As people age, their risk of medication-related problems increases. As a Consumer Reports article notes, "When it comes to risks from prescription drugs, seniors face triple jeopardy."
The three reasons cited:
- Older adults are more likely to take multiple medications. In fact, roughly half of adults 65 and older are taking five or more medications, according to research published in JAMA Internal Medicine. More medications also increase the complexity of managing and adhering to a drug regimen.
- Seniors are more susceptible to side effects due to physical changes that accompany aging. These include an increase in chronic illnesses, such as high cholesterol, arthritis, coronary artery disease, high blood pressure and diabetes. Furthermore, other factors associated with aging, such as memory loss and decreased eyesight, can lead to mistakes (e.g., forgetting to take a medication, taking the wrong medication).
- Older adults are at a higher risk of drug interactions, which are partly attributable to the increase in number of medications. The more medications one takes, the more susceptible they are to interactions with other medications, food, or alcohol.
While clinicians have a responsibility to help all their patients with medication management, the increase in medication-related risks associated with seniors requires clinicians to take an even more vigilant approach in support of their older patients.
Enhancing Elderly Medication Management
Here are six ways clinicians can improve medication management for seniors.
1. Focus on education
Patients who know what they should and should not do concerning their medications are more likely to properly follow their regimen. Clinicians must allocate time to speak — possibly at length — with patients whenever a regimen is changed and when reviewing a regimen.
Before diving into a discussion, clinicians should assess their patients to identify possible obstacles for patients to properly manage their medication regimen. This can include poor health literacy, declining memory and eyesight, language skills, and financial concerns. Clinicians should modify their communication style and approach to cater to patients’ specific needs.
There are many topics clinicians should cover when changing a regimen. When prescribing a new medication, clinicians should carefully explain:
- the reason for prescribing the new drug (i.e., what has changed that necessitates the medication);
- the medication's purpose;
- administration method/route;
- whether the medication can be taken with other medications and if there are any rules for how the medication should be administered (e.g., with food, not with alcohol).
- when and for how long the patient should take the medication;
- how the patient will know if the medication is working;
- possible side effects;
- what to do if the patient experiences a side effect;
- if there are any activities the patient should avoid when taking the medication; and
- what the patient should and should not do if a dose is missed.
When modifying a regimen without adding a medication, it's still important to review reasons for the change and any possible physical and/or mental effects.
If clinicians have concerns about overwhelming patients with information, they should focus on simplifying the details (e.g., only discussing the most common side effects) and ensuring patients know what to do if they have any questions or concerns. It is also recommended that clinicians utilize the “Teach Back” and “Show Back” method. Some patients may hesitate to contact their clinicians because they don't want to be a bother. Emphasize that reaching out for assistance is preferable to remaining silent.
2. Make it a priority to discuss cost
A growing barrier to successful medication management is the cost of drugs. Seniors are feeling these effects especially hard, according to a 2018 congressional report, which noted the following statistics:
- Prices increased for all of the top 20 brand-name drugs most commonly prescribed for seniors from 2012 to 2017.
- On average, prices for these drugs increased 12% every year during that period, which is approximately 10 times higher than the average annual rate of inflation.
- Twelve out of the 20 most commonly prescribed brand-name drugs for seniors had their prices increased by over 50% over that five-year period. Six of the 20 had prices increases of over 100%.
- In one instance, the weighted average wholesale acquisition cost for a single drug increased by 477% percent over a five-year period.
For seniors living on a tight budget and fixed income, affording their prescriptions can prove difficult. When faced with such a challenge, patients may choose not to fill a prescription, try to ration their prescription, or delay refills.
Clinicians should discuss their patients' financial situation at every appointment. This includes a patient's ability to afford their prescriptions and whether any life changes have occurred that could jeopardize their ability to pay for medications going forward. In addition, clinicians should be prepared to offer guidance and resources to help patients cover the costs of their prescriptions.
An article in The Morning Call highlights assistance available to seniors, including the Extra Help subsidy program and the State Health Insurance Assistance Program (SHIP).
