While sitting at breakfast with my parents, my dad placed ziplock bags filled with colorful pills - medications, a fiber chewable and vitamin and mineral supplements - on the table and told my mom it was time to drink up her OJ and take her pills. My dad at 92 is sharp as can be and a doctor, so I feel comfortable with his impressive attempt to manage my mom’s numerous medications. However, I was concerned about what would happen if for some reason he were not there, a hospital visit for example. Who would manage this confusing array of medication for my mom?
According to the Centers for Disease Control and Prevention (CDC), 41% of older Americans (age 65+) take five or more prescription drugs within a 30-day period. For seniors, the medications are often prescribed by multiple doctors, which may cause management issues. It’s no surprise that polypharmacy - taking multiple prescriptions - and failing to follow instructions are two major problems.
According to Barbara Moran, RN, Director of Patient Care for STEPS Home Care, “Medication non-adherence contributes to as much as 25% of admissions to hospitals and nursing homes. This can lead to disease complications, increased medical costs and unnecessary medication changes.”
Why Seniors Don’t Take Their Medications As Directed
There are several reasons why an older adult may intentionally, or unintentionally, fail to take their medications as prescribed.
Visual impairment - Disease or age-related vision loss can prevent a person from accurately reading the instructions, or make it difficult to distinguish between similar pills.
Cognitive issues - Memory loss and confusion can compromise the ability to follow even the simplest medication directions.
Swallowing Problems - Older adults may have trouble physically swallowing large pills.
Unpleasant Side Effects - One in 6 adults over age 65 are likely to have a harmful reaction to one or more of the meds they're taking, according to the American Geriatric Society. See more about seniors and drug side-effects on the AARP website.
Rising Prescription Costs - According to a new AARP study of 700 widely used prescription drugs, over the past twelve years, prices are up double the rate of inflation.
Beware of The Prescribing Cascade which occurs when the adverse effect of a drug is misinterpreted as a symptom or sign of a new disorder and a new drug is prescribed to treat it. According to the Merck Manual, Cholinesterase inhibitors - donepezil, rivastigmine, galantamine - may be prescribed for patients with dementia. These drugs may cause diarrhea or urinary frequency. Patients may then be prescribed an anticholinergic drug to treat the new symptoms. Thus, an unnecessary drug is added, increasing the risk of adverse drug effects and drug-drug interactions.
1. Get Organized. Create and maintain an updated medication and supplements list. Use this list to check off medications as you fill up their pillbox a week in advance. A comprehensive list of medications posted to the refrigerator in a plastic sleeve will also help any caregiver or emergency-response person easily access the information. In addition, bring a copy to doctor's appointments and hospital visits.
Include the following on your medication chart:
- Name of medication or supplement and strength (e.g., 600 mg tablets)
- Prescribing doctor and phone number
- Purpose (such as blood pressure, thyroid, dementia, blood thinner, bone density or pain)
- Dosage (examples: 600 mg, 1x/day; 25 mg, 2x/day)
- Comments (such as the generic name, special instructions, auto-refill or refill date)
2. Consult a Pharmacist. When a senior has so many physicians specializing in different medical issues, it is even more important to have accurate communication about prescription drugs, over-the-counter medications, vitamins and supplements. The antidote to managing too many doctors prescribing too many medications is to consult with your Pharmacist as a resource. Pharmacists don’t just dispense medication, they have trained for six to eight years in pharmacy school taking courses such as organic chemistry, physiology, and pharmacotherapy.
According to Pharmacist Phil Altman, RPh & Owner of Healthy Choice Compounding Pharmacy, which is located in Elmsford, NY and serves White Plains, NY and the rest of Westchester County. "Your body doesn't work the same, at 25, 55 or 75, as we age. As a compounding pharmacy we have the ability to create the exact medication and dose your age-related needs."
In addition, working with your pharmacist, you can address such things as drug and food allergies. "Corn starch is a filler that is used in a lot of the medications that are produced today. Patients with corn allergies may have sensitivities to these. As a compounding pharmacy, we make medications to fit an individual's needs; i.e. corn-free, gluten-free, kosher and others," added Dr. Altman.
3. Using One Pharmacy to fill all a senior’s prescriptions may not always be cost-effective, but doing so lets one pharmacy keep track of all medications prescribed and let’s the pharmacist screen for medication interactions and suggest useful management techniques.
4. “Medication Synchronization” is when the pharmacist coordinates the refill of your medications so you can pick them up on a single day each month. Many people miss doses of their regular medications and med sync can make you more likely to take them. Caregivers can ask their pharmacists about Med Sync programs. You can also visit the Grassy Sprain Pharmacy either online or at a physical location in Yonkers, Larchmont, or Harrison, NY. STEPS has worked with Grassy Sprain, and they provide Medication Synchronization services.
5. Brown Bag Check-Ups involves bringing all one’s medications, vitamins and supplements to the pharmacist and having them check to see if there are any possible interactions or negative synergistic effects between these substances. Most pharmacies allow patients to schedule appointments for a brown bag check-up. It’s advised that a person make one of these appointments at least annually.
6. Blister Packs are helping patients adhere to complicated drug regimens, which leads to improved outcomes and decreased costs to the health-care system. One example, the SureMed System, helps patients organize multiple medications in an easy-to-follow format that gives patients visual reinforcement of what drugs to take and when to take them. The blister pack, which looks like a booklet, is perforated, so patients can remove a page after they’ve completed a day’s drug regimen. Grassy Sprain Pharmacy also provides Blister Pack services along with free delivery.
Ask Questions. Questions a caregiver might ask a pharmacist about their love one’s medications include:
- How often should my loved one be taking this medication?
- Should they take this medication on an empty stomach, with water or with food?
- What are some warning signs that this medication may not be working as intended?
- What side effects should I look out for while my loved one is on this medication?
- Is there anything I can do to prevent or minimize the side effects they experience?
- Are there any foods, beverages or other medications that they shouldn’t have while on this prescription?
STEPS Home Care If you need additional information or want to speak with our STEPS Director of Patient Care, please contact us at (914) 618-4200.
Visit these top YELP rated Westchester Pharmacies for more information on how to manage medications.
About STEPS Home Care
STEPS Home Care is a family, female, and locally owned Licensed Home Care Services Agency with offices in White Plains, NY, Stamford, CT, and Garden City, NY. Our goal is simple. Provide you and your loved ones with peace of mind by using 3 guiding principles: FAMILY, PASSION, and STABILITY.