The elderly woman was so rigid that when lifted from her wheelchair her body remained frozen in a seated position. Her family didn't think she could live at home.
Then Dr. Rod Holladay stopped her tranquilizers. "The next day she was up and walking."Not all cases are as dramatic, but medication prescribed to help older people feel better too often has the opposite effect.
"The elderly are probably the most overmedicated segment of the population," said Holladay, medical director at the Geriatric Assessment Center at Methodist Hospital here.
"Five to 10 percent of the elderly population are suffering from overprescription," said Dr. William Applegate, chief of the geriatric medicine division at the University of Tennessee. The symptoms can range from minor to life-threatenng.
Medication is to blame in about one-third of cases involving someone age 65 or older becoming confused, disoriented or forgetful, said Toni Messenger, a nurse practitioner at the geriatric center. She said 5 to 30 percent of older Americans experience some reversible mental status changes.
Too often patients and their families accept medication-induced problems as normal aging. "They often blame old age and think this is how they're supposed to feel. Yet many of the problems may be due to medications and often something can be done," Holladay said.
It's a delicate balance. Chronic problems like high blood pressure, heart disease, emphysema and diabetes aren't curable and often must be controlled with medication.
For example, the diuretic prescribed to treat high blood prssure or congestive heart failure can leave the patient feeling lethargic and ill.
Tagamet for an ulcer might "cause an older person to become confused, disoriented and forget where they are," Holladay said.
Applegate said older patients commonly have problems with sedatives, tranquilizers and large doses of high blood pressure medication.
Age changes the way the body handles drugs. Drugs are commonly broken down by the liver and excreted through the kidneys. With age both organs slow down and drugs remain in the body longer.
It's also common for older patients to have a specialist for each problem. The heart specialist isn't necessarily aware what the person's urologist and rheumatologist are prescribing. The prescriptions combined can cause problems.
Applegate estimated that in 60 percent of overmedication cases, one medication is to blame and the remaining cases involve interaction of several drugs.
Having one doctor who oversees care can help reduce unnecesary medication or dangerous medication combinations, Holladay said.
People referred to the center bring in all their prescription and nonprescription medication, Messenger said. It's not unusual for people to tote in eight prescription medicines, plus aspirin, laxatives, antacids, eye drops and other common over-the-counter medicines.
Family and friend can help protect the elderly from overmedication. Ms. Messenger said any time an older person undergoes a change in mental status ask to see their medicines. "If they are taking more than four prescription medicines I'd want to contact the physicians and ask about the medicine," she said.