Medications are the most common treatment for many diseases and conditions seen in older adults. Medicines now not only treat and cure diseases, they aid in the early diagnosis of disease, prevent life-threatening illnesses, relieve pain and suffering. However, for older adults not using medications appropriately, effectively and safely can have devastating consequences.
Managing medications is a major part of providing care to older adults, as they are the largest users of medicines. The statistics on medication usage among older adults in Australia is eye-opening, and medicine use has continued to increase in Australia and worldwide. Research has shown that a high percentage of Australian residents are prescribed five or more medicines, with an average of 7–10 per resident. A study of more than 2000 residents at 41 residential aged care facilities, approximately 25% of the residents were prescribed 10 medicines or more. In Australian hospitals, the average number of medicines prescribed for older inpatients is 9–10 per patient.
For many older adults, the ability to remain independent in one’s home depends on the ability to manage a complicated medication regimen. As the largest users of prescription medication, yet with advancing age they are more vulnerable to adverse reactions to the medications they are taking. Most take multiple medications throughout the day and it can be easy for a mix-up to happen. Taking multiple medicines can also mean a greater chance of making mistakes, because they have more medicines to manage which often need to be taken at different times of the day or even week.
There are also problems with the way medicines are stored, managed and used in the home. Many older adults do not follow health-care provider instructions on how to take medications for various reasons. Such as, not understanding the directions, difficulty in swallowing medicines, poor medicine knowledge, confusion about different brands of medicines, difficulty in remembering and unpleasant side effects. Cost can also be a factor causing medication non-adherence with some older adults unable to afford to fill their prescriptions or decide to take less than the prescribed dose to make the prescription last longer. Other self-reported problems of older community Australians included difficulty in removing medicines from packaging, reading medicine labels or using complex dose forms such as puffers and patches. One of the most common issues identified by Australian pharmacists during these studies was older adults taking additional medicine unbeknown to their doctor (GP). It’s important to ensure your doctor knows about all the medicines taken, this includes those prescribed by other doctors, as well as vitamins, supplements, herbal remedies, and over-the-counter drugs.
There continues to be problems with medicine use and safety in older Australians from all settings. While it is difficult to make precise quantitative comparisons due to the lack of methods for detecting and reporting, it would appear that the Australian experience is similar to what is being observed internationally. Taking medicine correctly is essential for treating older adult’s health conditions and managing symptoms, that’s why medication management for older adults is so important. Putting a simple system in place and taking care of the basics, helps older adults avoid common medication mistakes.
More needs to be done for our older Australians living in residential aged care and those supported at home for problems in medication management. The young-old (ages 66–74) have been found to be more adherent to medication regimens than middle-aged older adults (75 over) who decreased comprehension of medication instructions. Living arrangements influence the older person’s ability to manage medications, and older adults who live alone were found to be more prone to medication errors due to the fact that there is no one to monitor, assist, or remind them about taking their medications.
To provide a safe environment that minimises medicine harm, the Australian Government must respond with appropriate support to keep older Australians safe. Patient education is a key intervention to assist older adults with medication management. Older adults require specific educational methods and more effective if information is explicit, organised and in logical order.
Here are 10 important tips for helping older adults safely manage their medications.
1. Store all of your medication into one place, that way you can see exactly what is being taken. If they’re all stored in different locations, it’s easy to lose track of the medication that is being taken. Store all of your medications in a designated location in your home, unless they require refrigeration or are labeled “store in a cool place.” Do not mix different medications together in one container; this will make it difficult if not impossible to identify your medications in an emergency.
2. Make sure medication is stored properly in a cool, dry place. Do not store your medications in the medicine cabinet in the bathroom or in the kitchen because heat and moisture cause deterioration. Instead, store your medications in a designated area in your bedroom, dining room or living room. Consider keeping refrigerated medications in a plastic box or container, separated from other items in the refrigerator. Be sure that your medications are stored out of reach of any children that may visit, especially if you have non-child proof containers. For any older adults with cognitive or memory problems, be sure all medications are safely stored away.
3. Create and maintain an up-to-date medication list. Keep updated lists of all medicines and keep with you at all times. Include prescription drugs, over-the-counter medicines, vitamins, other nutritional products, and herbal remedies on the list. The list should include the name of each medicine, amount taken, and time(s) taken. Share the list with all your healthcare providers, including physical therapists and dentists. Keep one copy in a safe place at home and one with you at all times as this will assist paramedics or doctor during an emergency.
