Imagine this: a 73-year-old man arrives at my clinic, concerned about recurrent episodes of fainting and loss of consciousness. He had already undergone a series of extensive—and exhausting—tests. Heart scans, brain imaging, blood pressure monitoring… yet no clear answer emerged.
His symptoms were disruptive, frightening, and, understandably, he and his family were growing increasingly anxious. Was it his heart? His brain? Something more serious? The unknown hung heavily over him.
But as we sat together and carefully unraveled the timeline of his symptoms, something stood out—a small but significant detail that had been overlooked amidst all the testing: a change in his medications.
The Hidden Culprit: Orthostatic Hypotension
This gentleman had been living with prostatic hypertrophy, a common condition in older men where the prostate enlarges and can make urination difficult. He was managing this well with a prostate medication, but then came a seemingly unrelated problem: his blood pressure.
To help with his mild hypertension, he had been prescribed a diuretic, hydrochlorothiazide. It worked to control his blood pressure, but it also worsened his prostate symptoms. To address this, a second prostate medication was added to his regimen.
What no one had considered was the combination of these medications. Together, they caused a drastic drop in his blood pressure whenever he stood up—a condition known as orthostatic hypotension. This sudden drop in blood pressure was why he kept fainting.
In essence, one medication triggered a side effect, another medication was added to manage that side effect, and together they led to a dangerous cycle that culminated in repeated loss of consciousness.
The Solution: A Simpler Approach
Once we recognized this pattern, the solution became clear. We discontinued the two medications that were causing the problem and adjusted his blood pressure treatment. With this change, his episodes of fainting stopped completely. He regained his confidence, his independence, and his quality of life—all without further invasive tests or hospital admissions.
The Dangers of Polypharmacy
This story highlights a common and often under-recognized issue in older adults: polypharmacy—the use of multiple medications, sometimes unnecessarily.
While each medication may have been prescribed with good intentions, their combined effects can lead to serious harm, especially in older adults who may be more vulnerable to side effects and drug interactions. In fact, medication side effects, interactions, and incorrect dosages are among the leading causes of hospital admissions in older adults.
The Importance of a Comprehensive Geriatric Assessment
Polypharmacy is complex, and it takes experience, attention to detail, and a holistic approach to recognize when medications are doing more harm than good. An experienced geriatric physician listens carefully to the patient’s story, considers the whole person—not just the symptoms—and can often find a simple solution that restores health and quality of life.
As we grow older, our bodies change, and the medications that once helped us might no longer be the best fit. In some cases, less is more.
If you or a loved one is experiencing new or unexplained symptoms, especially if multiple medications are involved, it may be time for a detailed medication review. Sometimes, the answer isn’t more tests or more pills—it’s simply taking a step back and reassessing the treatment plan.
Your health is a story worth listening to—and sometimes, the simplest solutions are the most effective.
Feel free to reach out if you’d like to learn more about medication management and how a comprehensive geriatric assessment can help improve quality of life.
