Medications: A double-edged sword

“Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”
Brown University
Long-term Care Quality Letter, 1995.

Modern medicines have contributed to longer life spans, improved health and better quality of life. Medications are the most common treatment for many diseases and conditions seen in older people and persons with disabilities. Medicines now not only treat and cure diseases that were untreatable just a few years ago, they aid in the early diagnosis of disease; prevent life-threatening illnesses; relieve pain and suffering; and allow people with terminal illnesses to live more comfortably during their last days.

However, for older adults and people with disabilities, medications—prescription, over-the-counter, social drugs such as alcohol, and herbal remedies/alternative medicines—can be a double-edged sword. When not used appropriately, effectively and safely, medications can have devastating consequences.

The changes that occur with aging and disability make people more likely to suffer medication-related problems (MRPs). Nevertheless, research has shown that medication-related problems are often preventable. Caregivers can play a key role in helping to identify when an actual or potential MRP is occurring. This assistance can help prevent the costly and unwanted negative consequences of medication use, such as admission to acute care hospitals, assisted living facilities or nursing homes. About one quarter of all nursing home admissions are due at least in part to the inability to take medication correctly.

Research has shown that a high percentage of caregivers help their friends or relatives manage medications. Caregivers for people with Alzheimer’s disease and other memory impairments commonly report problems with getting their relative or friend to take medications on time, in the right amount, and as directed. In surveys, caregivers often report that their knowledge of their loved one’s medications—intended uses, directions for use, side effects, possible interactions—is greater than that of the care recipients themselves.

When patients, caregivers, doctors and pharmacists function as a team, medication-related problems can be avoided, contributing to better outcomes and improved daily functioning.

How a Pharmacist Can Help You

Older adults, people with disabilities and caregivers may encounter challenges when taking medications. Resolving these problems can lead to much better results from medicines. Consumers and caregivers must alert their doctors and pharmacists to any difficulties they have taking medications, including the following:

• Memory: Difficulty remembering to take medications. The pharmacist can provide a variety of special pill boxes or other aids that remind a caregiver and senior to take medications. The devices range from low-tech, such as simple containers with compartments labeled for meals and bedtime, to high-tech, such as containers that beep when it’s time for a dose, or a special bottle cap that counts openings of a prescription bottle to tell if the day’s doses have been taken. For those with severe memory impairments, caregivers are key to the proper administration of all medicines. In addition, some aging-related service organizations offer medication reminder telephone calls for older persons with memory problems.
• Vision: Difficulty reading labels on prescription labels and over-the-counter products. Pharmacists may be able to provide prescription labels in large print. Health care providers and caregivers can read the information on over-the-counter products for consumers with vision impairment. Magnifying glasses may also be helpful.
• Hearing: Difficulty hearing instructions from health care professionals. Ask doctors, nurses, and pharmacists to speak louder and/or write down important information relevant to the safe use of medications. Caregivers can also be “the ears” for seniors with hearing impairments.
• Dexterity: Difficulty opening bottles, inability to break tablets, problems handling medicines such as eye drops, inhalers for asthma and other lung disease, and insulin injections. These problems are common for people with arthritis and certain types of disabilities. Large, easy-open bottle tops are available for prescription medicines. If a prescription dose is one-half tablet, the pharmacist can split the tablets for you. Caregivers are key to assisting with the administration of eye drops, inhaled medications, injections, and other dosage forms that require fine motor skills. Again, pharmacies can provide instruction sheets on administration of medicines.
• Swallowing: Difficulty swallowing tablets or capsules. Many prescription and over-the-counter products are available in a variety of dosage forms such as a liquid, skin patch, or suppository, greatly reducing difficulties associated with swallowing. Ask your pharmacist about alternative dosage forms.
• Scheduling logistics: Scheduling many different medications throughout the day. One of the greatest challenges for older persons and caregivers is working medication schedules into daily routines. Special pill boxes and other aids, described above, can help. It’s essential that older people and caregivers devise a plan for medication administration that fits their daily schedule. For example, meal times or bedtimes can be used as cues for scheduling medication if mealtimes and bedtimes are regularly scheduled. Doctors and pharmacists can assist in developing a plan to best suit your daily schedule.

Excerpted from the FCA fact sheet, Caregivers’ Guide to Medications and Aging, written by Kathleen A. Cameron, R.Ph., M.P.H.