In My Words
by Lyndon Drew, Gerontologist, Wichita, KS 

My father died in 2003 after battling diabetes and its complications. Medical mismanagement robbed him of all but a few good days during his last months of life. As a gerontologist, I learned the hard way that the long-term care system sometimes does more harm than good. I promoted better mental health and aging services for 10 years as a staff member for the Kansas Department on Aging. Now I have seen the dark side, the abuse of readily available psychotropic drugs. These drugs are meant to counter the symptoms of mental illness, but they can instead rob older adults of their mental abilities and increase their dependency on the long-term care system. 

My father's last days began in the hospital emergency room and intensive care because his blood sugar dropped to 20. His physician also diagnosed a urinary tract infection and prescribed Noroxin, an antibiotic. My father recovered from his low blood sugar and moved out of intensive care. Unfortunately, he quit eating. His lunch from a full tray of hospital food too often was a serving of jello. He would reject everything else, declaring, "I'm not hungry." Hospital staff discussed with family the alternative of assisted living, but his wife chose to take him home and assume the role of caregiver. The hospital discharged him starving to death. 

He went home with home health care, his Noroxin, and a prescription for Humalog (a form of insulin). The family and the home health nurses tried various approaches to treating the starvation. Usually he cursed them and refused all food. Family members theorized that he might be depressed, so the physician gave him free samples of Zoloft, an antidepressant. The Zoloft made him sick. He started to throw up what little food or drink he had consumed. The physician offered another drug to control the side effect of the Zoloft. We threw the Zoloft in the trash. The Zoloft experience had raised a question, "What are the side effects of Noroxin?" One side effect of Noroxin is a loss of appetite. The family decided to stop the Noroxin and buy milk shakes on the advice of a dietician. My father started eating. Within a week he was laughing and living. He survived his first encounter with the dark side of mental health and aging. The family discontinued home health care. In my last phone conversation with the nurse, I suggested that my father's starvation was drug induced. The nurse never  acknowledged that I had spoken. The case was closed. Normal life resumed for a few months until one day my mother reported that my father was falling and could hardly walk. The hospital admitted him pending an MRI to diagnose the stroke. My father entered the hospital coherent, but once in the hospital became incoherent. He often asked for help to get out of bed, to leave his room, to wander the halls. The hospital eventually transferred him to a private room across the hall from the nurse's station. Fortunately, he recovered his wits after a few days. By Sunday morning, he was different; he was sluggish, less coherent. I asked the nurse if he was taking any new drugs. She said yes, Celexa (an antidepressant). I objected, but the medical professionals thought the drug might make physical therapy for the confirmed stroke more possible. By the middle of the week hospital staff had to manhandle him just to get a sugar count. The family then agreed to refuse the Celexa. I wrote on the room blackboard, "No Celexa." The nurse and the physician got the message. 

A pain is his leg landed him in the hospital a third time. The emergency room physician diagnosed gout but an unusually low heart rate prompted hospitalization. The next day, nurses started giving him Xanax (an antianxiety drug) without the family's knowledge. He started asking for help to get in and out of bed, to leave his room, to wander the halls. Hospital staff wanted family members to stay with him throughout the night. The family learned about the Xanax and immediately asked nurses to discontinue dosages. My father's restlessness decreased. A new physician, a cardiologist, diagnosed advanced congestive heart failure, too advanced for treatment. My father had entered the hospital with misdiagnosed ischemic pain and left with hospice care.  

The family now understood that my father had missed his opportunity for treatment of a chronic illness and had suffered again and again from treatment for mental illness—with Zoloft when Noroxin robbed his appetite, with Celexa when a stroke took his mobility, with Xanax when congestive heart failure created pain and confusion. During his last days he got Lortab from the hospice whenever he needed a painkiller. The hospice social worker also suggested an antidepressant when he talked about his deceased brother. The hospice nurse brought Lorazepam for his anxiety. He subsequently fell, a possible side effect. So from the beginning to the end of his long-term care, my father suffered from drugs meant to help his mental health.

Research verifies that my father's experience was not unique (AHRQ,2003a; McCoy, 2002). I used to worry that older adults underutilized the mental health system. Now that 20% of older adults are using psychotropic medications, I worry that older adults are over utilizing mental health services (AHRQ, 2003b). Chemical restraints are regulated in nursing facilities, but they are readily available outside of nursing facilities. Medical iatrogenesis can take advantage of this  availability to create drug-induced dependency in older adults living in the community. 

I have already written a letter to my son advising him that if I suffer the same fate as my father, he should spare me the psychotropic drugs. Just give me more tomato juice. It seemed to help my father's mental health when all else failed.

References

AHRQ (Agency for Healthcare Research and Quality). 2003a. "Outpatient Prescription Drug-Related Injuries Are Common In Older Patients, But Many Can Be Prevented." Research Activities, March, pages 1-2. (http://www.ahrq.gov/research/mar03/0303RA1.htm)

AHRQ (Agency for Healthcare Research and Quality). 2003b. "Depression and Anxiety Affect a Substantial Number of Elderly People Living in the Community." Research Activities, September, pp. 17-18. (http://www.ahrq.gov/research/sep03/0903RA25.htm#head2)

McCoy, W. David. 2002. "Abundance of 'Cures' Brings Ills." New York Times, June 11. (http://www.globalaging.org/health/us/agedrugs.htm)

McCoy, W. David. 2002. "Abundance of 'Cures' Brings Ills." New York Times, June 11. (http://www.globalaging.org/health/us/agedrugs.htm)

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