Fall 2001 , Vol 5 , Issue 2
Medication and Older Adults

As care providers to older adults through our care management and home health services, we see firsthand the positive effects of a good medication regime, and the unfortunately and sometimes deadly results of improperly-taken medications. We include a medication reminder chart and an article written by one of our nurse consultants, Laura DiClerico, R.N., M.S., who discusses some medication issues that are important to patients. Caregivers need to be vigilant about ensuring proper dosage; older adults need to inform their physicians and pharmacies regarding all medications, including all so-called "over-the-counter" treatments. It is far better to question a dose or a particular medication than to regret not asking until someone becomes ill from over-medication, contra-indications or missed medication.

by Laura DiClerico, R.N., M.S.

Advances in drug therapy have had many positive effects on the health and well-being of society at large. For those who deal with the aging population, medications can be an ongoing source of problems. A General Accounting Office study in 1996 found that 17.5% of Medicare recipients were prescribed medications generally unsuitable for their age group. It is not only the type of medication, but also the number of different medications that an older person may be taking at one time that puts them at risk. Multiple chronic diseases being treated by different physicians is the major reason for the polypharmacy frequently found when assessing an elderly client.

Several intrinsic factors put the elderly at higher risk for negative side effects of drug therapy. The normal process of aging results in decreased liver and kidney functions, as well as an increase in fat and decrease in lean body mass. These factors cause the elderly to metabolize and eliminate medications differently than younger people. Older people are under-represented in clinical trials that determine suggested medication dosage levels. This is unfortunate, since this is the population that uses many of the medications.

How to best advocate in the area of drug therapy? If clients have the physical and mental stamina to fend for themselves, educate them to insist that they are prescribed the least number of drugs in the lowest possible doses. A good rule of thumb for the older adult is that any symptom should be considered a medication-related problem until found otherwise. When clients are unable to advocate for themselves, do it for them. Setting up pill boxes and writing out medication schedules provides assistance, but first and foremost one should undertake a careful review of the patient's medication regimen done in conjunction with the prescribing physician(s).

Medication Errors

To avoid medication errors, which account for thousands of deaths each year*, there are some steps consumers can take:

• If you take several prescription drugs, bring in all of your medication bottles for your primary doctor to see once or twice a year. Include drugs prescribed by other doctors, over-the-counter medications, vitamins and herbal medications, as these can interact with prescription drugs.
• Four out of ten older adults take medications prescribed by more than one doctor. Remind your doctors about medications prescribed by specialists. If you are scheduled for surgery, discuss what you are taking in the pre-admission meeting with the surgeon?don"t assume the information has automatically been passed along.
• Double-check when you fill your prescription. Ask your pharmacist to label each medication, and to confirm the name of the drug and its purpose. Verify that the dosage is what the doctor ordered and ask about special instructions for taking the medication. Check refills before you leave the store. If a medication looks different, ask why.

* Consumer Reports: On Health, November 2001

1. Why is this medication prescribed?
2. How does the medicine work in my body?
3. How can I expect to feel once I start taking this medication?
4. How will I know it is working? Is there a typical time period after which my symptoms should improve?
5. How long will I have to take the medicine? Will I need a refill when I finish this prescription?
6. Will this medication interact with other medications that I am taking now?
7. Should I take this medication with food? Are there any foods or beverages I should avoid?
8. Are there any activities I should avoid while taking this medication?
9. What if I miss a dose or take too much?
10. What is the cost? Is there a less expensive alternative or a generic?
11. For long-term prescriptions: Should I still take this medication I was prescribed some years ago?is it still relevant at my age?"