medications

As our bodies age and the health we took for granted in our youth fades into cellular disruptions, disorders, diseases and chronic aches and pains, we turn to the wonders of drugs — prescription, over-the-counter, and vitamins and supplements.

So much so, that by the time we are 60 and older, more than 76 percent of us use two or more prescription drugs and 37 percent use five or more, according to a 2008 National Health and Nutrition Examination Survey. And that figure does not include over-the-counter medicines, vitamins and supplements, which other studies indicate could easily double medication amounts.
It is little wonder that Home Instead Senior Care, an international network of more than 1,000 franchises of personalized care agencies, developed the marketing campaign, “It’s time to talk to your parents about drugs.”

The Omaha-based company surveyed its own clients and found that nearly one-fifth of those taking five or more prescriptions say they have trouble managing their prescriptions, including keeping track of which medications they have taken and when.
That confusion can cause problems with overdosing, under-medicating, duplicate prescriptions and drug interactions, which can lead to visits to hospital emergency departments, even hospital admissions and deaths.

“I have seen many, many seniors on 11 to 14 drugs,” said Rosemarie Lamm, Ph.D., executive director of the RATH Senior Connextions program in Lakeland and a retired professor of gerontology in the nursing program at the University of South Florida.

At RATH Senior Connextions, “we do a lot of educating seniors and their families” about drugs, dosages, interactions and medication management, Lamm said.

“One of the problems is getting medications confused,” Lamm said. “It is easy to do if you have six or eight medications. We had a patient who had mixed her heart medication with her blood pressure medication – she was toxic.”

As seniors get older, health care issues gets more complicated, said Temi Charrier, administrator and co-owner with her husband, John, of Home Instead Senior Care in Lakeland. Most seniors have several doctors and each doctor issues prescriptions. If the doctors aren’t communicating and if there is no single pharmacy overseeing the prescriptions, a patient can end up with a maze of overlapping prescriptions.

“Not long ago, we went to the home of a client who was on four different blood pressure medications from four different doctors and did not understand what was going on,” Charrier said. Among the problems was a crossover of name-brand and generic medications so the client did not recognize duplication, she said.
Home Instead, which is licensed by the state as a home health agency, can only do so much in helping seniors keep their medications straight, Charrier said. Although there is a registered nurse on staff, the caregivers are not nurses and cannot administer medications. The caregivers, however, can remind clients when it is time to take a pill, help a client open a bottle, read the label, and oversee a client organizing pills into multi-day pillboxes, Charrier said.

They can also ask adult children, spouses and friends to get involved by organizing the medications into multi-day pillboxes or looking into pharmacies that package medications and vitamins in single-dose packs.

PILLBOX HELPS

Marylou Taylor, 78, of Lakeland said a multi-day pillbox has made life much simpler for her. Taylor takes seven medications and a multivitamin daily.

Taylor, who has a doctorate in counseling and retired three years ago from the University of South Florida’s clinical mental health faculty, said she is active and healthy but over the past decade, the number of her medications have crept up. And a few weeks ago, while carrying a box in preparation for a move, “I literally fell over my own feet” and broke a leg. She is temporarily living with her older sister while she recuperates.
The multi-day pillbox is divided into morning, afternoon and evening for each day of the week, Taylor said. When she is busy, she might forget to take a dose, or she might not remember whether or not she had taken a particular dose.

“As long as I use my trusty pillbox, I know if I took them. If I did not have that, I could see me taking and then retaking them,” Taylor said.

“To fill up the pillbox takes maybe five minutes every Monday morning. Probably, as I get older, it will take longer and longer, but now I can do it in about five minutes,” Taylor said.

CHANGING BODIES

Not only is it confusing to keep track of numerous medications and their possible side effects and interactions, seniors might not realize their aging bodies react to drugs differently than younger, healthy bodies, Lamm said.

“At the cellular level, we retain more of the drugs, and we excrete them more slowly,” Lamm said. “If you take a drug at 2 in the afternoon, it might not be absorbed until 2 the next afternoon while with a young person it might be out of the body by midnight. That is why an older person who takes a sleeping pill at night might be groggy the whole next day.

“All our organs have a slower function as we age,” Lamm said. “Kidneys and livers do not function at the same level as when you were 25; it is a less adequate level.”

Medication is the first issue you look at when people have memory symptoms, falling, lack of balance, weight loss or gain, any change in physical status, Lamm said.

“Medications are lifesavers but they can cause so many side effects,” Lamm said. Not only can drug interactions cause problems but an individual’s reaction to even a single medication could cause any of those issues.

THE TALK

Any time a senior has a change in behavior, it can be a point of entry to discuss the possibility of a medication issue, Lamm said. If a senior mentions feeling dizzy, or if you notice Mom has been sleeping a lot lately or she cannot remember what she did yesterday, it’s an opportunity to start a conversation, Lamm said.

Charrier said she has observed many such talks over the years between elders and their families and has learned that its effectiveness is all about approach.

“Ask the person, ‘Where do you see yourself a year from now, five years from now?’ Ninety percent or more want to say ‘at home.’ Because the biggest issues that get seniors in trouble are medication and nutrition, you can say, ‘These are things we need to look at and keep organized so you can stay at home.’ ”

Louise Moore, who celebrated her 89th birthday Friday, said two years ago her doctor told her she could no longer live alone. “We had to do something,” said Moore, who wanted to continue to live in her ranch-style home of 35 years, which her late husband, Claude Moore, had built when he retired from Publix. So Moore and her daughter, Carolyn Sue Leitch of Daytona Beach, made arrangements with Home Instead for live-in caregivers.

Jeri Luna, who splits the 24/7 coverage with another caregiver, said when she arrived, Moore was taking her medications directly from the pill bottles three times a day. Luna helped her set up a weekly pillbox and now, Moore said, it is easy to keep track of her five daily medications and vitamins. “You can always check back to the pillbox and see whether you have taken it,” Moore said.

Charrier said that when she sees a senior getting upset with adult children, it is because the senior feels she or he is being told what to do, is backed into a corner or is being ganged up on. But when the approach is to work as a team to keep things organized, the senior welcomes the help.

Lamm said an adult child or friend who gives a senior a ride to the doctor can use that to remind the senior to bring along a paper bag with all the prescription medications, over-the-counter medications and vitamins and supplements he takes so the doctor can check for possible interactions and duplication.

If a senior comes in with a bag of medications, the doctor can flip open a computer screen and look them up, Lamm said. And with electronic recordkeeping — if the patient gives permission — each practitioner can check and see what other doctors have prescribed.

THE PHARMACY

Charrier said another way to keep things organized and safe is to use a single pharmacy. The pharmacist will watch for duplication and possible drug interactions.

If a patient is price shopping and finds that another pharmacy will fill a prescription for free or at a much-lower fee, the patient can ask his regular pharmacist to match the price, Charrier said. Most pharmacies will.
Other prescription issues can be more complicated. Sometimes insurance companies will allow only a limited number of fills from a retail pharmacy, then require the customer to order from an online pharmacy. Or a doctor may give a patient a free sample to see how a drug works.

Many things can make it difficult for seniors to keep track of what they are taking and for their pharmacist and primary care doctor to monitor for problems, Charrier said.

But adult children, or friends, can watch for signs of medication mismanagement and have the issue checked by a professional.

By Marilyn Meyer
The Ledger
marilyn.meyer@theledger.com
Follow her on Twitter @marilyn_ledger.