January 19, 2016
To help start the conversation with older loved ones about their medications or to assess potential medication risks, expand the sections below to learn what potential medication risks an older adult could be facing, what possible solutions may be available and where you can go for more information. If you’re a senior completing this guide, these tips could help you take the necessary steps to prevent the potential for medication mistakes.
After each condition, you’ll see a list of suggested solutions and resources geared toward helping you meet a senior loved one’s needs along with a conversation starter tool.
Please note that the following content, suggestions and tips from Dr. Jane Potter, geriatrician and director of the Home Instead Center for Successful Aging at the University of Nebraska Medical Center, are included in this resource and provided for informational purposes only. They are not intended to be and should not be construed as being medical advice or a substitute for receiving professional medical advice, diagnosis or treatment. Always seek the advice of a physician, pharmacist, or other qualified medical provider for any questions you or a loved one may have regarding a medical condition or medication. Home Instead, Inc. and the Home Instead Senior Care franchise and master franchise network do not warrant or guarantee that following any of the suggestions or tips included in this resource will help to prevent, eliminate or alleviate any of the medication risks discussed in this resource, and expressly disclaim any liability with respect to the content, suggestions and tips included in this resource.
Dietary restrictions or changes in diet and appetite
The risk: Perhaps a special diet has been prescribed as a result of an illness or chronic condition. Or maybe appetite has changed because of a surgery. New or existing medications don’t always fit into these changing situations. For example, some medications, like Prednisone, could increase appetite or even create spikes in hunger, which could trigger over-eating. Meanwhile, other medications can cause loss of appetite. Any of these issues could put older adults at nutritional risk.
Be on the lookout: Watch for weight gain or unintended weight loss of 5% or more over six months, which could also be a warning sign of risk.
Solutions: Read prescription labels carefully and check with the doctor about the potential impact of any new or existing medications on diet and nutritional needs.
Resources: For nutrition information, food plans, menus and other ways to help make food more appealing, visit FoodsforSeniors.com; CravingCompanionship.com and SundayDinnerPledge.com. For additional information about food, nutrition and medication, visit Nutrition.gov, a service of the National Agricultural Library.
Four or more medications are regularly taken
The risk: On average, seniors age 65 to 69 years old, take nearly 14 prescriptions per year; individuals age 80 to 84 take, on average, 18 per year.* With so many pills to take, it’s easy to see how mistakes could be made not only by confusing medicines but also misunderstanding any changes in dosages. Mismanaging medications could lead to the potential domino effect where a new medication is added to treat a symptom that is really the side effect of another drug. When taking three or more medications, there is the potential for medication interactions and side effects.
* Source: American Society of Consultant Pharmacists
Be on the lookout: Potential signs of medication misuse can include dizziness, confusion, memory issues, increased falls and even hallucinations.
Solutions: A pill organizer is helpful for older adults who have many medications to manage. Pre-packaged pills are another solution that could be just the ticket for older adults and one less worry for family caregivers.
Resources: Simple Meds℠ (not currently available in Canada) offers a convenient way to help seniors take their medications correctly. Also, go to SeniorEmergencyKit.com for valuable resources for managing medications including a sample medication tracker, emergency contact list and doctor visit worksheet.
Uncertainty about why medications have been prescribed
The risk: A senior goes into the hospital and is diagnosed with congestive heart failure. When he leaves, perhaps he has a new prescription, one has been eliminated and another has a dosage change. Who wouldn’t be confused when prescriptions begin to mount or change? One of the most vulnerable times for a senior is during a transition, such as from home to hospital and back. Unwanted problems may arise when new doctors enter the picture and prescriptions are added, dropped and changed.
Be on the lookout: Watch for signs of confusion. Many conditions, such as those arising from a recent surgery or dementia, can also cause confusion.
Solutions: Dr. Potter recommends taking a list of current medications as well as the actual medication bottles (including supplements) to doctor appointments to help the doctor cross-check medications. Also make available to the doctor a list of all providers who are prescribing medications. Anyone on multiple medications could benefit from a hand to help ensure they are taking the correct dosages and understand the purpose of the medications. To that end, it’s a good idea to appoint one doctor to take charge of the overall “big picture.” Some patients even request that all prescriptions go through their primary care provider.
Resources: Simple Meds℠ (not currently available in Canada) offers a convenient way to coordinate medications and help to ensure they are being taken correctly by offering a pre-packaged system of prescribed pills. Also, go to SeniorEmergencyKit.com for valuable resources including a sample medication tracker, emergency contact list and doctor visit worksheet.
A recent surgery
The risk: Surgeries can result in temporary new prescriptions, such as those for pain killers as well as sleep aids. Or new medications may be needed to support surgical procedures that have been performed. Being in the hospital could also take you out of a medication routine.
Be on the lookout: Watch for signs that the medication regimen may not be working, which may include pain or potential symptoms of infection such as fever or increase coughing up phlegm and redness.
