Dr. Clarfield is the Chief of Geriatrics, Soroka Hospital Centre, Professor, Faculty of Medicine, Ben Gurion University of the Negev, Beersheva, Israel, and Professor (Adjunct), Division of Geriatric Medicine, McGill University, and Jewish General Hospital, Montreal, QC.
The other day, I was consulted on a 75-year-old lady who was (supposedly) ingesting 12 different medications: ranging across the daylight hours and in all the colours of the spectrum, exhibiting various shapes and sizes. Some were to be taken before, others after, and the remainder with meals. The total number of tablets that was theoretically being consumed by this lady was 62. Individually, all of these medications could have caused adverse drug reactions (ADR), and many of them are also known to interact in various ways with each other. My patient exhibited a typical "final common pathway" of the results of basic research, drug trials, pharmaceutical marketing, physician prescribing practices and pharmacist dispensing behaviour. Unfortunately for the patient in question, the option of noncompliance was not available since her husband tried his best to help her ingest this immense pharmacological load.
This lady represents an extreme example of the kind of medication problems that elderly patients can face in Canada. Yet, it must also be pointed out that the modern pharmaceutical armamentarium is more extensive and far superior to that available 30 years ago.