Medication management is difficult for many patients, but the challenge is often elevated for seniors. Several factors contribute to an increased risk of medication nonadherence (sometimes referred to as medication noncompliance) for the elderly, including the following:
Polypharmacy: The American Society of Consultant Pharmacists states that people aged 65 to 69 take an average of 15 prescriptions a year. Meanwhile, those aged 80 to 84 take 18 prescriptions a year. These figures do not include other drugs (e.g., over-the-counter, herbals, vitamins, minerals). An American Nurse Today article states that about 44% of men and 57% of women older than age 65 take five or more prescription and non-prescription drugs per week; about 12% of both men and women take ten or more per week.
Cost: While government insurance — and private/supplementary insurance, for those who can afford it — covers the expenses of some medications, patients will typically need to pay out of pocket for their prescriptions. The costs can add up quickly when the number of medications increases. Complicating matters is that prescription drug costs have been increasing significantly, and patients must still cover health insurance premiums and other healthcare services.
As a Kaiser Family Foundation (KFF) survey found, "… one-fourth of older adults (23%) who take prescription drugs say it is difficult to afford their prescription drugs, including about one in ten (8%) saying it is "very difficult." The survey also found that "About one in five older adults (21%) say they did not take their medicines as prescribed at some point in the past year because of the cost." Skipping medications greatly increases health risks.
Effects of aging. As Mayo Clinic notes, "Your brain undergoes changes as you age that may have minor effects on your memory or thinking skills." For patients with some level of cognitive impairment, such effects are often significantly magnified. Medication side effects can also impact cognition and lead to problems with concentrating, confusion, and memory loss, among others. Such issues can contribute to patients forgetting to take a medication, taking the wrong dosage, taking a medication at the incorrect time, failing to fill or renew a medication, and other medication management shortcomings.
Combatting Medication Nonadherence
These factors and others make it essential that providers have a plan for how to increase medication compliance in the elderly. Here are six steps providers should include in their plan.
1. Reduce the number of medications
The more medications — prescription and non-prescription — that a patient needs to manage, the more likely it is that mistakes, such as those noted above, will occur. As an article in Expert Opinion on Drug Safety notes, "Research has clearly established a strong relationship between polypharmacy and negative clinical consequences."
Providers should regularly review their elderly patients' medication regimen and look for opportunities to safely reduce polypharmacy. This can include eliminating duplicate medications and determining if a single medication exists that can provide the same effects as multiple prescriptions. Providers should also closely examine a patient's various non-prescription medications and determine whether any are unnecessary. Convincing patients to stop taking even a few non-prescriptions can help improve medication management and compliance with a regimen.
2. Encourage patients to bring medications to appointments
An elderly patient's medication regimen can undergo significant and frequent changes. This is particularly true for patients with chronic conditions. Prescriptions can be frequently added, removed, or have their dosage adjusted. Depending upon the effects and side effects of those prescriptions, patients may choose to adjust their non-prescription drugs.
That's why it's a good practice to ask patients to bring a detailed medication list or, preferably, the medications themselves in their original containers to their appointments. This will allow providers to discuss any changes, answer questions, make recommendations (such as what medications to stop taking), and discuss strategies to better ensure medication compliance.
There are an increasing amount of solutions that make it easy for patients to maintain an up-to-date medication list. Click here to check out five patient-facing medication management apps that can help patients stay on track with their medication regimen.
3. Reduce the number of pharmacies
A study published in the Journal of the American Geriatrics Society found that "Filling prescriptions at multiple pharmacies was associated with lower medication adherence across multiple chronic medications, and a small but statistically significant increase in drug-drug interactions among concurrent pharmacy users." Work with your elderly patients to keep their number of pharmacies to a minimum. If possible, this number should be one. When patients only need to go to a single pharmacy, it makes filling and refilling prescriptions simpler.
In addition, as the American Pharmacists Association states, "It is best to use only one pharmacy so all medication records are at one location. This way there will be less risk of duplicating medicine or having one prescription interact harmfully with another."
When this is not possible for the patient, providers should consider a solution that makes it easy to see all fill and pickup behavior across pharmacies. One such solution is our medication management solution, Meds 360°, which you can learn more about here.
4. Discuss cost frequently
Whether your patients can afford their medications is a topic that should be broached regularly and always when a new medication is prescribed or dosage increased, both of which can raise expenses. As discussed earlier, cost is a significant potential barrier to medication compliance. If patients express concern about their ability to afford medications, providers should be prepared to discuss ways for lowering costs. Medicare.gov identifies six such options.
5. Watch for warning signs
If your patient is showing any confusion about or adverse effects when taking their medications, it is imperative that you immediately stop them from managing or taking medications on their own until you can further assess the patient's condition. Confusion can result in patients taking medications incorrectly, which can have serious — even fatal — consequences.
If your assessment determines that the confusion is not a sign of cognitive impairment, you can consider allowing the patient to continue managing their medications. However, if there are indications of cognitive impairment, you will want to work with the patient's caregivers to develop a safe medication management routine.
6. Leverage technology to help patients in between appointments
The five steps discussed thus far speak to specific actions providers can take during face-to-face visits. But one of the most effective steps for improving medication compliance can be taken around these visits: using comprehensive medication management (CMM), a technology-enabled service.
As we previously discussed, CMM that is powered by a platform like Cureatr's Meds 360° helps prevent medication nonadherence and identify medication noncompliance quickly. Users of this solution can easily review what medications are included in a regimen and gain access to real-time prescribing and medication pickup information. Other CMM benefits include better care coordination, cost savings, and improved provider work-life balance. See how Meds 360° takes the guesswork out of medication management by scheduling a demo.