The National Institutes of Health (NIH) reports that an estimated 40 to 75 percent of elderly patients either forget to take their medications, overuse them, or take them improperly.
Increased health problems as people get older, as well as an explosion of new medications available to treat these chronic health conditions, can lead to difficulties managing multiple medications.
“If you’re aging normally, you probably won’t have a problem remembering to take your medications,” says Dr. Lindsey Dahl, a Sanford Health internal medicine doctor who specializes in geriatrics. However, with multiple medications it’s important to establish some sort of routine, and a way to track which medications you’ve taken and when you’ve taken them to avoid overdosing or other complications.
Dahl says being actively involved as a patient or patient advocate will ultimately eliminate issues of overmedication. Good advocacy always involves maintaining communication with your primary care provider and pharmacist.
Sanford Health Registered Pharmacist Cheryl Halvorson stresses the importance of not only knowing the implications of medications, but also understanding how multiple prescriptions can adversely interact with one another. “Most elderly people are on a lot of prescription and over-the-counter medication,” she says. “Each person needs to be their own patient advocate or have someone who can speak on their behalf.”
If you or someone you care for takes a variety of medications on a regular basis, here are some practical tips and routines to help promote regular, proper use of prescription and over-the-counter therapies.
Befriend a pharmacist
It’s the job of your regular doctor to know a patient’s body and overall health so he can prescribe medications as needed. But your pharmacist is often an untapped source of information about medications.
From side effects to drug interactions, visiting the same pharmacy and talking with the same pharmacist each time you fill a prescription means you have another advocate watching out for your health and well-being.
“If I have a patient who uses our pharmacy exclusively, I’ll have a complete list of their medications and I will be able to tell if we may encounter a drug interaction,” Halvorson says. “When I get to know the patient, they are also often more comfortable asking questions.”
Maintaining communication with a trusted pharmacist and your physician are two ways to avoid overmedication or other harmful drug interactions.
Make a medication list
Santa Claus isn’t the only guy who makes a list and checks it twice. You should be doing the same with your list of medications, says Halvorson.
“It’s extremely important that everyone has a complete list of all the medications they are taking,” she says. “Brand name and generic drugs can be prescribed in different ways by different doctors.” Keep the bottles your drugs come in. The labels include the name of the drug and how to take them, and also how many refills you have left.
Even though nutritional and herbal supplements are not regulated by the Federal Drug Administration, it’s important to add these items onto the list of medications you are taking as well, because they are considered drugs. “Supplements should be seen as drugs and should be taken with caution with prescription medications,” Halvorson says. Many supplements are known to interact negatively with other prescription and over-the-counter drugs.
Here are a few more considerations about medication lists:
- Make a complete list of all your medications including prescriptions, over-the counter, and supplements.
- Update the list every time you add or eliminate a medication.
- Include known drug allergies and sensitivities.
- Keep note of current dosage amounts and update as needed.
- Keep a copy of the medication list with you at all times.
- Give a copy of the list to a family member, trusted friend, or keep a copy posted on your refrigerator to grab in case of an emergency.
- Take the medication list with you to all medical appointments, especially if you are visiting a new doctor or pharmacist.
- Share your medication list with your registered pharmacist.
Know your meds
If you can’t identify what a medication is and what it’s used for, ask a doctor or pharmacist and take good notes.
“Take responsibility to know what medications you or your loved one are on,” Halvorson says. “Know why it is being prescribed and what they do.” There are medications that are safe for people in their 50s and 60s that are not always safe for people in their later years. Medications as ordinary as the sleep aid Tylenol PM, for example, are considered potentially unsafe for use by the elderly.
Once you have a working medication list, in addition to adequate knowledge about the medications, you are more likely to take them regularly, correctly, and at the prescribed time.
As supplementary information sources, internet sites like www.rxlist.com and www.drugs.com offer data about virtually all prescription medications. In addition, a Google search for most medications will direct you to information from the NIH.
Internet words of caution: Be careful when searching and avoid “discussion groups” where people chat about side effects and various ailments. These are usually inaccurate resources and can cause “cyberchondria,” a condition much like hypochondria, where people compulsively research real and imagined symptoms in an effort to self-diagnose.
Federal Guidelines for Drug Disposal from the Food and Drug Administration (FDA)
Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.
Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community. The Drug Enforcement Administration, working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take Back Days throughout the United States. The next one is scheduled for April 28.
If no instructions are given on the drug label and no take-back program is available in your area, throw the drugs in the household trash, but first:
- Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to people who may intentionally go through your trash.
- Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.
FDA’s Deputy Director of the Office of Compliance Ilisa Bernstein, Pharm.D., J.D., offers some additional tips:
- Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
- Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
- When in doubt about proper disposal, talk to your pharmacist.
- Bernstein says the same disposal methods for prescription drugs could apply to over-the-counter drugs as well.
Medication reminder services
Medication reminder services help patients properly take their medications and are available at little or no cost. These services will contact you multiple times in a day, if necessary, to remind you to take your medications. The site www.MyMedSchedule.com helps you manage your meds for free and, among other things, allows you to set up text or email reminders to take your medications. Medication Reminder Service is another option that can be as low as $14.95 per month.
Use a pill reminder
Pill organizers come in a wide selection of organizational categories from weekly to monthly. Some organizers have removable daily compartments you can take with you. You can even purchase zip-top plastic pouches with a markable label on them to organize your medications. Products available online from sites like www.medcentersystems.com can also be effective tools in helping to categorize, organize, and streamline medications.
If you have an iPhone, Droid, or other smartphone, you can download a pill minder app. One iPhone owner downloaded the Pill Minder and raved about the service, going so far as to say: “After using this app two things have happened…I remember to take my pills…BUT THE BIGGIE FOR ME…I don’t take them twice…there were so many days where I took them and then took them again because I can’t remember if I took them.”
If you find yourself taking care of a loved one and are responsible for managing medications, communicate with a trusted doctor or pharmacist.
“When there are issues, it’s easiest to have one family member as the go-between between me as the physician and the patient,” Dahl says. “The most important thing is for children and spouses to be aware that there could be a problem and have some oversight so that they are helping with the pill box.”
Be sure to interact regularly and often with your loved one so you are aware of behavioral changes, especially if there is significant memory loss or dementia. “People can really function well in short interactions with their family members,” Dahl says. “But they can be missing pills that we’re not aware of until it’s a big issue.”
Here is a list of questions adapted from www.agingcare.com for caregivers to ask whenever a doctor prescribes a new medication for an elder dependent:
- Why is this medicine prescribed?
- How does the medicine work?
- What are possible common side effects?
- Will this medicine interact with other medications?
- When will the medicine begin to work?
- What should I do if my loved one misses a dose?
- Should he/she take it with meals?
- Does he/she need to drink a whole glass of water with it?
- Are there foods, drugs, or activities he/she should avoid while taking this medicine?
- Are there any foods or beverages to avoid?
- Is it safe to drink alcohol while on this medicine?
- How long will he/she have to take the medicine? Will we need a refill? How do I arrange that?
- Do you have written information about the medicine that I can take home with me?
The final important tip when managing multiple medications is to purge the medicine cabinet on a regular basis. Every six months to a year, it is recommended you bag up all your prescriptions, supplements, and over-the-counter medications and take them with you to your doctor for a complete review.
More Prescription Tips
Ohio State’s Wexner Medical Center offers many useful tips on managing medications. Here is some practical advice about safely using prescription and over-the-counter drugs:
- Keep medications in their original containers—except for those you put in an organizer. The labels contain important information such as medication name, dosage, doctor’s name, and expiration dates.
- Do not take medication in the dark, when you are tired, or when you are distracted. You might take the wrong medication or too much. Ask for help, if needed, to find and take the correct medication.
- Alcohol can interact with many different kinds of drugs. Ask your physician or pharmacist if it is safe to drink alcohol with any prescription or over-the-counter medication.
- When children or grandchildren are around, keep medication containers out of reach, particularly those that do not have childproof caps.
- Never take a medication that was prescribed for someone else.
- If your physician has told you to discontinue a medication, dispose of it immediately.
- Dispose of a medication once the expiration date has passed. Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. (See FDA guidelines for additional information.)
- Never stop taking a medication on your own—always get your physician’s guidance. Some medications must be stopped gradually to avoid complications.
- If the medication is making you feel sick or causing side effects you find difficult to tolerate, talk to your physician about adjusting the dose or changing the medication.
Lonna Whiting is a freelance writer. She lives in Fargo.
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