Every year, 50,000 people age 80+ are hospitalized due to emergency drug reactions in the United States.
Many common prescriptions are characterized as high-risk medications for people 65+. These drugs can have serious health consequences when not taken correctly or not monitored. This includes commonly prescribed medications for diabetes, hormone replacement therapy, urinary tract infections, allergies, heart and gastrointestinal conditions, antidepressants, and anti-anxiety drugs.
Are Seniors Taking Too Many Drugs?
It is rare to find an adult that doesn’t take at least one prescription medication. One-quarter of people age 65 to 69 take at least 5 prescription drugs. Sound like a lot? Among people 70 to 79, 46% are taking 5+ prescription drugs. That doesn’t include over-the-counter medications, herbal supplements, alcohol, marijuana, and narcotics.
According to Sandra Boodman, “researchers estimate that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions, a figure that jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression, insomnia, or other disorders.”
According to U.S. Pharmacist, there is no clear consensus on what constitutes “polypharmacy.” Some general guidelines state that polypharmacy includes taking 5 or more medications, duplication of medications, and negative outcomes as a result of taking too many medications. The incidence of overuse of prescription medications is growing for two main reasons:
- Drugs are a for-profit business and companies continue to make new ones.
- As the aging population grows, there are more and more medical conditions to treat. Generally speaking, our medical system emphasizes medications over lifestyle changes.
Risks of Too Many Medications for Seniors
Consider the following when it comes to risk factors for seniors:
- More health challenges equal more medications. As people age, they may have more medical problems. Examples include diabetes, heart conditions, high blood pressure, dementia, and osteoporosis. This means they are more likely to take several medications. In medical literature, polypharmacy means taking 5 or more prescription medications.
- Multiple medications can have adverse effects. The more medications someone takes, the greater the risk of side effects. These include dizziness, fatigue, mental confusion, sleep problems, appetite problems, dehydration. In a Canadian study, 12% of seniors taking 5+ prescription drugs had to visit a doctor or emergency room because of bad side effects. The leading cause of injury-related deaths in older adults is falling. A contributing factor in falls is medications, especially multiple medications. A caregiver can reduce fall risk for seniors in their own homes, which can help mitigate this risk.
- Doctors don’t catch everything. Every medical professional involved in care is responsible for assessing their patient. However, in real life, doctors can miss the big picture and prescribe a medication with only one specific reason in mind. So, doctors can miss the potential adverse effects of combining medications. Also, different doctors can prescribe different medications. These may have negative side effects when taken together.
- Inconsistent compliance. Under or overtaking medications means that medical conditions may be undertreated or not treated at all.
How Aging Impacts Reactions to Medications
Older adults react differently to medications than younger people and dosages for medications are determined by studies that rely on younger people, not older people. These are some of the age-related differences of older adults:
- Age-related changes in the body can affect the appropriate dosage. These include body composition and metabolism. U.S. Pharmacist says: “With age, body-fat stores increase while total body water decreases. These are important changes that can alter therapeutic drug levels, resulting in greater concentrations of water-soluble drugs and longer half-lives for fat-soluble medications.” What this means is that a standard recommended dosage may be too high for an older adult which then results in a negative reaction.
- Older adults have more medical problems, which is why they are taking so many medications, to begin with. These conditions may affect how medications are absorbed, metabolized, or eliminated.
- Lifestyle factors have a significant impact on the efficacy of medications. For example alcohol use, cigarette smoking, poor nutrition, and dehydration.
- Use of over the counter drugs can complicate and affect prescription drug interactions and efficacy.
Are Medications Taken Correctly?
As a family caregiver, you may assume that medications are being taken as prescribed. Diving a little deeper may be quite revealing. Don’t assume that what your parent or spouse tells you is true or accurate. An accurate, up to date medication list is essential.
- Start with the bottles. Go through all the bottles of medications. Check the prescribing physician, refill dates, and expiration dates. Take a look in the medicine cabinet and in drawers in the bathroom and bedroom. You may be surprised to discover lots of other medications and supplements that don’t match what is being prescribed. Expired medications can be disposed of. Check with your local pharmacy to find safe disposal locations.
- Keep track with a medication list. Take the time to find out what condition each medication is treating. You may be surprised to find that your parent or spouse has medical conditions that you didn’t know about. Write down each medication. Also record the amount, time of day, and any contraindications.
- Identify the method used to take medications. Is your parent or spouse taking medications right from the bottle? Is there a 7-day plastic pill box? If there is a 7-day plastic pill box, check the original labeling to see that the medications for each day are taken properly.
- Look for physical or mental changes. Has there been an increase in falls, dizziness, or confusion?
- When possible attend physician appointments with your loved one. Don’t be afraid to ask about the possibility of reducing the number of medications. Are there behavioral changes that can treat medical conditions in place of medications? Also, ask about possible adverse side effects. If you aren’t attending every doctor’s appointment with your loved one, medications may be prescribed that you don’t even know about! At the very least, call after any appointment that you can’t attend and get a summary update on the visit. That way you can update the medication list.
