Autumn is upon us and it ushers in festive gatherings, nostalgic memories, various emotions and new schedules that alter regular routines. This is a time to pay additional attention to staying on track with medication by not forgetting or taking drugs incorrectly and avoiding adverse drug effects because of these mistakes and/or celebratory alcohol consumption. An (2010) article in American Nurse Today notes that “44% of men and 57% of women older than age 65 take five or more medications per week; about 12% of men and women take 10 or more medications per week. Additionally, due to older adults metabolizing drugs differently, they are more vulnerable to possible harm from their medications.” A study published in Pharmacotherapy revealed that more than two-thirds of hospitalized elderly adults had an adverse drug effect over a four year period. It is not a surprise to hear doctors report that they see medication mismanagement as #4 on the senior mortality list, after heart failure, cancer and COPD (Chronic Obstructive Pulmonary Disease such as emphysema or chronic bronchitis).
We are all aware of the rising costs of health care and how expensive prescription medicines can be, particularly for seniors. However, are we aware of the cost of not taking medication properly? Government estimates reveal that in the U.S. annually, more than 177,000 older adults visit the emergency room due to medication problems and additionally 125,000 die from failure to take medication properly and this adds approximately $100 billion in preventable emergency room, hospitalization and repeat physician visit costs to the health care system which translates to a minimum of 10% of all hospital admissions. Furthermore, the statistics for seniors are quite alarming:
- Up to 23% of admissions to nursing homes may be because of an older adult’s inability to self-manage medications at home.
- Over 21% of all complications related to drugs are the result of patient failure to properly maintain their medication regiment due to accident, negligence or intent. The most common reason is that they just forget. Additionally, there is the issue of the more medications a senior takes, the greater the chance for side effects, interactions and emergencies due to adverse events.
- Up to 58% of all seniors, while taking their medications, make some kind of error, with 26% of these mistakes producing potentially serious consequences.
- 12-15% of elderly individuals were found to abuse prescription drugs, according to a report by Prevention Tactics; while John Hopkins Medical School documents that the number of Americans over age 50 abusing drug prescriptions is projected to rise to 2.7 million in 2020 which reflects a 190% increase from the 2001 number of 910,000. It is important to note that there is a distinction between misuse and abuse since there is a difference between dependence and addiction. Addiction is often the result of drug abuse. Seniors who become dependent on prescription drugs are being treated for legitimate medical issues such as pain, anxiety, depression or insomnia. They may increase their medication against medical advice so that they may experience greater relief from their condition. This is drug misuse. The abuse level is found when there is a repetitive and willful habit of taking the drug for the purpose of pleasure and/or euphoria and not the repeated use for therapeutic purpose. This is important to note because the seniors who are misusing their medications for therapeutic reasons may be doing so because their current treatment is not effective in addressing their symptoms. Physicians would need to reevaluate treatment options; while drug abuse, on the other hand, presents a more difficult path and may require a drug treatment plan.
- More than a third of seniors 60 years old and older consume excessive alcohol amounts that are potentially harmful in combination with certain disease conditions they have and the medications they are taking. Alcohol abuse and addiction is just as dangerous and destructive as drug addiction. Many of the signs and symptoms of alcohol and medication abuse/misuse can mirror signs of aging in general and can be difficult to assess initially while the outcomes create harmful consequences.
The healthcare system was not necessarily designed to provide ideal care to people living a long time with chronic illnesses. Doctors see patients during short visits which can make it difficult to think carefully about prescriptions and they are also challenged for keeping up with the latest medical knowledge. “Inappropriate prescribing” is common in older adults; this means that when patient charts are carefully reviewed, it is often found that seniors are receiving medications that are ineffective, duplicate the effect of another medication and lack a basis for being prescribed. The best remedy is to conduct a methodical medication review, on a regular basis. Some medication tips for safety and review consideration are:
- Periodically tell the doctors that your preference for yourself/ parent/relative/friend is to be on fewer medications if possible. Ask the doctors or pharmacist to help identify any medications that could be eliminated; when considering starting or continuing a medication, ask the doctor to clarify the benefit vs. the risk. In some cases it may be possible to treat a problem with non-drug therapies that can be safer and equally effective. Also, if a medication was added during a hospitalization, make sure the primary doctor re-evaluates all the medications for current appropriateness and safety. Will your new prescription work safely with other medicines, vitamins and herbal remedies? Are there any potential side effects?