Solutions: It’s important for family caregivers to be engaged during these times or for an older adult to seek out help from family, friends or a professional caregiving service. Don’t be afraid to ask for help!
Resources: To learn more about returning home from the hospital including suggestions for managing new medications, go to ReturningHome.com.
Mobility Issues (e.g., trouble walking)
The risk: Seniors with underlying walking difficulties may be at risk for experiencing issues with any medicine that might cause a drop in blood pressure. Many medications (not only blood pressure pills) can cause the blood pressure to drop when an older person stands up which, in turn, could create a fall risk. In fact, according to the CDC, one-third of seniors age 65 and older falls each year.
Be on the lookout: Side effects from medications and incorrect dosages could make an individual particularly vulnerable to potential hazards. Adverse reactions could include such symptoms as light-headedness and dizziness. Also watch for bruises and other signs that a senior may have fallen.
Solutions: Discuss with a doctor any new or increasing unsteadiness that you experience when a medicine is started or the dose is changed. This may be a side effect caused by the medication. What’s more, it’s important to always have easy access to an alert button or wear a medical alert pendant to summon help in case of a fall.
Resources: Visit PreventSeniorHospitalizations.com to check out assessment and balance exercise videos that are intended to help protect seniors from falls. For more information about fall prevention, visit the CDC site.
The risk: Discerning what is causing dizziness can be tricky. The issue could be anything from a medical problem, to a medication interaction, to an incorrect dosage of medicine. Only a doctor may know for sure. For example, dizziness or light-headedness could be the result of over- or under- medication. Medications such as antibiotics, blood pressure and pain medicines, and medications to treat depression or anxiety could have this effect as well. Dizziness combined with mobility issues might, in turn, lead to falls.
Be on the lookout: Look for unsteadiness when walking and getting in and out of chairs. Ask your loved one if he or she is dizzy, or tell someone if you are dizzy and you think it is the result of a medication.
Solutions: Check with a doctor to find out whether dizziness is a side effect of any medications you are on. If you experience dizziness, contact a health care provider to make sure you are taking the correct dosages as well as to confirm whether the medication is still correct.
Resources: For more about the potential causes of dizziness, go to the Cleveland Clinic Center for Continuing Education.
Sleep problems, including insomnia
The risk: Insomnia is the most common sleep problem in adults age 60 and older, according to the National Institute on Aging. That could explain why sleeping pills are among the typical culprits for putting seniors in the hospital. Long-term use of sleep aids can put older adults on a slippery slope that could eventually jeopardize their independence. Stopping such use too abruptly can trigger “rebound insomnia” and continued use might create the need for increasing dosages to be able to get to sleep.
Be on the lookout: Sleep aids can remain in the body for 24 hours and cause side effects, such as gait problems, that can last throughout the day. Watch for potential signs of insomnia at night and confusion during the day.
Solutions: Talk to a doctor about how long it is safe to stay on a medication for sleep and discuss whether there are any ways to taper off a medication that has been taken for an extended period of time.
Resources: For more about some of the potential side effects of sleep medications, visit the U.S. Food and Drug Administration site.
The risk: About one of every five U.S. adults has doctor-diagnosed arthritis that could include more than 100 different rheumatic diseases and conditions, according to the CDC. Some forms of arthritis, such as rheumatoid arthritis and lupus, can affect multiple organs and cause widespread symptoms. Taking multiple medications for arthritis pain could potentially have serious side effects.
Be on the lookout: For some seniors, use of nonsteroidal anti-inflammatory drugs (NSAIDs) could lead to stomach problems, heart problems and kidney damage. Taking steroid drugs, on the other hand, might increase the risk of bone thinning, weight gain and diabetes.
Solutions: The pain of arthritis can prompt individuals with this condition to look for any solution to ease the suffering. Be sure to thoroughly research and discuss with a doctor the side effects of any treatment. Discuss with the health care provider the benefits of water exercise, physical therapy, topical rubs, and heat or cold packs, which can bring relief. If there is trouble opening pill bottles as a result of the pain of arthritis, ask for easy-open pill bottles at the pharmacy.
Chronic Obstructive Pulmonary Disease (COPD)
The risk: COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs that can lead to shortness of breath and coughing. Although COPD can be effectively treated with a variety of medications, doctors note that some of these medications may carry side effects. Patients with severe COPD, for example, may need long-term use of oral steroids that can potentially cause serious side effects.
Be on the lookout: Watch for weight gain, any diagnosis of diabetes, osteoporosis, or cataracts, and any potential symptoms of infection (such as fever and redness). Some medications carry risks such as a fast heartbeat and shakiness.
Solutions: Someone with COPD should remain under close doctor observation since a change in medications and diet not only might cause a medication reaction but also could potentially trigger dangerous side effects. Medicine comes in many forms such as inhalers, pills and syrup. Ask the doctor to write down the name of the medicine, how much to take and when to take it. After the checkup, keep the list at home where everyone can find it.
