Kerala - Thiruvananthapuram   

Go easy on the drugs for a healthier and happier old age

Thiruvananthapuram: Metformin tablets for diabetes have been a staple in the medicine box of Madhavan Nair since he turned 50. Now 75, Mr. Nair says that he has lost count of the additions that have come into his medicine chest.

What used to be a monthly medical bill of Rs.250 to Rs.300 now stands at Rs.3,500, for medicines prescribed for various ailments that have accompanied diabetes over these 25 years.

He is on statins for lowering cholesterol and drugs to tackle hypertension, neuropathy, heart problems and gastric problems, and of late, those to alleviate memory loss and neurological degeneration.

Mr. Nair has been taking 15 drugs daily for the long term. He says that he cannot give up any because his diabetologist, cardiologist, neurologist and gastroenterologist have prescribed them. He does wonder at times about the increasing number of drugs and the possible side effects.

This is a problem faced by almost all elderly persons with multiple ailments. Most health complaints are born out of the ageing process or a systemic disease such as diabetes, and it is the specialists who treat them, resulting in a drug regimen with at least 10 to 15 drugs and complex dosage schedules.

“The concept of geriatric care is yet to take off in Kerala. There is no one to guide the patients and take care of their general health,” says Mathew Thomas, former Professor of Internal Medicine, Government Medical College, Thiruvananthapuram.

“People are not satisfied unless they see a specialist doctor, but specialists are trained to focus only on the specific problem. It is actually the physician who should be in charge of the elderly, who should see the patient and decide the drugs combination and dosage.” Prescribing drugs for the elderly is one of the most challenging tasks in clinical medicine, given the age-related physiological and biological changes as well as the multiple pathologic conditions they may have. “It is my experience that in patients over 65 years, 80 per cent of their health problems are due to the large number of drugs they take. When there are too many drugs, the compliance goes down and the dosage and schedule confuse the elderly. The number of drugs should be kept minimum. What they need is more of physical activity, some physiotherapy and entertainment.” In an elderly person, the focus should be more on the general health, good mental state and improved physical activities. Not every complaint requires full-fledged treatment. More than physical ailments, it is psychological issues and loneliness that adversely affect the health of the elderly. Hence, counselling for them as well as their family members is an important part of the treatment of senior citizens.

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