Seniors and Their Medications: The Good, The Bad and The Ugly
As we all know, people are living longer. This fact is attributable in part to the advances in medications that help control disease progression and improve quality of life. However, as people age they often end up taking a variety of different medications, both prescription and over-the-counter (supplements, herbals, vitamins), which may result in dangerous side effects and serious drug interactions. In addition, the medications that once were therapeutic at a younger age may have lost their efficacy or are not metabolized adequately by the liver so are more harmful than helpful.
Polypharmacy (defined as “many drugs”) is common in seniors and even more common in those seniors who have more than one provider. Before the advent of specialists (cardiologist, pulmonologists, orthopedists, endocrinologists, etc.) the primary care physician (PCP) oversaw all of the medications for his patients. This is no longer the case. In addition, there are now hospitalists who see patients only while they are in the hospital, adding one more to the list of providers who may be prescribing medications for seniors. Today more than 40% of people over the age of 65 are taking five or more medications. In addition, about one-third of those seniors experience an adverse drug effect—a fall, precipitous drop in blood pressure, confusion or even heart failure.
Medication mismanagement, either taking the incorrect dosage, forgetting to take a medication, or stopping certain medications precipitously, is one of the most common causes of emergency room visits for seniors. A 2008 study found that about half of the 2.1 million visits Americans made to emergency rooms for adverse reactions to medications, or about 1.1 million visits, were made by people age 50 and older. Of that group of visits, about 61% were made by individuals 65 and older, of whom 60.9% were women.
To help address the medication issues faced by seniors and their caregivers, The Beers Criteria [PDF] was developed by the American Geriatrics Society (AGS). These guidelines caution against the use of certain medications in older adults and alerts seniors to risky medications that are potentially harmful for them. While some of the guidelines may seem surprising; cautioning seniors not to take regular Aspirin over the age of 80 or the fact that some antidepressants can cause dangerous drops in sodium levels in the blood, they are important in preventing unnecessary trips to the emergency room as well as possible subsequent hospitalization. There are 53 different medications on this list which was recently updated on March 1, 2012.
In addition, seniors and/or their caregivers should keep an up-to-date comprehensive list of ALL medications they are taking, not just prescription medications, so that each provider is aware what another physician has prescribed. Good communication with the ordering physician is necessary to report any side effects, allergies, or previous health issues which may impact the prescribed medication, positively or negatively.
The use of a weekly medication reminder box will help considerably in medication compliance. It should be set up by a person who is knowledgeable about the medications, their dosages, their administration times, and the reason for taking the medication along with possible side effects. If the senior is not capable of preparing his or her weekly medications then a family member or nurse hired from a skilled home health care company can perform this task for them. Another alternative is to locate a pharmacy which dispenses daily medication doses in pre-packaged envelopes.
It is important to remember that while medications are of benefit, there are inherent risks in even the most innocuous drugs such as Ibuprofen. It is up to the seniors and their families/caregivers to be proactive in order to prevent adverse drug reactions which can only lead to a health crisis.
By Nancy Hanley, RN
Geriatric Care Manager