Medications affect elderly people differently than adults. 5

from book

During the first year of her medical training residency, the author made a mistake. She assumed, like many doctors and doctors-in-training, that treating an elderly patient wasn’t so different from treating an adult patient. As a new internist, she’d inherited a group of patients from the senior residents who’d graduated. Among these patients was a woman named Anne. Anne was almost 90, and she always had a huge smile on her face. She and Aronson quickly became friends. When Anne showed up to an appointment without her usual smile, Aronson knew something was wrong. With tears in her eyes, Anne shared the bad news. She’d been forced to put Bess, her sister, in a nursing home. Before this, Anne had been caring for Bess, but she was too weak to continue doing so. Anne’s sadness gave Aronson pause. But after speaking to her supervisor, Aronson decided not to prescribe any medication. Anne was grieving, not depressed. When Anne came in for her next appointment, however, Aronson took action. Anne hadn’t been eating or sleeping, and her usual activities gave her no pleasure. Aronson prescribed an antidepressant. Though Aronson had followed protocol at every turn, she’d already made her mistake. She assumed that treating Anne’s depression would be the same as treating a younger patient’s depression. It’s hard to blame her. After all, before the National Institute of Health’s 2019 Inclusion Across Lifespan Policy, medical drug trials were not required to include older people. Ironically, most people who require these drugs are usually elderly. For example, most cases of atrial fibrillation occur among older people, but the drugs to treat it often have an unfortunate side effect: they cause patients to become confused. But since the drugs are “trial proven,” they continue to be prescribed, though they’re potentially unsafe. As it turned out, the antidepressant that Aronson had prescribed could cause elderly patients to develop extremely low sodium levels. Low sodium has many effects, including lethargy and confusion. In severe cases, it can cause death. Aronson only learned of the antidepressant’s impact on older people after unearthing some recently published case reports. But, by then, Anne had already been readmitted to the hospital, requiring urgent care. Her son, Jack, had already questioned Aronson’s competence. It was an experience as humbling as it was educational.