Over-medication and mis-medication are serious problems for older people. One study found that as much as 50% of all medication used by seniors is used inappropriately. Caregivers and professionals who are involved with older people need to be aware of the reasons this occurs and the symptoms which indicate there is a problem with medications.
It has been estimated that the average 85 year old is on eight different medications; the number for nursing home residents,perhaps due to their frailty, is even higher. With this many medications, it is easy to understand some of the confusion which can occur and how easy it could be to have unanticipated drug interaction side effects.
As people age, physiological changes in the body can change the effects and effectiveness of medications. Kidney and liver functioning decrease. The digestive system slows down.The percentage of water and muscle in the body decreases, and fat tissue increases. Drugs may take longer to be absorbed, broken down, and excreted. This means that the effects of medication on an eighty year old may be different from the effects on the body of someone who is forty.
Other reasons for medication problems include:
- Multiple medications prescribed by different physicians
- Prescriptions of medication inappropriate for older people
- Cognitive impairment/Dementia
- Visual impairment
- Depression
- Use of prescription, over the counter, and herbal medications without telling anyone
- Confusion about how and when to take them
- Self -medicating for pain or other conditions
The effects of mis- and over-medication can be subtle, and may take a while to develop to the point where they are noticed or something happens. This is over and above the “normal” side effects that occur from medications. Watch for:
- Confusion
- Falls
- Retarded motor skills
- Irritability or other mood changes
- Sudden changes in behaviour
- Bowel or bladder incontinence
- Constipation
- Dry mouth
- Lightheadedness
Problems with medication management can lead to falls, broken hips, and hospital and nursing home admissions. In a worst case scenarios improper medication use can cause death. Because of these concerns, risk management is something that needs to be considered and discussed between caregiver and the older person.
There are many systems available to help people with their medications. A plastic container divided into days, called a dosette, can be purchased, and medications divided up for the older person. Pharmacies will often bubble or blister pack medications, so all pills are in separate little bubbles on a card, and they are pushed out. There are machines that can be purchased that will dole out medications on a pre-timed basis and alert someone if they are not taken. There are services that will electronically call someone to remind them to take pills.
The best way to prevent problems is to be vigilant on an ongoing basis. Do not assume everything is all right and medications are being taken properly.
Case History: Mrs.T
90 year old Mrs. T. lives by herself in the same home she has been in for over thirty years. She is a widow. Her only family is a daughter who lives out of town. When we met her, Mrs. T. told us she is only on one pill. She opened the drawer in her washroom stand and pulled out a bottle of Tylenol. “This is what I take to sleep,” she told us.We obtained consent,and spoke to her physician. He told us she is on eight medications, taken mornings and evenings. We asked her about her pills again the next time we saw her. She didn’t know what we meant. Later we found them, covered up by a dishcloth on a chair next to her bed. She was taking them five days ahead of when she should have been. She had missed a whole week during the past month.
Mrs. T. has not been deemed incapable, but she is clearly at risk. This is a good illustration of what can happen to older people who have some memory impairment, as they struggle to maintain themselves in their home. It is not uncommon.
Mrs. T. told us, ” Living in my own home, I feel like I am winning.” Diamond Geriatrics’ goal is to help her be safe, but also keep winning. We are activating the systems and obtaining the resources necessary to help reduce her risk. We will be there to monitor her. Should she decide to move to Seniors Housing (and we talk about it with her), Diamond Geriatrics will help her to make the transition with her head held high.
Tips on Safe Medication Use
- Be aware of all medications, including herbal remedies and over the counter.
- Consult with a pharmacist about potential drug interactions.
- Monitor for side effects when there is a change or addition to a medication schedule.
- Discuss with prescriber the necessity for medications.
- Use the net and other resources to learn about the medications that have been prescribed.
- Use available technology to reduce risk. 7. Review necessity of medications on a regular basis.
- Be aware that all medications potentially have some side effects.
