Medication Management Prevents Unnecessary Hospital Trips for Seniors
A recent poll in Caring Right at Home found that more than a third of respondents take five or more medications. Could the medicines we take send us to the hospital? As our population ages, medication management is more important than ever.
Hospitals save the lives of many seniors each year and help many enjoy a higher level of independence and quality of life. Yet studies show that time spent in the hospital can leave seniors vulnerable to urinary tract and other infections, delirium, bedsores, sleeplessness and even falls. Many of these patients are readmitted within 30 days of discharge—often due to a complication related to the hospital stay, rather than to the original ailment. With a price tag of billions of dollars each year, this problem is receiving increasing attention from insurance companies, Medicare, other government agencies and consumers.
What is behind this growing problem? According to the Agency for Healthcare Research and Quality (AHRQ), nearly half of preventable hospitalizations are due to medication problems. The Centers for Disease Control and Prevention (CDC) notes that older adults are seven times more likely to experience unintentional drug overdoses and other adverse drug events, and has called for increased attention to medication management for senior patients.
The medicines seniors take can help keep them healthy—but those very medications also can cause health problems. For example, the medication an arthritis patient takes to control pain may also raise the risk of a debilitating fall. Prescription drugs can cause dizziness, depression, confusion and general decline. Still other health problems result when seniors forget to take their medications. Dr. Cara Tennenbaum of the Université de Montréal reports that "common medications to treat insomnia, anxiety, itching or allergies can have a negative impact on memory or concentration in the elderly." And the CDC recently reported that blood thinners and diabetes medications pose a particularly high risk of hospitalization.
Why is medication management such a challenge for older adults? Jennie Chin Hansen, CEO of the American Geriatrics Society (AGS), explains, "Older adults run a particularly high risk for adverse drug effects, in part because age-related physiological changes and multiple health problems make them vulnerable to such reactions." As we grow older, our bodies begin to respond differently to medications. For example, it takes longer for substances to be eliminated from the body than it did when we were younger, so we might need a lower dosage of a drug. Confusion, vision changes and memory loss make it challenging to take medications correctly. Perhaps the most important factor: According to the American Medical Association, up to 40 percent of people older than 65 take five or more prescription drugs. The complex management of this "polypharmacy" increases the risk of interactions and overdoses. Yet the AGS says that one-third of these adverse drug events are preventable.
The Role of Healthcare Providers
The CDC, Medicare and other agencies urge hospitals and doctors to review all the medications a senior patient is taking, improve patient-education materials, coordinate care among a patient's providers, and perform necessary tests to affirm that patients are receiving the appropriate dosage. Brown University experts also caution that 21 percent of elderly patients take medications that are considered high-risk for older adults, and for which there are safer substitutes.
The Role of Patients and Families
Many nursing homes and other supportive living communities have full-time medication aides to help residents take their prescription drugs correctly and to identify negative side effects. But what about seniors who live alone or with family? A report from the AARP Public Policy Institute and the United Hospital Fund showed that almost half of today's family caregivers perform tasks for their loved one that could be considered medical/nursing—including 78 percent who assist their loved one with medication management. Without this help, many of these seniors would not be able to remain in their homes. But family members report that they feel stressed by this task. They may be trying to provide dosage reminders while at their desk at work. They often fear they will make an error. The AARP recommends improved communication with family when doctors prescribe medications, as well as increased caregiver training.
The Role of In-Home Care
For many families, home care is a valuable resource as they juggle their caregiving tasks, job duties, other family responsibilities and perhaps health issues of their own. If their loved one's needs are complex, skilled nursing can be provided in the home. In many cases, in-home nonmedical companion care is a good choice, and is provided at a lower cost. A trained caregiver can be hired during the hospital recovery period, or on a long-term basis for clients with an ongoing need for help at home. Professional in-home caregivers support effective medication management by:
Helping clients fill prescriptions. In-home caregivers can take clients to the pharmacy, or pick up prescriptions.
Reminding clients to take their medications on time, and in the right way. Following the instructions of family and the client's healthcare provider, in-home caregivers provide medication reminders and notify family of any problems with maintaining the schedule.
Helping clients use prescription memory aids. Pill organizers, specially packaged doses, medication checklists and medication calendars for keeping track of the timing and amount of drug doses are great aids. In-home caregivers help ensure these devices are used properly.
Reporting negative drug interactions. Seniors themselves don't always recognize when they are experiencing side effects of drugs. Professional caregivers are alert to signs such as sleepiness, confusion, dizziness or other changes that might signal the need for a medication review.
Promoting all-around wellness. Healthy lifestyle choices benefit seniors of every age. In-home caregivers prepare nutritious meals, supervise exercise, encourage socialization, drive clients to healthcare appointments and provide a reassuring presence that might be considered a tonic of its own! In some cases, seniors who practice lifestyle improvements even might need less medication for pain and depression. But, remember to talk to the healthcare provider before making any changes.
Medication management is one of the many ways that home care keeps seniors healthier, provides valuable peace of mind for families and saves money for our nation's long-term care system.