Seniors and Medications: The Good, the Bad and the Dangerous
You've probably read news coverage of today's opioid epidemic. Federal data shows the problem is so serious that it has actually lowered the average life expectancy for Americans.
Although the stereotype of a narcotics abuser is a younger person scoring drugs on a street corner, older adults are just as likely to improperly use codeine, oxycodone or hydrocodone. But most older adults begin with a legitimate prescription from their doctor (or, often, from a number of their doctors).
Only a few years ago, patients often would walk out of the doctor's office with a prescription for an opioid pain medication and the reassurance: "Don't worry about addiction; if you take these drugs for pain, you won't become addicted." But the American Medical Association now reports that although most patients who take opioids do indeed take them only for a short time, an alarming minority of patients go on to misuse these drugs. It is a balancing act. The World Health Organization refers to effective management of pain as a fundamental human right. Yet opioid abuse takes many lives every year. (To learn more about the opioid crisis, see the Right at Home blog.)
Opioids aren't the only drugs that present health problems for seniors. Seniors take prescription medications to control a wide variety of health conditions and their symptoms. These drugs can lengthen and preserve the quality of lives. But changes in the way our body processes substances as we grow older might mean that some drugs we've taken for years are no longer safe. Older adults are more likely to experience undesirable drug side effects, such as dizziness, depression, confusion and bone loss. The Dartmouth Institute even reported recently that 21 different classes of medications raise the risk that a senior will suffer a debilitating fall!
Too much or too little
A Caring Right at Home poll found that one-third of our respondents take five or more medications. This is about average for the total population of adults—and the number goes up as we grow older. This "polypharmacy" is a big part of the problem. The more medicines we take, the harder it is to take them at the right time and in the right way. Should we take a medication in the morning? At night? With or without food? For how long? What side effects should we be aware of? When a new drug is added, is there a danger of a negative interaction with a drug we're already taking?
With all the media attention on drug overdoses, it's also easy to overlook the opposite problem. A recent study published in the British Journal of Clinical Pharmacology showed that 67 percent of senior patients were getting an underdose of their prescription medications. The research team, from Ghent University in Belgium, reported that underuse of a prescribed drug raises the risk of hospitalization by 39 percent, and the risk of death by a startling 26 percent!
Medication management for patients with multiple health conditions
Here is a good example from the American Heart Association (AHA). In July 2016, the AHA warned heart failure patients that prescription drugs they were taking to manage other health conditions could worsen their heart condition, either by affecting the function of the heart, by making their heart failure medications less effective, or by interacting with their heart failure drugs in a dangerous way.
Prescription drugs weren't the only problem. The AHA noted that some nonprescription pain medications, such as ibuprofen, can cause dangerous fluid retention. Heartburn medications and cold remedies can be high in sodium. And many "natural remedies," among them St. John's wort, ginseng, hawthorn and green tea, are high in sodium or can interfere with heart failure medications.
How can patients know what to do in such a complicated situation? In the AHA report, author Robert Page of the University of Colorado advised, "Keep a list of all your medications and doses to show at every medical visit, and inform a healthcare provider treating your heart failure before stopping or starting any medication. Ideally there should be a 'captain' who oversees your medications. This person might be a physician, advanced practice nurse, nurse or a pharmacist who is managing your heart failure."
This is good advice for anyone who is dealing with multiple health problems. The first step is to have medications reviewed by their primary care physician and/or the pharmacist. Patients should ask their doctors about the medications they take. What is a medication for? Is it really needed?
The second step is to get organized. Put a system in place for obtaining and taking medications. If possible, use a single pharmacy for all prescriptions. The pharmacy may be able to help simplify the management process. According to Professor Jalpa A. Doshi of the University of Pennsylvania, "Synchronized prescription programs that adjust medication refill dates so that all prescriptions are 'due' for a refill at the same time may be an effective strategy."
The third step may be to get help! The American Geriatrics Society recently reported that managing medications is especially challenging for seniors who are age 75 and older, who have memory problems, and who have problems performing the activities of daily living. Said Duke University researcher Brenda D. Jamerson, "Some older adults can put themselves at risk for experiencing problems if they don't receive the assistance they may need."
Help from home care
Medication assistance can be provided in a senior's home. This might include skilled nursing care to assist with administration and management of medications. Less costly nonmedical home care services also help clients overcome the top four obstacles to optimum medication management:
- When clients can't drive, transportation may be the biggest obstacle! In-home caregivers can drive clients to the pharmacy or pick up prescriptions.
- Keeping track of all their medications is another challenge. In-home caregivers can provide medication reminders, and help clients with prescription memory aids, such as pill boxes, specially packaged doses, checklists and calendars.
- Seniors who are experiencing side effects such as confusion, lethargy or depression may not be aware that it's happening. In-home caregivers are able to observe changes in condition of the client and report problems right away.
- Most people with Alzheimer's disease or other dementia need help managing their medications. It's important to know that while antipsychotic drugs once were frequently prescribed to control agitation, aggression or sleep disturbances, the Alzheimer's Association now warns that these drugs are not appropriate for treating dementia symptoms. In-home care can help address the underlying causes of troubling behavior changes—which are often an expression of distress and unmet needs, frustration, loneliness or pain.
In-home caregivers help clients take part in non-drug treatments and lifestyle changes that can lessen pain and improve health in many ways, such as lowering cholesterol and blood pressure. This might include transportation to physical therapy or an exercise class … exercise supervision … preparing meals as prescribed by the doctor … and providing companionship and mental stimulation that benefits people of every health condition by warding off isolation and depression.
An important note: Consult with your doctor before stopping, starting or changing the way you take medications. The information in this article is not intended to replace the advice of a person's healthcare provider.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.