Prescribing drugs for every symptom can result in drug-induced health complications, especially among the elderly. 7

from book

Aronson once had a patient named Dimitri. At age 79, with advanced Parkinson’s and a slew of chronic diseases, including dementia, Dimitri took ten medications, many of them multiple times daily. That might seem normal for someone Dimitri’s age, but, far too often, patients take drugs to treat side effects caused by other drugs. This can have disturbing consequences.  When Aronson first met Dimitri, he was almost unresponsive. Lying in bed with his eyes closed, he could hardly reply to Aronson’s questions. What was his name? He silently moved his lips. Was he in pain? No response. However, Dimitri seemed quite fit. He was muscular, with healthy organs. Aronson, trying to figure out what was going on, took a closer look at his list of medications. None was uncommon, and all were appropriate to his diagnoses. However, two of them were included on a list of medications that might have adverse effects on older people. Upon seeing this, Aronson called Dimitri’s daughter, Svetlana, and asked how long her father had been in such a dire condition. To Aronson’s surprise and horror, Svetlana responded that Dimitri was completely healthy a year ago. Even six months ago, he’d been able to walk, talk and read. Aronson immediately stopped eight of his medications and began reducing the others. Within a week, Dimitri was sitting up. Day by day, he began talking more, as well as eating and moving. Six weeks later he moved to the assisted living unit, where he took up painting and became romantically involved with a fellow resident. So, what had happened? Well, Dimitri had been the victim of a “prescribing cascade.” This refers to when a prescribed drug’s side effects are treated by another drug. The side effects of the new drug are then treated with a new drug. This continues until the patient is taking a great deal of medication. First, Dimitri was prescribed medication for his blood pressure. When that caused him to develop gout, he was prescribed yet another medication, and when that caused heartburn, yet another. This continued until he’d developed drug-induced Parkinson’s and dementia. Of course, prescription drugs are not the primary cause of Parkinson’s and dementia. But we’ll never be sure how many cases like Dimitri’s go undiagnosed until we cease to prescribe drugs for problems caused by other drugs.