Medication adherence is vital to successful treatment, with the World Health Organization emphasizing, "Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." And yet the data, such as those statistics highlighted by a U.S. Pharmacist report, indicate that non-adherence is commonplace.
A specific group at greater risk of non-adherence is the elderly. Older adults are typically prescribed more medications than younger adults. They are also more likely to have a higher rate of chronic diseases, such as high cholesterol, heart disease, high blood pressure, and diabetes. When elderly patients struggle with adherence, their wellbeing and even their lives are endangered.
Here are four common medication adherence challenges associated with (but not necessarily exclusive to) elderly patients and solutions to help overcome them.
1. Challenge: Management of Multiple Medications
As an UpToDate article notes, a survey of more than 2,200 community-dwelling adults aged 62 through 85 years found that at least one prescription medication was used by 87% of these individuals, five or more prescription medications were used by 36%, and 38% percent used over-the-counter (OTC) medications. A Pharmacy Times report references that almost 20% of community-dwelling elders 65 years or older take 10 or more medications. With each new prescription, the patient's medication regime becomes more complex, increasing the likelihood of non-adherence.
Solutions: To help with multiple medication adherence, some recommendations to consider providing to patients are as follows:
- Use a chart or pill calendar to establish a schedule for all medications and track when medications are taken.
- Use a weekly pill case to help ensure all mediations are taken each day.
- Take pills at consistent times of day (e.g., with breakfast, lunch, dinner).
- Ask family and/or friends to provide reminders.
- Suggest that the patient utilizes a medication adherence application. Here are five to consider.
2. Challenge: Cost
A Health Affairs article notes that over a two-year period, "more than 2 million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost." Consumer Reports surveys noted that many people skipped filling a prescription, skipped a scheduled dose (without approval), and cut pills in half (without approval) because of cost and to save money.
Solutions: Cost is a significant barrier to medication adherence for the elderly that is magnified for patients who are uninsured or only marginally insured. Consider the following recommendations:
- Discuss a patient's ability to pay for medications during appointments and when modifying a regimen.
- Determine a medication's cost when issuing a new prescription and ask the patient if the amount is a concern.
- Suggest generic medications, whenever possible.
- Direct patients to prescription assistance programs, such as NeedyMeds, which links to hundreds of programs, and the Centers for Medicare & Medicaid Services' list of recommended programs.
- Direct patients to state pharmaceutical assistance programs (if available). Many states and the U.S. Virgin Islands offer help.
3. Challenge: Drug Interactions
As the U.S. Food & Drug Administration (FDA) notes, "It is important to be aware that more use of medicines and normal body changes caused by aging can increase the chance of unwanted and even harmful drug interactions. … Because of these body changes, there is also a bigger risk of drug interactions among older adults." Examples of types of drug interactions highlighted by FDA are drug-drug, drug-condition, drug-food, drug-alcohol.
Solutions: Drug interactions that lead to negative and potentially dangerous side effects can discourage patients from continuing to take the medication(s) associated with the side effects. Some recommendations for how to address drug interactions with patients are as follows:
- Discuss drug interactions and side effects with patients during appointments, reviewing what side effects are possible and what patients should do if they occur.
- Make sure discussions with patients focus on all medications, not just prescriptions. This means asking about OTC medicines, eye drops, dietary supplements, vitamins, and topical medicines.
- Advise patients to document all side effects and share this information with providers at appointments.
- During appointments, ask patients whether they have made any changes to their lifestyle or diet that could impact medication effectiveness and side effects.
4. Challenge: Decline in Faculties
As patients age, their mental and physical faculties naturally weaken. Unfortunately, these developments can create barriers to medication adherence. For example, declining vision can make reading medicine labels and instructions more difficult, which can discourage patients from taking their medications or lead to mistakes in following instructions. Declining strength can make opening pill bottles, specifically those with childproof tops, more difficult, which may discourage usage. Declining mobility may hinder a patient's ability to obtain prescriptions and refills.
Solutions: Since decline in faculties is inevitable, appointments should always include discussion about whether patients are noticing any changes in areas such of as their vision, strength, and mobility. If decreases are identified, consider the following:
- If vision is declining, print medication regimen instructions and labels on medicine containers in larger type.
- If patients are becoming physically weaker, arrange for prescriptions to be placed in easy-to-open containers. Note: This is only advisable if children are not in the home or likely to visit.
- If getting to a pharmacy may prove difficult due to mobility issues, advise patients to consider use of a mail order or online pharmacy. Online pharmacies should be licensed and undergo successful review and inspection by the National Association of Boards of Pharmacy. Ensure patients have a backup plan in the event that there is a problem with mail service. If a patient expresses a desire to go to a physical pharmacy but wants to limit the number of trips, see if a patient's preferred pharmacy offers a medication synchronization program. Such a program will allow the patient pick up all most or all prescription refills in a single visit each month.