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Tuesday, February 02, 2010

Call to end exclusion of elderly from drug trials

This news story caught my eye because I have become concerned about this very issue over the past six or seven years. In my way of thinking it is important to set up specific drug trials not just for Elders but for children and women too.

In 2003 my mother suffered a closed head injury, and as a result of her fall and the TBI she developed expressive aphasia.

Expressive aphasia is condition  and an acquired disorder of language due to brain damage. Most aphasias and related disorders are due to stroke, head injury, cerebral tumors, or degenerative diseases.  People may lose the ability to produce speech, to comprehend speech, to repeat, and to hear and read words in many nuanced ways. Language difficulties can also be affected by pharmaceutical drugs often over used in faculties that care for Elders.

Speech and language therapy is the mainstay of care for people with with aphasia. The timing and nature of the interventions for aphasia vary widely. Blinded studies are limited, and recovery of many degrees is expected.  Studies also indicate that speech and language therapy does improve clinical outcomes in aphasia, but individualized programs are important. 

The potential for functional recovery from primarily expressive aphasia after stroke is excellent. A neurologist should be key in evaluation and care, as well as speech therapy.

After her injury, my mother was placed in a 5 Star facility in Naples, Florida.  She was loaded up with an over abundance of psychotropic drugs, including  Zyprexa, yet did not have a neurologist or speech therapy prescribed.

Zyprexa is questionable for the elderly, especially for use in elderly women, and it can precipitate diabetes.  The case in point is that regardless of the number of drugs prescribed, and failure of the center to evaluate the drugs for interaction, no one except me questioned the use of this drug in my mother's care.  Zyprexa has an unusually difficult time being excreted by older women and as a result has a longer half-life.

Another drug being given to my mother, not prescribed by a neurologist, was Neurontin, and it is implicated in the development of impaired speech. And yet another one of the several SSRIs perscribed has a known side effect of suicidal thinking.  My mother tried to jump out of a window.  The outcome: more drugs to sedate her further.

The house psychiatrist diagnosed my mother as depressed.  Yet when I asked how he diagnosed her with the aphasia, he could not answer.  He just prescribed more drugs.

I contacted a colleague in the pharmaceutical research section dealing with psychotropic durgs at the FDA for an opinion on the list of drugs prescribed to my mother.  He was shocked, and especially noted the severe issues indicated by the drug interaction profile.

The care center supplying pharmacy never conducted a thorough interaction profile. 
The attending GP, a whining DO from a near by town, most likely interested in the Medicare reimbursement more than my mother's condition, whined to my brother after I talked with him, saying he did not like the questions I was asking.

The director of nursing threatened forced relocation if my mother was taken off any of the drugs.  Since the bill went to Medicare I am sure reimbursement was more the concern than my mother's well being.  And of course there is the issue of staff convenience.

Well, my mother died last summer.  She won't be forced now to take any more drugs, but for six years which must have been agonizing for her, she was over drugged and could not communicate.

My little brother, who held POA, a player in the insurance/finance business, made absolutely no effort to see that my mother was taken to a nationally recognized neurologist in Naples.  Nor would acknowledge my concerns over the drugs and her treatment.  He failed to get her even the most clearly established care for  the aphasia, but was concerned over the cost of the drugs.

He also failed to tell the care center that my mother had a daughter, and didn't make any effort to contact me about this incident until three months after it happened.
Read the complete areticle here -

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