Medication Management When Caring for Seniors at Home White Paper May 24, 2013 2013 Physician s Choice Private Duty http://private-duty.pchhc.com 1
Proper medication management for seniors who live at home is vitally important, especially given the fact that as people age, they typically take more medications. Many seniors end up taking several doses of various prescribed medications day in and day out. This makes it increasingly difficult to properly manage a senior s medication. This is concerning because a missed, mixed, or incorrect dose can have dire consequences. Additionally, a new study has found that many doctors in the United States routinely prescribe potentially harmful drugs to elderly patients. Even so, there are measures that both professional home health care providers and caregivers can take to properly manage a senior s medication. I. Keeping Seniors Safe in Their Homes Adverse drug reactions harmful or unintended reactions to drug treatments should be a primary concern for those caring for seniors who are taking multiple medications. According to the National Council on Patient Information and Education 1, around 90 percent of Medicare recipients take prescription drugs, and two out of five reported having to take five or more medications, many of which are non-adherent to doctor s orders. This non-adherence all adds up to $1 billion annually in hospital costs, according to the New England Journal of Medicine 2. Meanwhile, the FDA 3 figures that more than 2 million serious adverse drug reactions occur each year, which are responsible for about 100,000 deaths annually. Pharmacokinetics and pharmacodynamics Some seniors are at greater risk for adverse drug reactions due to differences in how their bodies process the drugs. Pharmacokinetics what the body does with the drug can change in older adults and result in drugs staying in the system longer, producing heightened sensitivity to medications 4. Conversely, pharmacodynamics is what the drug does to the body. Seniors bodies are more prone to having a paradoxical, or unreliable response to the drug. 1 http://www.talkaboutrx.org 2
2 http://www.nejm.org/doi/full/10.1056/nejmp1209034 3 http://www.fda.gov/drugs/developmentapprovalprocess/developmentresources/druginteractionslabelin g/ucm110632.htm 4 http://allnurses.com/home-health-nursing/keeping-seniors-safe-765461.html Medication management Medications that commonly have increased effects on elderly persons include: Anticholinergics Antihistamines Barbiturates Benzodiazepines Digitalis Medications that commonly have a decreased effect include: Amphetamines Beta-blockers. Common signs of an adverse drug reaction are many and diverse and can include: Confusion Dizziness Falling Nausea Constipation Weight loss Loss of appetite Tips for home care professionals Nurses and other professional home care providers play a crucial role in administering the appropriate use of medications among older adults, and can instruct their patients to do the following: Keep an up-to-date list of ALL medications (including vitamins, dietary supplements, and herbal remedies), and give a copy of the list to a family member and all prescribing clinics. Use only one pharmacy. Use medication as directed (take prescription in full, do not skip doses, etc). Use a pill organizer and/or reminder system (Section II). Don t take medication in the dark. 3
Call the prescribing doctor immediately if the patient experiences any side effects when taking medication. Check expiration dates and get rid of outdated medicines. Patients with arthritis can request contains without childproof caps. Other rules to keep in mind: Keep up with blood testing (if recommended by provider). The provider should wait twice as long as recommended before increasing dose. Use the least invasive medication route. For persistent pain, use round-the-clock dosing. To avoid polypharmacy, encourage discontinuation of one drug when a new one is added. One drug should not be used to treat side effects from another. Rather, try to change the offending drug or decrease dosage to decrease side effects. II. Keeping Track of Medication Regimens for Independent Seniors There are many reminder technologies that can help a senior who lives independently take their medication properly. The level of intervention depends on the senior s ability to independently take medication. When choosing a medication reminder, take into account the patient s current needs, and what those needs might be in the near future. Telephone-based reminders Telephone-based medication reminders have the lowest cost and least intervention of any of the options here. For a small monthly fee, you can usually subscribe to an automated calling service that calls the senior each day to remind them to take their medication. If the person doesn t answer or acknowledge the reminder, the system will notify the designated contact by email and/or telephone. No fancy new telephone required. Reminders integrated as part of home monitoring or safety devices Several personal emergency response systems should be available through the local pharmacy. These services are often built around wearable products like pendants or watches. These vary in degrees of sophistication, from programmable medication reminders to a personalized emergency response system. 4
Electronic pill-dispensing systems Electronic pillboxes are a small, yet advanced way to offer medication reminders. These may be ideal for seniors who can load and count their own pills, or those with regular support from a caregiver. These dispensers hold medications and only allow a predetermined amount of medication to be released at a predetermined time. These dispensers often come with alarms to remind patients when to take their medication. Medication dispensers also make it less likely that someone will forget that they took medications and take a double dose, and often lock to prevent taking medications at any other time than the one that was predetermined. III. Elderly Patients Often Prescribed Risky Drugs A new study found that doctors in the United States routinely prescribe potentially harmful drugs to elderly patients. The study, published by the National Center for Biotechnology 5, also shows that this practice is particularly problematic in the southern United States. Researchers looked at the data of more than 6 million older adults enrolled in Medicare Advantage plans. Among these seniors, roughly one in five (1.3 million) had been prescribed at least one high-risk medication in 2009, even though safer substitutions were available. Around 5 percent of the elderly in the study were prescribed two or more risky medications. Elderly Americans in the southern U.S. from Texas to South Carolina were roughly 12 percent more likely to be prescribed a high-risk medication than older adults living in other regions. The reasons behind this are unclear, but researchers suspect that education, socioeconomic status, and access to quality medical care could be factors. For example, as socioeconomic status shrank, the likelihood that a patient was prescribed high-risk medication grew. Among the harmful drugs are anti-anxiety medications like Valium, a benzodiazepine that is difficult for elderly patients to metabolize, which in turn can lead to prolonged sedation and potentially devastating falls. Also on the list: many muscle relaxants and diabetes medications. We started this study because we know that these medications are likely to have more harms than benefits in older patients. -Dr. Amal Trivedi, an author of the study, to the New York Times. 5
As mentioned in Section I, many older adults are likely to take multiple medications at once, resulting in a heightened risk of dangerous interactions. 5 http://www.ncbi.nlm.nih.gov/pubmed/23129159 Beyond the brief list already mentioned in this white paper, there are several lists of drugs that are harmful to elderly patients that are readily available on the internet. Patients and care providers alike should take ownership of medications and regularly review them with pharmacists and physicians. IV. Conclusion Through proper training and general awareness, nurses and other professional home care providers can reduce the risk of adverse drug reactions among older adults, which are currently responsible for upwards of 100,000 deaths annually. Seniors living independently may benefit from one or more medication reminder systems, depending on their needs and abilities. What s more, studies have shown that doctors routinely prescribe potentially risky drugs to older adults, a practice linked in part to a patient s socioeconomic status. 6