Among the elderly, inappropriate use of both prescription and over-the counter drugs is a significant, and growing, problem. As we age, chronic health issues increase. And in this age of specialization, the list of specialists that older Americans see for medical problems tends to grow. The cardiologist, the rheumatologist, the allergist - all in addition to the primary care doctor.

Ideally, the "primary physician" - the internal medicine, family practice, or geriatric physician, is the medication "gatekeeper". As such, he or she should keep a current and accurate list of all medications prescribed by every other doctor.

But for whatever reason, and there are many, this does not always happen the way it should.

Patients who see several doctors also may forget to tell each one about the drugs being prescribed by other doctors, or even that they have seen another physician.

Some doctors tend to automatically renew prescriptions, even when the patient no longer has the need. Others prescribe medications to counteract symptoms that may actually be medication-related.

As the body ages, tolerance for drugs tends to decline. Age-related changes in body composition, metabolism, and organ function affect the way that the body processes drugs. What was an appropriate dose when the patient was 35 is metabolized more slowly at age 75 and can become toxic.

Non-prescription items, even "natural" products, may be dangerous when taken in combination with some drugs, or even with each other. For instance, many prescription and over-the-counter products contain acetaminophen.  When taken in combination, dangerous liver complications are possible. Ginko Biloba, often taken as a memory enhancer, can produce problems when combined with blood thinning medications. 

What to look for: Some symptoms of over-medication can be...

•  Increased confusion

•  Constipation

•  Depression

•  Drowsiness

•  Falls or balance problems

•  Incontinence

•  Loss of appetite

•  Memory loss

•  Nausea & vomiting

•  Restlessness

•  Skin problems

•  Sun sensitivity

•  Tremors

If you notice that any of these symptoms have recently occurred, or have become worse, see your doctor right away.

What You Can Do

To reduce dangerous levels of drug usage and prevent  dangerous combinations, tell all your doctors about everything you're routinely taking, including all vitamins, herbals, and over-the-counter medications.  Non-prescription medications might include cold pills, pain relievers, antacids, allergy pills, cough preparations, sleep aids, eye drops and medicated skin creams.

On the first visit to a new doctor, "BAG IT." Put all your medicine, vitamins, and supplements in a sturdy bag and take it with you. Have the doctor take a close look at everything in the bag and look for dangerous combinations or drugs that you might safely stop taking. If you're taking something and you're not sure why - ask.

For follow-up visits, either bag it up again, or take a complete list of your medications with you. The doctor can review the list again to make sure that you are taking the right medications in the proper amounts and at the right times.