- The quirky, popular syndicated column Straight Dope recently
examined the legend that the 'Eskimos' put their old people on ice floes
and set them adrift. Author Cecil Adams said 'senilicide' (the killing
of old people) did occur during severe famines, but the last recorded case
was in 1939, and even before that it was a rarity.
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- "The common perception of taking granny out to the
nearest ice floe and setting her adrift is wrong."
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- But the common belief that granny is a lot better off
today than in the mythically cruel Arctic of old may be equally wrong.
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- In fact, there is ample evidence that senilicide is more
common in our wealthy, modern Canadian society than it ever was in Inuit
society. We don't set our elders adrift on ice floes, but we do the modern
equivalent: We drug them into icy oblivion.
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- Overmedication of seniors is an ever-worsening epidemic.
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- Troubling information emerged recently that Ontario nursing
homes are relying heavily on drugs to control patients with dementia. The
study, conducted by the Institute for Clinical Evaluative Sciences, found
that one in four newly admitted nursing home patients was prescribed anti-psychotic
drugs within a year. Almost 10 per cent of them received excessive doses.
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- Patients in hospitals and nursing homes are chemically
restrained -- sedated if you prefer -- to protect them from harming themselves.
But the practice also occurs because of understaffing and our disdain for
aging and the elderly.
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- Mundane, everyday overprescribing is just as troubling.
Almost 88 per cent of Canadians over the age of 65 have taken a prescription
drug in the past month.
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- It is virtually unheard of for a senior to leave a physician's
office without a prescription. They are prescribed blood-pressure medication,
cholesterol-lowering drugs, arthritis drugs, diabetes drugs and anti-depressants
in dizzying numbers.
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- Once a person is admitted to hospital, the number of
drugs prescribed increases. A recent study found that, after hospitalization
for a heart problem, elderly patients leave the facility with, on average,
eight prescription drugs. Another research paper showed that one in three
seniors is improperly prescribed drugs.
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- While drugs have benefits, they also have side effects,
particularly when they interact, when they are taken in the wrong doses,
or when the wrong drug is prescribed. About 10 per cent of all admissions
to hospital among seniors are due to reactions to drugs.
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- Misuse of drugs also occurs frequently in hospitals.
A new report on "adverse events" (also known as medical errors)
found that between 9,250 and 23,750 Canadians annually die as a result
of these avoidable errors in hospitals.
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- Most of the deaths were among seniors -- the principal
clientele of hospitals -- and a significant percentage were drug-related.
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- Of course, all this prescribing is well-intentioned --
but so was setting people on an ice floe. It does not excuse the dreadful
outcomes.
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- Dr. Michael Rachlis, a University of Toronto professor
and author of the book Prescription for Excellence, estimates that at least
$1-billion a year is spent on prescription drugs for seniors that they
should not take.
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- The World Health Organization, in a report, estimated
that up to 50 per cent of prescribing worldwide is irrational -- useless,
unneeded, wrong dose, harmful. In Canada, that works out to $8-billion
a year in unnecessary spending, and related harm.
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- Aside from the obvious waste of money in a cash-strapped
system -- money that could be better spent providing seniors with services
they desperately need, such as home care -- there is very little tracking
of the appropriateness or inappropriateness of prescription drugs.
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- Take, as an example, drugs to treat osteoarthritis, a
common condition among seniors. About one in three seniors takes daily
painkillers for arthritis pain. One in five takes a new class of drugs
called cox-2 inhibitors. While these drugs are much more expensive, there
is little evidence they work any better. In fact, according to a recent
study, again by ICES, these drugs are associated with a higher risk of
heart failure than traditional painkillers. And this is not an isolated
finding. Earlier research found that diuretics (known as water pills) costing
only pennies were just as effective in treating high blood pressure as
fancy new heart drugs called ACE inhibitors, which cost hundreds of times
more and have markedly more side effects.
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- There are virtually no cost-benefit analyses done on
prescribing practices, and very little follow-up on how individuals --
and seniors, in particular -- fare. Without this information, without these
checks and balances, our elders are being cast adrift, not on an ice floe,
but in a pharmacological haze.
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- -apicard@globeandmail.ca
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