Without doubt, many medications improve seniors’ quality of living, some even save their lives. But if not managed properly, the drugs they ingest can also sicken or kill them. In fact, an estimated 100,000 older Americans die each year due to mismanaged medications.
As the number of medications a person takes each day increases, so do the dangers. And those dangers loom large for older people, as a reported 57% of seniors take four or more prescription medications daily.
Adding to the problem: Many people are not willing to talk openly about needing help with medication complications. According to a recent study by a senior care franchise, Home Instead, nearly one-fourth of the seniors surveyed said they have difficulty managing their medications and feel overwhelmed by that — and at least that many admit they do not have a current list of the medications that have been prescribed for them. Yet half of the respondents said they do not have conversations with family members about their medications — most of them citing the concern that they “don’t want to burden them.”
There may be another profound reason for their reticence. In that same poll, more than three-quarters of the older respondents said they feel that their ability to remain independent depends upon the capacity to manage their medical regimens. In fact, many seniors ultimately move from their homes to assisted living or other facilities because of struggles or mistakes with managing their medications.
In addition to combating and covering their fears of losing independence, a closer look reveals some of the other common challenges many seniors face in dealing with daily medications.
Practical problems. An exhaustive study of people age 70 and older published in The Journal of the American Geriatrics Society focused on practical problems they experience with medications. Nearly all, or 95%, reported problems with:
- Reading and understanding the instructions for use
- Handling the outer packaging, which included opening it to get to the contents and confusing similar-looking packaging
- Handling the inner packaging, particularly opening the containers or bottles
- Completing preparations before using them, such as breaking tablets in half, and
- Taking the medication — especially in swallowing large pills and experiencing repugnant smells or flavors.
Adhering to proper regimens. For various reasons, many older people find it impossible to take medicines in the dosage and according to the timing prescribed — and that failure is highest among people with the most to lose: those suffering from chronic conditions such as arthritis, diabetes, or Chronic Obstruction Pulmonary Disease (COPD). The underlying explanation may simply be forgetting to take the pills and potions as prescribed — or forgetting to get timely refills. And pharmacies report that as many as a third of the medication prescriptions are never filled; for many individuals, particularly older people on fixed incomes, the cost is prohibitive.
Frequent scenarios with older patients: They quit taking medications when they feel better, without following the full course prescribed, often undoing the beneficial effects. Or their medications are not refilled because they have canceled a doctor appointment or two — and then those meds are simply forgotten.
Worries about overmedicating. Many seniors subjected to the barrage of news about opioid addiction have become leery about taking any kind of medication. And that instinct may be a healthy one, according to geriatrician Leslie Kernisan, who is quick to point out that the more medications a senior takes, the greater the chance of side effects, interactions, and emergencies due to adverse effects. On the practical side, taking fewer medications also lessens the likelihood of confusion — and the cost.
Lack of oversight by healthcare professionals. Sometimes the finger of blame can be squarely pointed at the medical profession. Some doctors, uncertain about medications’ effects on frail elderly patients, habitually underprescribe them. But the opposite is more often the case: According to a recent study, nearly half of older adults take one or more medications that are not medically necessary.
In addition, most seniors see a number of different doctors in a year, yet medical records are rarely coordinated — even within the same hospital or clinic systems, resulting in problems with drug interactions or deadly duplications.
Side Effects. Age-related changes in the liver, kidneys, heart, and central nervous system may cause older people to metabolize drugs differently over time and leave them vulnerable to side effects and drug interactions. Frequent monitoring becomes essential, and again, rarely occurs without some intervening advocacy.
There are several tips for seniors and those looking in on or taking care of an older person that may help with proactive medication management.
Talk about it. As with so many other nettlesome problems, communication is key. If you are involved in caring for an older person, ask about any concerns he or she has about medications — and really listen to the answers. Make the person feel part of any solution reached, rather than strong-arming solutions yourself. Bear in mind that any discussion about medications may actually call up pressing personal concerns, such as the possible loss of independence. For help in framing the conversation, go to LetsTalkAboutRX.
Get an organization system. For some people, the ubiquitous pill organizers divided by day may be enough to do the job — as long as they are fastidiously and regularly restocked. Others use a daily checklist, or store the drugs near something linked to a daily habit: an alarm clock, a toothbrush, a coffeemaker. Many pharmacies and clinics also offer medications in prepackaged doses, made into prepackaged bundles for each patient.
Whittle down to one. If possible, use a single pharmacy or dispensary for all medications, which can help greatly with avoiding mistakes and duplications. Also appoint one healthcare professional, such as a primary care physician, to be responsible for overseeing all medications to be taken, both prescription and over-the-counter — and ask him or her to do a comprehensive review of all that are on the list.
People who have Medicare and suffer from more than one chronic health condition may also qualify for a patient navigator to perform this function through the Medication Therapy Management Program.
Medicate mindfully. Be sure you know the potential risks and benefits of every drug prescribed. The American Geriatrics Society (AGS) maintains a roster of medications likely to cause problems for seniors called the Beers list. You can access the most current list, which runs several hundred pages but is easily searched online, by registering as a nonmember and paying a small fee on the AGS website.
Be proactive. For better and worse, these days good medical care often requires constant consumer monitoring. Bring the unused portion of all drugs currently being taken — prescription and nonprescription — not just a list of their names, to all doctor visits. Armed with the knowledge gained from checking the Beers list, ask whether any of the prescribed medications can be eliminated — and whether non-drug treatments such as exercise, a change in diet, or psychotherapy may be effective substitutes to treat particular conditions.
Also report any changes in thinking, feeling, or appearance that may be related to drug use or interactions. Discuss problems encountered in taking any medication; a doctor may switch to a liquid form of a medication if there are swallowing difficulties, for example. And finally, if paying for medications is a problem, ask if there are samples or less expensive generic versions available.
The need to be proactive extends to pharmacists, too. Ask him or her to confirm the directions for taking all medications prescribes, as well as possible side effects or interactions with food or other drugs.
The U.S. Food & Drug Administrations publishes an online informational pamphlet, “Medicines and You: A Guide for Older Adults,” that is particularly helpful in preparing older patients with questions to ask doctors and pharmacists about drugs prescribed for them.