About 1.5 million drug mishaps occur in the United States each year, and thousands result in fatalities. With ninety percent of Americans age 65 and older taking medication daily, and nearly half of them taking five or more drugs, it’s not surprising that older adults have the greatest susceptibility to complications from overmedication, dangerous drug interactions, and cognitive impairments affecting their daily activities.
Besides increased medication use as we age, physiological changes in our bodies affect how we absorb or digest drugs. According to the Geronotological Society, most health care professionals do not receive adequate geriatrics training to fully understand the complex health needs of older adults. Moreover, new drugs undergo very limited testing on people age 65 and older, so they may work differently than expected. All this taken into account, difficulty with medication management is a primary reason why older Americans transitioning from independent living to health care facilities.
Despite these inherent risks, you can help your parent keep track of his/her medications safely and effectively by utilizing a number of management techniques:
- Create a personal medication list. Write down all medicines that your parent takes (prescription and over-the-counter) with times per day, dose, form (pill, liquid, injection, cream, drops), reason for use, and start/stop dates for each. Include any drug allergies, side effects, or sensitivities your parent has.
- Recording forms can be printed from the AARP website.
- Or you can call 1-888-OUR-AARP (1-888-687-2277) and ask for stock number D18589.
- Keep a copy of the personal medical list for your reference, give a copy to your parent to carry with him/her at all times, and keep a copy in your parent’s medical records notebook.
- Provide a copy to both the doctor and pharmacist for their review. (Update these copies any time there is a change, and ask for possible drug interactions to be checked each time.)
- If possible, have the instructions for all medications adjusted so they can be taken on the same schedule to make it easier for your parent.
- Get to know the pharmacist and simplify record-keeping by using the same pharmacy to fill all prescriptions and to purchase over-the-counter medications and supplements. Pharmacists have more detailed information about medications than doctors do, and they can make helpful suggestions to both you and your doctor about alternative prescriptions and dosing. In addition, the pharmacy’s computer program can do a quick medicine-interaction check.
- Carefully read any documentation that comes with each medication, especially directions and warning labels.
- Suggest the use of a pill organizer. They are available in daily, weekly, and monthly configurations. Some even allow for multiple daily dose times − morning, mid-morning, noon, mid-afternoon, and evening. Check fairly often to make sure your parent is filling the organizer on a regular basis.
- Insist your parent follows all medication instructions exactly.
- Insist your parent eats a consistent, nutritious diet with a variety of foods to help alleviate drug and food interactions.
Basic Rules for All Medicines
- Never take medicines belonging to another person.
- Don’t mix medications unless directed by your physician.
- Take medicine at the dose and times prescribed.
- Never take medicines past their expiration dates. (The drug’s chemical composition changes and no longer has the intended health effect.)
- Store medicines in a cool, dry, dark place to prevent the chemical composition from breaking down.
- Store medicines in a safe location where children and strangers have no access.
- Keep everyone’s medications in separate places so no one takes the wrong ones by mistake.
- Open medicine bottles over a flat surface, such as a countertop, so it’s easier to find a pill if one is dropped.
- Remove the cotton plug from medicine bottles because it attracts moisture.
- Keep oral and topical medications in separate places.
- Never throw expired or unused medicines in a wastebasket where pets or children have access.
Herbs and Homeopathic Medication
- Consider herbal products and other natural medicines the same as drugs because they can cause side effects and interact with each other or with traditional medicines.
- Remember that the Food and Drug Administration does not test herbal products like they do traditional medicines: there is no guarantee of the exact strength of the ingredients.
- Look on the label for the words “meets USP standards,” www.arthritis.org/jump.php?url=http://usp.org/ which indicates the product has been tested for quality and purity.
- Only choose products that clearly state the name, address, and phone number of the manufacturer or distributor on the label.
- The container should be fitted with tamper proof protection that has not been broken.
- Since herbal products such as ginkgo biloba, kava, or St. John’s Wort can interact with prescription medicine, learn as much as possible about the product before taking it.
- If your parent has diabetes, high blood pressure, heart disease, Parkinson’s disease, an enlarged prostate gland, an autoimmune disease, a blood clotting disorder, a psychiatric problem, or other serious medical condition, avoid herbal products unless under the supervision of a doctor.
At the Doctor’s Office
When the doctor is prescribing a new medication, ask:
- What are the alternatives? Anything besides medication?
- Why is this the best treatment for my parent?
- Is the generic version okay?
- If this drug is new, is there a drug with a longer history that would work as well?
- Is there a drug with fewer side effects?
- Is this the lowest dose my parent can begin with?
- Is there a drug that would be better for my parent that’s not on his/her approved drug list? Can the doctor request it? (insurance appeal or pre-authorization)
- How will we know the medicine is working?
- How long will that take?
- How long will this medicine continue?
