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Aged Koreans should escape from life buried in medicineKim Chul-joong’s Differential Diagnosis
  • By Kim Chul-joong Columnist
  • Approval 2017.03.16 10:45
  • comments 0

Ms. Lee was 85 years old and had been pretty healthy. She never had surgery, nor had she suffered from any major illness. She took hypertension medication from the local clinic and occasionally received physical therapy for her knees -- usual stuff for someone her age.

That was until about three months ago when she started experiencing excess phlegm. It has become something of a trend among Korea’s elderly in recent years. Respiratory surgeons attribute it to the increase of fine dust in the air. Because the old exhale less forcefully, phlegm that gets dislodged begins to accumulate.

Ms. Lee went to the local clinic and received an apophlegmatic to remove the sputum. She received several more treatments after that, but her airways remained blocked. At the same time, the old lady lost her appetite and ate noticeably less. She became weak overall and sought help from the geriatric internal medicine department of a university hospital.

The medical workers did blood work, conducted urine tests, and took a chest x-ray but they didn’t come up with anything besides the patient’s original hypertension. There were no signs of illness like pneumonia. Her cholesterol levels were just a little high. Since a hormonal imbalance can cause a lack of appetite, the hospital checked her thyroid and did a test for adrenal insufficiency, but there were no abnormalities. A depression test came back normal, and her cognitive functioning was also excellent. Given that she could independently carry out daily tasks, it wasn’t senility, either.

Then the hospital told her to bring in all of her medications. Here they found a clue to explain her overall weakened state. In the course of alternating between two hospitals, she ended up taking “14” different medications. Every time the patient exhibited a symptom, she received a new drug.

First, when she had a hard time breathing due to phlegm, she received apophlegmatic, bronchitis, and asthma medication. Then, a doctor prescribed an antiplatelet agent for reduced peripheral arterial circulation and cold extremities. To improve her memory, she received treatment for attention and dementia. Another doctor prescribed a different pill to lower her cholesterol. She used anti-anxiety and sleeping pills to get through the night; and took an antispasmodic, gastritis remedy, and prokinetic to relieve indigestion and abdominal discomfort. At another hospital, Ms. Lee received prescriptions for liver function and osteoporosis. Counting her usual functional health foods, these constituted a comprehensive assortment of drugs for an elderly.

When a geriatric physician analyzed the patient's condition and medical history, he thought she didn’t need to take all of this medicine. Convinced that she was suffering from general weakness and sudden loss of appetite due to a drug overdose, he persuaded the old lady to discontinue everything but her hypertension and cholesterol medication. He replaced her osteoporosis drugs with injections. A month later, Ms. Lee was back to her usual self. She was eating well, and roaming around the market by herself.

The geriatrician who told this reporter about Ms. Lee’s case said it was a typical example of an elderly drug overdose. This story embodies the sociology of Korea’s senior citizens today. The older generation lived through an era of poverty when medical services were too expensive for most people to afford. Back then, medicine was very precious to them. They still believe that the more costly and potent a drug is, the better it is for the body. They also rely on medication for minor abnormalities. They don’t bother taking lots of pills -- so much so that they fill up on them.

On the other hand, doctors often say that they will have to close the hospital if they don’t prescribe medicine to these patients. Even if doctors want to give out placebos, they can hardly do so because the new system of separating and prescribing drugs calls for the full disclosure of prescriptions. As a result, the pills are stacking up like mountains.

All drugs have side effects, but we take them because the benefits outweigh the risks. Sometimes drugs mingle and cause unexpected adverse side effects. Also, it is mostly younger adults, not the elderly, who participate in clinical trials to assess drug toxicity and efficacy. Therefore, the drug safety evaluation system doesn’t accurately represent the old.

People in their 70s and 80s represent Korea’s first generation of aging society. Korea has become an aging society before it prepares for and agonizes over it. The elderly have very little understanding of what aging entails, and are ill-prepared for it. There is a tendency not to accept the old body.

By nature, old age is somewhat depressed and uneasy. Digestion is slow, and the memory begins to fade. All this is normal aging unless a serious problem occurs. But when we regard these phenomena as diseases and try to cure them with medication, there is no end to the prescriptions. It is necessary for us to adapt to aging. Now is the time to get out of this practice of storing and offering medicines. Korea may probably be the only country in the world -- where people bring medicine as a gift when visiting a patient.

doctor@chosun.com

<© Korea Biomedical Review, All rights reserved.>

Kim Chul-joong is a radiologist and medical correspondent for Chosun Ilbo. He also served as the former president at the World Federation of Science Journalists (WFSJ).

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