Bruce Hall, 81, directed a cab driver to take him from his Marin County, California, home to the Golden Gate Bridge. When they arrived, Bruce gave the driver all his money, got out of the car, and attempted to jump off the bridge.
“I couldn’t get over the edge,” Bruce told Healthline. “It was terrible.”
While he was conscious of what he was doing, Bruce says the impulse to end his life was out of his control. The retired banker and deacon of his church had attempted suicide two times within a span of a few months leading up to that day on the bridge.
However, for 80 years of his life, Bruce never had a suicidal thought.
“Bruce suffered from a series of strokes and had brain surgery. He became psychotic from the medicine he was prescribed,” his wife, Ellen Hall, told Healthline.
Shortly after the bridge incident, Bruce called 911 and told them he was going to kill himself. Immediately he was committed to the psychiatric unit of a hospital. Bruce was medicated there even more before moving to a nursing home.
“At the nursing home, he looked like a dead man walking. He didn’t have any real emotion. He couldn’t walk, talk, read, or write,” Ellen recalled.
Bruce’s primary care doctor suggested that Ellen contact Dr. Elizabeth Landsverk, a geriatrician in Burlingame, California, who evaluates medications that elders are on.
Landsverk believes too many seniors are overmedicated. She’s on a mission to change this.
“As geriatricians, we’re trained to take off medications first before we put more on. But often once medications are on, unless there’s a blatant problem, they don’t come off,” Landsverk said.
The main reason medications aren’t stopped, she adds, is because doctors don’t want to override medications given by another doctor.
“This is where I am different. I’ll call specialists and make sure a patient really needs a medication,” Landsverk said. “I also make house visits with patients.”
This was her approach with Bruce Hall.
“I started getting rid of a number of medications he was taking. It took me months to [wean Bruce off] the Ativan he was on, and because he was psychotic, he needed antipsychotic medication, so I had to find the right combination,” she explained.
Over the course of a year, Bruce stopped having suicidal thoughts and slowly gained back his ability to communicate. He’s back living at home with Ellen and has a part-time caretaker who works with Landsverk to continually adjust his medications.
“I couldn’t read or write, and now I’m writing and giving sermons again at my church,” Bruce said. “My life has changed.”
Landsverk says most of her clients come to her because an elder is agitated.
Oftentimes, she says anti-anxiety medications cause agitation, like Ativan and Xanax, or sleeping pills.
“I do not use these medications [in my practice]. Even with my own mother’s care, I have found that when you give elders these medications, it’s like giving them shots of vodka. And what happens is they get more confused and agitated,” Landsverk said. “A month after we get all of the anti-anxiety and sleeping pills out of their system, they are less agitated.”
She says Xanax is particularly dangerous because it’s short acting.
“Elderly are given it more often as needed or to sleep and then they get hooked, and within a few days or weeks they can be withdrawing from it and can be more agitated and fidgety. To deal with the increased agitation, they are given a higher dose, which makes them more irritable, aggressive, confused, and susceptible to falls,” Landsverk said.
She adds that anxiety medications often replace antipsychotics and pain medication, which exacerbates the problem.
“There’s a movement of ‘hugs not drugs,’ which on the surface sounds great because the push is to not drug elders with antipsychotics. But Ativan and Xanax are being used to treat what antipsychotics and narcotics were used for,” Landsverk said.
She believes if pain is properly treated, older adults no longer need psychiatric medications more than half of the time.
“People are upset and agitated because they’re in pain,” Landsverk stressed. “The goal should be to get rid of other sedating medications and treat their pain.”
She recalls an elderly man who was in physical therapy after breaking his hip. Landsverk was called because the man wouldn’t participate in rehab and was agitated and violent.
“When I visited him, the therapist asked him to get up and walk, but they hadn’t given him any pain medication. His hip hurt, so he was hitting them to get away from him,” Landsverk said.
While pain medication is often prescribed to older adults as needed, she says sometimes an ongoing regimen is needed.
“People with dementia can’t often locate where the pain is, even if it’s a repaired hip fracture, so what’s better is to give them a standing dose of Norco twice a day and watch them,” Landsverk said.
Still, she acknowledges the opioid crisis is serious, but said, “With older adults, there’s an occasional addict, but really old people are in real pain. They have bone-on-bone arthritis, spinal pains, and fractures.”
A few reasons may be to blame.
Pharmaceutical companies play a part. According to a report in
Commercials and ads that people see can lead them to ask their doctors for specific medications. Doctors will often prescribe medications their patients request, despite the drawbacks of those requested medications, according to research published in
Landsverk points out that a lack of communication between specialists and primary care doctors is another contributing factor to overmedication of older people.
According to a
Bruce Hall believes this contributed to his situation as well.
“I was on a dozen medications and there were three or four doctors giving me meds at the same time. They were all good doctors, but they didn’t all understand how the medications they prescribed me played together,” he said.
Some of this may be exacerbated by the fact that electronic medical records aren’t efficient at or user-friendly enough to make it easy for doctors to know all the medications a patient is taking.
All the more reason Landsverk says geriatricians are needed.
“It’s complicated for doctors to communicate with every doctor who treats every one of their patients. That’s where I come in and call specialists and get the whole picture,” she said.
However, Landsverk notes there’s a shortage of geriatricians, with only 6,000 in the United States today. Compare that with the more than 49.2 million people ages 65 or older who live in this country, and the problem seems pressing.
Another unintended reason for overmedication of older people may involve patients wanting a quick fix for a problem and doctors wanting to help them quickly without thoroughly thinking through possible side effects.
This sentiment resonates with Illinois resident Marina Mantas.
In 2015, her 68-year-old father, Gus, had a sinus infection and was prescribed prednisone, a steroid to reduce inflammation. He was a smoker and had diabetes.
“My dad started experiencing panic attacks. The kind that made him shake uncontrollably. We all were at a loss. We never questioned what his doctors prescribed him. Not until a few days later when we noticed a change in behavior.
“Then we researched what he was taking and were shocked to learn that the steroid can increase blood sugar levels and also cause chemical reactions that affect moods,” Mantas told Healthline.
Gus’ doctor went on to prescribe him medication to address the panic attacks.
“It was one drug after the other. He finally gave up and told my dad to see a psychiatrist,” Mantas said.
In an attempt to help Gus, his psychiatrist provided therapy but also gave him medication to help with his anxiety and depression.
“Once again he began months of trying every type of medicine. They would switch medicine so quickly that sometimes we felt that there wasn’t enough time for it to kick in before he was on to the next medicine,” Mantas said. “This then led to symptoms of withdrawal from the last round of meds he was on.”
During this time, Mantas says her dad was so overmedicated that he couldn’t even hold a conversation with her 5-year-old daughter.
“Thankfully, my sister lived next door to him and could help him with his daily tasks: making sure he had food to eat, reminding him to shower, and to turn off his oven,” she said.
After seeing nearly 20 doctors over the course of three years, Mantas says her dad has found some relief with a doctor who treats him with electroconvulsive therapy and continuously works to decrease his dosage of antidepressants.
“Although our dad is not back to his normal state, he now has some independence,” Mantas said.
To others with older loved ones, she adds, “When it comes to their health, they need oversight and supervision. One wrong decision and it can turn their life upside down so quickly.
“Having a doctor add notes to their file will not suffice. Go to appointments with them. Ask about side effects related to drugs and how long the medicine stays in their system. Be their advocate.”
Cathy Cassata is a freelance writer who specializes in stories about health, mental health, and human behavior. She has a knack for writing with emotion and connecting with readers in an insightful and engaging way. Read more of her work here.