- When should we call back to discuss whether or not there has been an improvement?
To aid in double-checking the accuracy of the prescription, have the doctor write on the prescription:
the reason for the medication
- both the brand and generic names of the medication
At the Pharmacy
When filling the prescription, ask the pharmacist:
to make the label with large print
- to include what condition it treats (the reason for the medication) on the label
When picking up the prescription, the pharmacy staff will have you sign a statement certifying that counsel about the medication was declined. Even if you already signed this, you can still speak with the pharmacist.
Try to be there when the drugstore isn’t busy so you can ask as many questions as you want. During the consultation, ask for:
- a review of the updated personal medication record
- a thorough explanation of dosing for the new prescription
Some possible questions for clarification about the new prescription include:
- When to take it? How many times a day? At what hours of the day?
- Okay to take it at the same time as other medications?
- With or without food or drink?
- How long before eating or after eating?
- Okay to split the pill or crush it into food if difficult to swallow?
- What about drinking alcohol?
- Does this medication have special storage requirements? (refrigeration, etc)
- If a dose is missed, should it be made up? If so, when?
- Should any activities be avoided? What about driving?
- What side effects are more likely for older people?
- What, if any, side effects might be dangerous and warrant emergency attention?
- How many refills?
- What if the prescription runs out?
If There’s a Negative Reaction
Since older bodies absorb and excrete drugs differently, it’s important to know how your parent normally reacts to drugs in order to detect something unusual that might need medical attention.
If your parent experiences an alarming side effect or drug interaction, call the doctor or pharmacist immediately. Possible symptoms that need reporting include:
- Blurry vision
- Ringing in the ears
- Coordination problems
- Skin rashes
- Memory problems
If symptoms indicate something life threatening, call 911.
Be prepared to provide important information:
- What symptoms were experienced and when? How are these different than he/she normally experiences?
- What information is on the drug container label? (Have the drug container with you for the call.)
- When was the medication taken?
- Could anything else have caused the symptoms?
Monitor How Drugs are Working
Keep a “pain log” for your parent, and join a pain support group to compare how other patients are doing. For information, visit the American Chronic Pain Association (ACPA) website. The ACPA also offers a selection of literature on the topic of pain, including a family manual that addresses challenges that often result when someone you love is living with chronic pain.
Note any changes in how your parent feels when taking the medication, write them down, and remember to tell your doctor or pharmacist. If no changes are noticed, ask the doctor when you should report back to discuss whether or not your parent has noticed any improvement.
Insist on a medication review at least once a year. For each medication on the list, ask the doctor, “Is this still needed?”
If a medicine has been added to treat the side effects of another one, this is called prescription “cascading.” Instead of piling on more medicine, ask the doctor if the first drug could be adjusted or replaced to alleviate the problem.
If tests are necessary to monitor ways the medication may affect a person’s body (internal organs, for instance), make sure your parent doesn’t miss or postpone these appointments: They are key to avoiding dangerous side effects.
Also, write down the results of the tests. If more than one health professional is involved in treating your parent, let each of them know the results of the monitoring tests.
An abundance of information is available to educate yourself about prescription drugs. But heed a word of caution: Don’t rely on online drug research without taking into consideration your parent’s individual circumstances and medical history. Read the available material about safety, effectiveness, and price comparison; then consult the doctor, pharmacist, or other health provider before making changes.
To address the unique needs of seniors, locate a certified Geriatric Pharmacist by calling 703-535-3038 or by using the website directory.
Senior Care Pharmacists specialize in the medication-related needs of older adults.
A number of resources provide helpful drug-safety information, such as new drug warnings, drug label changes, shortages of medically necessary drug products, and recall alerts. Try AARP’s Drug Directory and the FDA Drug Safety website.
AARP’s Drug Research Guide summarizes what current medical research says about the safety and effectiveness of prescription drugs. Cost comparison tables are also provided.
The National Council on Patient Information and Education (NCPIE) offers some great ideas on medication safety and questions to ask medical professionals. Visit their website or call 301-656-8565.
Consumer Reports (CR) offers a site to recommend particular drugs for different medical conditions. They tell which ones they consider to be a best buy and why. Other CR documents are linked to expand on the drugs’ safety, cost, and effectiveness. New drug reports appear each month.
AARP runs an online seminar to help you explore reputable, easy-to-use websites when researching particular medical conditions and medicines to treat them.
A word of caution: Don’t rely on online drug research without taking into consideration your parent’s individual circumstances and medical history. Read the available material about safety, effectiveness, and price comparison; but then consult with the doctor, pharmacist, or other health provider before making changes.
For any other questions about managing medication, call AARP at 1-888-OUR-AARP (1-888-687-2277).
To help you communicate more effectively with health care providers in managing medication safety, effectiveness, and cost, an AARP brochure entitled “Medicines Made Easy” can be downloaded.