4. Pre-sort medications for the week. Staying organised is essential to good medication management for older adults. Using a Webster-pak is a peace of mind for managing medicines. Your pharmacist can pack your medicines in a weekly pack, so that you take your tablets and capsules at the right time and in the right combination. The tablets and capsules are sealed in a blister pack so that they are placed in the clear blister well for the particular day and time of day. The pack lists all the contents of the pack and when it comes time to take your medication, simply push out the contents of the blister packaging through the foil backing for the correct time and day. You know you are up to date as you can see exactly where you are up to by the pushed out blisters.
A pharmacist can answer many of your questions about medications. Try to have all your prescriptions filled at the same pharmacy so your records are in one place. This will help alert the pharmacist if a new drug might cause a problem with something else you are taking. If you’re not able to use just one pharmacy, show the pharmacist at each pharmacy your list of medicines when you drop off your prescription.
5. Double check for negative drug interactions. Medicines help us live longer and healthier, but taking them the wrong way or mixing certain drugs can be dangerous and cause serious problems. For instance, it is dangerous to use aspirin when taking a blood-thinning medicine. You need to be careful to keep track of your medicines and use them safely.
As many older adults are taking multiple medications, it is important to double-check to make sure none of them will cause negative drug interactions. Older adults may get tempted to increase the dose of a certain medication, or may decide to take their medication more frequently to treat a symptom faster. Self-medicating increases risk of over medication and drug interactions that can cause serious harm to their health. If a medication is not providing the expected relief, call your doctor or pharmacist for advice right away and don’t make any changes on your own.
6. Follow the doctor’s instructions. Understand which medications are safe to take at the same time and which need to be spaced out to prevent negative side effects. For example, some medications need to be taken on a full stomach while others need an empty stomach. If there’s any uncertainty, don’t be afraid to ask the doctor or pharmacist for explanations and detailed instructions. It’s their job is to make sure the medications will improve older adults overall health and well-being. A personal connection with your doctor or pharmacist is an important part of medication adherence.
7. Make sure you set reminders. With so many medications, it can be tough for older adults and caregivers to remember when to take each dose. A medication reminder system and tracking log can help your older adult know that they’ve taken the correct meds at the right times. A simple way of tracking when medications were taken is to take notes with paper and pen. To help remember when it’s time to take medicine, there are different ways to set reminders. Some older adults might like to set a series of alarms on their mobile phone or have a friend or family member be responsible for reminding them. If your older adult isn’t tech-savvy and only takes a couple of doses per day, a basic alarm clock could work well. Some people make it a habit to take certain medications with certain meals. Keeping a routine helps them remember when to take which pills.
8. Understand potential side effects and drug interactions. This helps you watch out for any health changes that could happen after your older adult starts a new medication, increases dose, or combines medications differently. Research has shown that a high percentage of carers help older adults to take medications on time, in the right amount and as directed. Carers can play a key role in helping to identify when an actual or potential medication-related problem is occurring. It’s important to keep in mind that medication effects can directly impact the daily functioning of older adults. These effects may include excessive drowsiness, confusion, depression, delirium, insomnia, Parkinson’s-like symptoms, incontinence, muscle weakness, loss of appetite, falls and fractures, changes in speech and memory. When these symptoms appear, they should be considered “red flags” If you do notice changes or problems, contact the doctor right away. Common side effects could increase fall risk, upset the stomach, cause pain or weakness and more.
9. Help older adults with Alzheimer’s or dementia. If your older adult seems confused about their medicine or been diagnosed with Alzheimer’s disease or dementia, they will likely need to have their medications carefully managed and monitored. Create a calm and quiet environment, stick to a daily routine, as it can do wonders for someone with dementia. With a regular schedule for taking medication, your older adult will get used to it and become more cooperative. Also, be alert to side effects or illness that make them feel sick or uncomfortable.
10. Plan ahead for medication refills. Medications have expiration dates so pay close attention to these because taking expired medications can cause serious side effects. Expired medications and any medication that your doctor has discontinued should be discarded, and consult your doctor about getting a refill prescription. With long-term prescription medications, it’s essential to get refills on time so your older adult won’t miss doses. Having a primary care provider, such as a family physician or geriatrician, can help make care coordination easier. It’s also best to get all medications from one pharmacy to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions. Most pharmacies keep a file for some of their customers who prefer to keep their prescriptions at the pharmacy. Be sure to mark the refill dates on your calendar so you’ll always remember to order a refill and pick it up before your older adult runs out.
Medication management is a complex process that consists of multiple activities. Carers, nurses, family members, as well as doctors, pharmacists and other health care professionals play a pivotal role in the medication management process of older adults. Providing comprehensive assessment and interventions to assist older adults in accurate and safe management of their medications will provide cost-effective care and increase the quality of life of older adults struggling to manage their often-complex medication regimens.
References: Patient Safety and Quality: An Evidence-Based Handbook for Nurses- Medication Management of the Community-Dwelling Older Adult