- Always remember to take your list of updated medications to show your doctor, specialist, pharmacist, family member or friend. Check and see if any of the medications are on the Beer’s List. This is a list of medications that older adults should avoid or use with caution. You can find the Beer’s List on the computer (use the search function and/or this website: americangeriatrics.org) or just ask your pharmacist. If you find a medication you are using on the list, the pharmacist can assist or use the guide from the American Geriatrics Society: What to Do and ask your Healthcare Provider if a Medication you take is listed in the Beers Criteria for Potentially Inappropriate Medications to use in Older Adults.
- Are there any foods or drinks that should be avoided while taking a medication? This question and the use of alcohol while taking medication should be discussed with your doctor for approval. You should always read the drug information page that comes with your prescription for correct dosage, when to take the medication (does it need to be the same time every day?), how long to take the prescription, should you take the drug on an empty stomach or with food? If you miss a dose, what are your options? What is the proper storage for this medication? Is it alright to drive while taking the medication?
- Check the expiration date on your medicine label to make sure that the medicine is still effective. Also check the label on the medicine to make sure your name is listed and the correct directions prescribed for you are written. Do not share drugs or take prescriptions that aren’t yours. Do not stop taking prescribed medicine just because your symptoms have gone away. Stop only with your doctor’s approval.
- If the cost of your medication has become a concern, ask your doctor and/or pharmacist if there is another medication that costs less and is still just as effective. Or is there a generic version that can be prescribed? Do not take half doses to extend the prescription duration.
- Speak to your doctor about whether you need blood tests, x-rays or any other lab tests to determine if the medicine is working effectively. As we get older our bodies, as mentioned, metabolize various drugs differently; ask your doctor if your dosage is age appropriate since sensitivity to some drugs increase, while others produce less sensitivity. Sometimes it may be advisable to avoid adverse effects by starting with a lower dose and moving upwards, as needed.
- Minimize the number of doctors and pharmacists you use so that your care can be better coordinated. Good communication must be maintained to minimize problems. Shopping prices for medications at multiple pharmacies adds another level of review in order to prevent adverse drug interactions. If you are concerned about a prescription or diagnosis, don’t be afraid to seek out a second opinion.
- Organize your medications to help you remember to properly take them. Some pharmacies offer blister packed medication set up, in prescribed order, for daily dispensing. There are also a variety of inexpensive pill boxes that can be used to set up medications for daily and weekly compliance. Additionally, there are a variety of electronic dispensers that range from providing alerts for medication time to sophisticated phone line digitalized medication dispensers that offer reminder prompts for the medication times and specific instructions to remember while taking the medications (such as taking the medication with food or advising that the medication may promote drowsiness, etc.). Medication reminder systems are very helpful for those individuals diagnosed with some cognitive impairment or confusion; however, if there is Alzheimer’s disease or another form of dementia, self-management of medications is not advisable.
Medication safety management is truly about becoming your own advocate! It is about mindfulness (keeping and carrying your own updated med list), talking to your doctor and pharmacist (if the purpose of a medication is to control a symptom, then keep track of when the symptom was last checked and how it’s doing), staying aware of drug interactions (dizziness, confusion, misuse/abuse consequences) and practicing eating healthy, staying active and taking necessary medication as prescribed.
Sources:
Senior Living Blog May 2015, June 2015
Leslie Kernisan MD, Helping OlderParents.com
Sarah J. Stevenson, Senior Living Blog Jan. 2014
Jeff Anderson, A Place for Mom author: The Quiet Epidemic of Senior Drug Abuse
americangeriatrics.org
Senior Umbrella Network Advocacy Medication Checklist / seniorumbrella.org
Please contact Stephanie Pacchiano at: spacchiano@uam.org ,with any further inquiries on this topic.