As we age, our bodies go through a number of changes, and some of these changes result in the need for medication. Today, about one-third of older adults living in the US are prescribed 5 or more medications each day. While many medications offer life-saving benefits, taking too many medications (polypharmacy) poses a chance of harmful interactions. Polypharmacy may also cause side effects that can have a negative impact on your quality of life. As primary care providers, our role is to offer personalized care to each individual patient and optimize their medications for their current needs.
How Medication Management Can Improve Quality of Life
Recently, I reviewed medications on a 95-year-old patient who was taking 20 prescribed medications a day. It was very challenging for her to take all of these medications because some had to be taken on an empty stomach and others only after eating. She felt as if she were chained to her medication cabinet and watched the clock all day long. After careful review, there were many issues identified. One example was a duplication of medication where she was taking the same medication each day and wasn’t aware that one was generic and the other was the same, just under a brand name. By eliminating the brand, we reduced her medication and saved her money.
Additionally, she had two medications added to combat the side effects of her ibuprofen, which is not an optimal medication for older adults. By working with her, and the therapy department, we added some gentle exercise and the use of a heating pad to alleviate her low back discomfort and were able to discontinue three medications and improve her overall mobility.
The medication management program focuses on what is essential for the each patient's health and current conditions. Providers should monitor all medications, decide if medications are still necessary, and ensure medications do not interfere with What Matters, Mentation, or Mobility.
Medication Management Challenges in Senior Living
There are unique challenges when it comes to managing medications for older adults, especially in senior living communities. Polypharmacy, confusion, and cost are some of the most significant challenges.
- Polypharmacy: Older adults are being prescribed many medications, and some of those interactions cause side effects that can alter an older person's quality of life. Polypharmacy is the simultaneous use of multiple medications by one individual to treat one or more conditions, and it can lead to an increased risk of adverse drug reactions, falls, and cognitive impairment.
- Confusion: Some older adults may be confused about which medications they're supposed to take, when, and for how long. This confusion can be due to cognitive impairment, changes in medication regimens, and the complexity of the medication regimen. Some older adults may also forget to take their medication or take it more frequently than prescribed, leading to side effects and adverse drug reactions.
- Cost: Medication distribution is an additional expense that can create a barrier for some residents and/or families. Distribution frequency is also often connected to senior living community charges – it's an expense from the pharmacy and a charge for each distribution. This cost can make it challenging to afford medications, and they may have to choose between taking the medications they need and paying for other essential expenses.
Managing Medications Successfully
There are several steps residents and their families can take to successfully manage their medications. These include:
- Maintaining an updated written medication list and keeping your primary care provider informed of all medications you’re taking, including over-the-counter medications and supplements.
- Gathering all of your medications, supplements, and vitamins in one place so you can see everything you’re taking together. Consult with your primary care provider on potential interactions between medications and supplements, vitamins, and even food.
- Pre-sorting your medications for the week in a pill organizer with enough compartments for all of the medications you need each week and setting up reminders. Know when each medication should be taken and if they should be with or without food.
- Take note of any new side effects and inform your primary care provider immediately. Common side effects include dry mouth, dizziness, headache, blurred vision, unstable gait, constipation, loss of appetite and more.
- Set up refill reminders. Check if your pharmacy offers automatic refills and deliveries. Another convenient option is to request 90-day supplies through a mail service pharmacy for long-term medications.
When you have concerns or questions about your medications and their side effects, be vocal with your care team. Don’t worry about telling providers if you’re not taking them as prescribed. There are many valid reasons for this and you and your provider can help you move past the difficulties with easy-to- follow solutions. As partners in your healthcare, your provider is there to listen and make sure you are involved in making the best informed healthcare decisions for yourself.