The importance of medication management cannot be overstated, especially when it comes to caring for the elderly, who often take multiple medications simultaneously to treat different conditions and symptoms. In official terminology, this is called polypharmacy. While we’ve quickly become used to the idea of our aging parents taking more and more vitamins and pills each day, polypharmacy has a number of potential health hazards, including overmedication and dangerous drug interactions.
THE COSTS OF POLYPHARMACY
A quick look at the numbers is sobering. According to a 2010 article in American Nurse Today, “44% of men and 57% of women older than age 65 take five or more medications per week; about 12% of both men and women take 10 or more medications per week.” In addition, because older adults metabolize drugs differently, they are more susceptible to possible harm from their medications.” A 2005 study published in Pharmacotherapy revealed that more than two-thirds of hospitalized elderly adults had an adverse drug effect over a four-year period,” reports the Hospitalist.
TIPS FOR EFFECTIVE MEDICATION MANAGEMENT
What can be done to help older adults take medications safely? Besides taking care to avoid some of the most common medication mistakes, such as taking drugs incorrectly or taking more than is prescribed, many caregivers and seniors rely on other sources of help to stay on track. Pill organizers, medication management devices like pill dispensers, and even reminder services can be useful tools for some. However, nothing substitutes for responsible caregiver advocacy and being proactive about the drugs we and our loved ones are taking. Here is some advice to keep in mind:
1. Make sure the pharmacy label says why you are taking the prescription
This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. It can also help caregivers police whether their loved one is being given too many medications to treat the same issue, or whether a less scrupulous provider has prescribed a drug for a purpose it wasn’t intended to treat.
2. Create and maintain an up-to-date medication list
American Nurse Today says, “keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency, and reason for taking the drug.” This can help reduce the risk of polypharmacy.
3. Bring a medications list – or the medications themselves – to the doctor with you
Take your list of prescription medications – and a list of over-the-counter drugs and any herbal supplements you might be taking – and bring it to the doctor’s office with you, or to a pharmacist. The more information your provider has, the more accurately they can pinpoint any potential adverse effects or drug interactions.
4. Ask your provider if the dosage is age-appropriate
Because of the way our bodies metabolize various drugs as we get older, seniors can be more sensitive to some drugs and less sensitive to others. They are also more likely to experience adverse effects. Double-check with your pharmacist or doctor to ensure that the dosage on the prescription is age-appropriate, and ask if it’s advisable to start with a lower dose and taper upwards.
5. Talk to the pharmacist and ask questions
If you have any concerns at all about the combination of medications you or your loved one is taking, or how a new medication will affect you, ask your doctor or pharmacist. Learn about the potential side effects, dosage, proper storage, and anything else that will help you take medications correctly. You should also talk to your provider if you are thinking of stopping a medication.
6. Get a second opinion if you are uncertain
Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses. If you are concerned about a prescription or a diagnosis, don’t be afraid to seek out a second opinion.
7. Be aware of medications deemed unsafe for the elderly
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective. For instance, commonly prescribed sedatives in the benzodiazepine category, like diazepam (Valium), are on the “avoid for certain conditions” list because older adults may be more sensitive to these drugs. Ask your pharmacist if any of your loved one’s medications are on the caution list, and whether you should be concerned.
8. Know the side effect profile of your medications
Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. Some side effects can mimic other health conditions, including dementia, so make sure to bring a list of your medications to every doctor visit. This will help the provider properly diagnose the problem—and help the patient avoid unnecessary or dangerous medications.
9. Tell your provider about any previous adverse drug effects
This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know.
10. Closely monitor medication compliance in the cognitively impaired
If your loved one shows signs of confusion about their medications, or has been diagnosed with cognitive impairment, Alzheimer’s disease, or another form of dementia, do not allow them to manage or take their own medications. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal.
11. Minimize the number of providers and pharmacists you use
Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. “The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems,” says American Nurse Today. They also advise people to “use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.”
12. Check on prescriber behavior in Prescriber Checkup
Rather alarmingly, Medicare may not monitor prescription safety as effectively or as closely as we might like, as noted in a recent ProPublica report. “In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug [carisoprodol] to patients 65 and older,” says the report – a drug that was pulled from the European market in 2007 and is on the Beers caution list. If you have concerns about a provider, or if you simply want more information about the drugs prescribed in your area, check ProPublica’s online Prescriber Checkup tool.