA, Georgia (CNN) -- One cold November weekend five years ago, Kelli Phillips and her husband traveled from their home in Norman, Oklahoma, to Kansas City, Missouri, to watch their beloved Oklahoma Sooners play in a Big 12 championship against Kansas State. Checking into the hotel, they looked forward with great excitement to the game.

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Kelli Phillips' mom, Nancy Burns, turned out not to have Alzheimer's disease but was overmedicated.

And then Phillips' heart sank.

"When we got to the hotel that night, I turned my cell phone on, and I had four or five messages from my mother wanting to know what day it was and if it was morning or nighttime," Phillips says.

Phillips immediately called her brother, Brad Burns, who went the next morning to check on their mother. He found Nancy Burns stumbling around her home, confused and slurring her words.

Phillips and Burns took their 66-year-old mother to the emergency room when Phillips returned from Kansas City. At first, doctors thought she'd had a stroke, but tests showed that she hadn't. Burns was admitted to the hospital, and a neurologist diagnosed Alzheimer's disease or possibly Pick's disease, another form of dementia.

"Something in my gut told me it wasn't right," Phillips said. They took their mother to a geriatrician at the University of Oklahoma for a second opinion. Video Watch more on overmedication risks for seniors »

"She sat down with us and said, 'I don't believe your mother has Alzheimer's or Pick's disease. I believe she's overmedicated,' " Phillips remembered. "My brother and I looked at each other, and it was like, we knew it. We knew it."

Every year, 38 million older Americans suffer drug complications, 180,000 of which are life-threatening, according to research by Dr. Jerry Gurwitz, chief of geriatric medicine at the University of Massachusetts Medical School.

The risk for drug errors is seven times greater in seniors than in people under age 65, according to Medco Health Solutions, a pharmacy benefits manager.

"When I was in training, my mentor taught me the maxim that any new symptom in an older person should be considered a drug side effect until proven otherwise," Gurwitz said.

Only a doctor can tell you whether your older relative is suffering from medication side effects or from an actual disease. But here are steps you can take to help your doctor sort out which is which.

1. Click here for a list of drugs that often cause problems for older people.

"Doing this is a giant step forward," said Dr. Mark H. Beers, who developed this list, called the Beers Criteria. "You can look these up so simply."

If a senior is taking a drug on this list, don't stop immediately; instead, talk to your doctor, urges Beers, a professor of medicine at the University of Miami School of Medicine.

"You really need to go to your doctor and say, 'I'm taking one of these medicines I've read can be really bad for older people. What should I take instead?' " Beers said.

Why are these medications potentially problematic for older people? Some, like certain sleeping pills, can make an older person woozy when standing up and likely to fall.

Older people metabolize drugs differently from younger people. In the aging body, the liver and kidneys may not easily process medications, and changes in the fat and muscle distribution of older people make them more susceptible to drug problems, according to American Society of Consultant Pharmacists.

You can also click here for a list of drugs to be avoided for people who have certain diseases.

2. Click here to find out about drug interactions.

It's easy: Type in the name of a drug, and it will tell you what interactions it has with other drugs or with food. Here's another tool that's similar.

Some very common drugs don't mix well in the elderly, according to Dr. Robert Epstein, chief medical officer at Medco. For example, he says, anti-anxiety medications and sleeping pills can cause dizziness and falls, blood thinner and aspirin can make the blood too thin, and beta agonists for lung issues and beta blockers for cardiovascular issues can cancel each other out.

To find out whether a drug interacts with certain herbs or supplements, click here.

3. Get a "brown bag review" from your doctor.

Geriatricians recommend having a doctor review your medications regularly to make sure they don't interact -- and to double check that you really need all of them. It's sometimes called a "brown bag review" because some patients bring their medications in a brown bag.

This is especially important for seniors who see multiple doctors, because physicians often don't consult with one another before prescribing a drug or changing the dosage on an old one.

A classic example is where two doctors prescribe blood pressure lowering medications, says Dr. Joseph Agostini, a geriatrician at Yale University School of Medicine.

"Sometimes, someone has a fall, and you think it's a mini-stroke or they're dehydrated," he said. "But it's that another physician added an additional blood pressure drug or raised the dosage on one they were already on. This is a very common occurrence."

But even physicians are very clear that a "brown bag review" won't solve everything.

"These older people can be on 16 medications. So you've got a 15-minute doctor's appointment, and you're going to go through all these 16 medications one by one?" Gurwitz said. "It's really, really hard."

4. Get your pharmacist to review your medications.

Another option, then, is your pharmacist, who most likely has drug interaction software your doctor doesn't. Make sure the pharmacist doing the drug review knows everything you're taking, including drugs you're getting from another pharmacy.

Another option is to hire a certified geriatric pharmacist to review all your medications -- click here for a state-by-state listing. This site also lists pharmacists who have an interest in geriatrics, but not all of them are certified by the Commission for Certification in Geriatric Pharmacy.

A consulting pharmacist charges as much as $300 for an initial consultation and about $100 per hour after that, according to Lee Meyer, president of the American Society of Consultant Pharmacists.

5. Ask your doctor: Do I really need this medication?

In the end, it all comes down to math.

"Once you're taking more than two or three drugs, you have to realize that every time you add a new drug, the risk of something going wrong goes up exponentially, not linearly," Beers said.

He advises thinking through with your doctor whether there are alternatives to drugs. "Let's say I'm taking five medications that I absolutely need to take. Then when I have trouble sleeping, and a doctor wants to prescribe another drug, I should think, 'Is there something I could do besides take a pill?' " he said. "Or if I have swollen ankles, is it possible to cut down on salt rather than take a diuretic?"

Here's another useful question you can ask your doctor, suggests Agostini: "What's the evidence this drug will help, and if I take it, can I get rid of another medication I'm taking instead of piling on one medication after another?"

In Nancy Burns' case, it turned out that several doctors had prescribed various powerful drugs for her manic-depression.

"When we finally saw the geriatric psychiatrist, he said, 'She's taking enough to choke a horse,' " her son said. "She didn't need all of them, and they were causing problems."

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Back in 2003, Burns was taking eight medications. Now she's taking four and is back to normal.

"It wasn't just the drugs I was taking. It was the combinations of the drugs," Burns remembered. "If it hadn't been for my children, I'd be in a nursing home right now."

CNN's Jennifer Pifer, Sarah Hill and Sarah Edwards contributed to this report.

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