- Be aware of medication changes in the hospital or rehab setting. Despite all of your careful monitoring of medications when someone is at home, things can change in a hospital or rehab setting. It is not at all unusual for the physician on duty to add or change medications without notifying you. These changes may be appropriate, but the same level of scrutiny applies.
Medication Management: Reasons Seniors Don’t Take Medicine
If your loved one isn’t taking medicine the way they should, it’s important to create a medication management system that works for them. Take the time to examine the reasons why medications may not be taken correctly. There might be one or more problems to solve. Design a medication system that addresses each problem.
These are some potential reasons why medications may not be taken as prescribed:
- Difficult to understand instructions. Your parent or spouse doesn’t understand why they are taking a particular medication. Therefore, they think it isn’t important. Get involved. Call the prescribing physician. Ask why particular medications are being prescribed. Better yet, attend the next primary care appointment. Inform the primary care physician if any other doctor is prescribing medicine. Ask the primary care physician if all the medications are necessary. Can some be eliminated or dosages reduced?
- Negative side effects. It is possible that your loved one has experienced side effects and has not mentioned it. Instead, they just stop taking the medication. Talk with your family member about this possibility. Speak with the doctor about some alternative medications with fewer side effects.
- Physical or mental challenges. This includes poor eyesight, memory problems, or hearing impairment. Are the med boxes or bottles difficult to open? For someone who has dementia, that may cause it to be impossible for them to take their medications accurately.
- Confusing methods. Perhaps the pill box doesn’t hold enough medications for a day or week. Is your fancy dispenser too challenging for your parent or spouse to use? Or, perhaps your family member insists that taking the medications straight out of the bottle is working just fine. When you look in the medicine cabinet there are multiple bottles, duplicate and expired medications. A complete revamp of the system may be necessary.
- Know the prescriptions and over-the-counter drugs. Talk to the primary care physician or pharmacist about any over the counter medications. Certain over-the-counter medications are contraindicated for older adults.
- Difficult to take. Pills aren’t the only medications you may have to deal with. Consider insulin injections, eye drops, suppositories, and patches when determining if all medicines are being taken correctly.
- Difficult to remember. Enlist the help of a paid caregiver if possible. Paid caregivers can administer medications in some states if they have certain licensing. In states where this is not allowed, involve the caregiver. Caregivers can be invaluable in giving reminders. They can check medication boxes to see that medications are being taken correctly. They can alert family members or the agency when they notice that medications are running low.
- Cost. The high cost of medications might be a deterrent. Find out what prescription drug plan your loved one is on and what the co-pays may be. Investigate drug coupons that may help significantly with the cost of medications. Perhaps a generic of the same drug is available at a lower cost.
Medication Reminders for an Older Adult-What are my Options?
As you consider your options, remember that your loved one has to be able to use the system you set up. Don’t assume the fancy system you get will work! Options include:
- Simple pill boxes. A simple pill box is best for people who don’t have cognitive or physical issues. You can fill them or a nurse can fill weekly. You could use one simple pill box for each time of day — morning, mid-day, evening, or use a “twice a day” double-sided dispenser.
- Automated systems. Consider systems that automatically dispense medications with reminders. One easy to use system is Med-Q. Keep in mind that you or a medical caregiver will need to fill the medication dispenser every week. However, it will be much easier for the person taking the medication to have timed, audible and visual reminders. Another recommendation is Medminder Jon. New systems come on to the market every year.
- Blister packs. Many pharmacies will fill your parent or spouse’s medications in self-contained packs. These can often be mailed directly to the home. Some people find these packs easier to manage.
- Medication reminders. A hired caregiver is great for this. Each day they are with your loved one, they can ask “have you taken your medications today?” If the person refuses or forgets to take medications, the caregiver can report this problem.
- Write a list of medications and what each is for. Post somewhere visible. Don’t assume your family member can remember what and why they are taking a medication!
- Hire a nurse to set up weekly pill boxes. This may be an expensive option but can give you peace of mind. A nurse can also provide some oversight and management of weekly medication compliance and report back any problems.
Key Questions to Ask About a New Prescription
Don’t be afraid to question a healthcare provider about a new prescription. Whether you are the patient or a family member, you have the right to know why something is being prescribed. These are some questions to ask:
- What condition is this drug treating? Perhaps the condition being treated is not life-threatening or urgent. If that is the case, is the new medication worth the possible side effects risks?
- What would be the outcome of not taking this medication?
- What are the side effects of the recommended drug?
- Are there lifestyle changes that can help treat my condition? Is it reasonable to try those first before a new prescription?
- How will this new drug interact with the other medications, herbal supplements, or over-the-counter drugs I am taking?
- What is the out of pocket cost of this prescription? Is there financial assistance available to help cover the cost?
- If I experience unpleasant side effects, is there an alternative medication?
- Ask the prescribing physician for recommendations on medication compliance if that is an issue.
Take the time to develop a solid understanding of your loved one’s medications. Remember that medication management and monitoring is an ongoing mission! Medication errors can have serious consequences. Develop a system that works for you and your parent, spouse, or friend. You will rest easier.