3. Reduce complexity
As already noted, the more medications patients take, the more opportunity there is for errors as management becomes more difficult. These include:
- missed doses;
- taking more than the prescribed dose;
- taking an extra dose;
- taking different medications at the same time that should be taken separately;
- taking an over-the-counter drug that should be avoided because of potentially harmful effects when mixed with a prescription medication; and
- missed refills.
The risk for these errors, particularly missed doses and extra doses, goes up further as the number of times patients must take medications in a day increases.
Clinicians should strive to reduce the number of medications and their frequency. This can be accomplished by identifying a medication that provides the same treatment as multiple medications and prescribing a higher dosage with a lower frequency. Not only can such efforts improve adherence to a regimen, it may also help reduce the cost of the regimen.
4. Provide and recommend resources
While delivering verbal instructions and guidance to patients is important, this form of communication has its shortcomings. Trying to remember verbal information can be difficult, with the challenge growing as the complexity of the information increases. Patients experiencing memory loss can easily forget information or mix up critical details.
It is essential that clinicians support their patients' efforts to adhere to a medication regimen by providing and recommending resources. For example, clinicians should help patients create a current medication list at each appointment. Details to consider including are as follows:
- Names of each medication, including prescription drugs, over-the-counter medication, vitamins, and supplements
- Administration method and frequency
- How long patients should take the medication
- Prescriber's name
- Medication's purpose
- Most common side effects
- Anything patients should avoid (e.g., food, drink, other medications) and/or do (e.g., drive) when taking a medication
- Refill dates and number of refills
If you require assistance in creating a medication list, consider reviewing the Agency for Healthcare Research and Quality's "How to Create a Pill Card" and the American Society of Health-System Pharmacists' "My Medicine List."
Another example of a resource clinicians can provide or at least recommend is a pill organizer. There are numerous types of organizers, from those with a simple design — boxes with sections labeled by day of the week — to more detailed — boxes broken out further by time of day.
There are many other resources clinicians can consider recommending to patients, including digital dispensers, timers, and, as we will discuss in the next section, mobile apps.
5. Leverage technology
Technology is available that can help patients better manage their own medications and clinicians better mange and monitor their patients' medications.
For patients comfortable with using a smartphone — a 2018 Pew Research Center survey showed that nearly half of U.S. adults 65-plus years of age owned a smartphone — clinicians may want to recommend a medication adherence app. With many options to choose from, clinicians should research what's available and be prepared to discuss a few solutions they feel are worthwhile and best-suited for senior patients' needs. We shared a few medication management apps we really like in our blog on favorite healthcare mobile apps of 2018.
For clinicians, there are a variety of solutions available that can help them support patients' medication adherence outside of in-person consultations. One technology we're particularly fond of is our own Meds 360°.
Officially launched in January 2019, Meds 360° provides clinicians with a comprehensive, current view of their patients' medication histories. Among its many benefits: helping identify when patients fail or are at risk of failing to adhere to their medication regimen. A solution like Meds 360° can greatly elevate clinicians' efforts to strengthen medication management.
6. Conduct regular medication reviews
As noted at the beginning of this blog, as patients age, their bodies undergo more frequent changes. From a medication perspective, what this can mean is that a drug prescribed today may not still be the best drug a little down the road. If a patient develops a new illness or makes a major change to their diet or physical routine, continuing to take a particular medication may lead to an adverse event.
It's imperative that clinicians perform routine, comprehensive medication reviews that examine all medications a patient is taking and assess whether those medications are still the most appropriate for the patient. Clinicians may need to make changes to a regimen, such as stopping a medication, replacing one medication with another, changing the dosage, and changing the frequency.
As part of these reviews, clinicians should engage in discussions with patients to determine if they have experienced any recent health or lifestyle changes that may influence the decision of whether and how to adjust a regimen. Through routine reviews, clinicians can better ensure that the medications taken by senior patients are most likely to provide the best treatment possible at that particular time of their lives.