Resources: For more information, go to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) at GoldCOPD.org.
The risk: Diabetes is a group of diseases characterized by high blood glucose levels. Insulin and oral drugs used to treat diabetes are among the top four medications, used alone or together, that account for two-thirds of emergency hospitalizations, according to the CDC.
Be on the lookout: Side effects of using diabetes medications can run the gamut from nausea and diarrhea to cold and flu symptoms. Potential reactions to insulin or pills to lower blood sugar can also cause some individuals to become confused and even unconscious.
Solutions: Newer medical studies show that seniors with adult onset diabetes (Type 2) need higher target blood glucose levels than were previously recommended. Keep regularly scheduled doctor appointments if you are diabetic and ask about this new information. Reducing over-treatment and the incidence of low blood sugars should help to minimize the risk of hospitalization. A pill organizer or a pre-sorted dosage service such as Simple Meds℠ could also benefit an individual with diabetes.
Resources: For more information about the potential complications of diabetes visit the American Diabetes Association at diabetes.org.
The risk: Approximately every 43 seconds someone in the United States has a heart attack, a condition that occurs when oxygen to the heart muscle is reduced or cut off. According to the American Heart Association, a heart attack is just one of a variety of different types of heart conditions.
Be on the lookout: Because treatments for heart disease may vary considerably, risks could develop when different medications are used to treat various specific conditions. One example is antiplatelet drugs, which are designed to prevent clotting in some heart patients but could trigger bleeding elsewhere in the body, Dr. Potter noted.
Solutions: Someone on heart medications should check with a doctor any time a medication is added, removed or changed to help protect against having an adverse medication interaction. Managing a heart condition might require various lifestyle changes, from weight and stress management to proper nutrition and physical activity. Find a doctor who you feel can help you achieve your goals.
Resources: The American Heart Association at heart.org provides information about various heart conditions and treatment plans in addition to ways to help prevent heart disease.
The risk: Stroke is a disease that affects the arteries leading to and within the brain. It is the fifth leading cause of death and a leading cause of disability in the United States, according to the American Stroke Association. If you have suffered a stroke, the potential risks of not following a prescribed medication regimen could be hazardous, Dr. Potter explained.
Be on the lookout: Missing medications could cause blood pressure to go up and further increase the risk of having additional strokes. Medications for strokes also can pose risks. For example, while Warfarin is effective in preventing strokes, it interacts with many medications and, as such, may increase the risk for hospitalization.
Solutions: Up to 80 percent of strokes could be prevented, according to the American Stroke Association. Preventative measures include lifestyle changes such as weight and blood pressure control, exercise and stopping smoking, along with treating diabetes and atrial fibrillation. As with heart conditions, managing medications and lifestyle changes are important to maintaining health.
Resources: For more information about the treatment of strokes, visit the American Stroke Association at strokeassociation.org.
Alzheimer’s disease/other form of dementia
The risk: While there is currently no cure for Alzheimer’s disease, medications can help to slow the increase in symptoms of Alzheimer’s such as memory loss, confusion, and problems with thinking and reasoning. However, according to Dr. Potter, care needs to be taken, especially when more than one medication is being used, because an individual with dementia may be unable to manage a complex medication regimen. Someone in the early stages of dementia may be able to manage his or her medications without much assistance. But it’s important for family caregivers to stay involved and develop a plan for assistance when the senior can no longer safely manage medications on his or her own.
Be on the lookout: Watch for the potential symptoms of a dementia illness such as confusion and memory loss, medication mismanagement, mood changes and problems with judgment.
Solutions: When taking medications for Alzheimer’s disease, the Alzheimer’s Association recommends the following safety tips to help avoid medication-related problems:
- Coordinate with all care providers.
- Ask your doctor or pharmacist to check for possible medication interactions.
- Get the details about all medications.
- Take all medications as directed.
- If swallowing is a problem, ask if the medication is available in another form.
- Maintain medication records.
Resources: To learn more about medication safety and Alzheimer’s disease, check out the Alzheimer’s Association’s Alzheimer’s and Dementia Caregiver Center.
The risk: Most mental health experts agree that when depression is severe enough to impact the ability to function in life, medication can be helpful, even lifesaving. However, research shows that antidepressants fall short for many people. Studies also show that antidepressants may increase the risk for falls, fractures and bone loss in older adults. For many patients, counseling works as well as medication, Dr. Potter said.
Be on the lookout: Signs of potential side effects and problems with antidepressants could include nausea, increased appetite and weight gain, insomnia and constipation.
Solutions: Consult with a doctor about whether an antidepressant is the correct solution. If you decide to stop taking antidepressants, it’s essential to first consult a doctor and taper off this medication slowly. Some of the unpleasant withdrawal symptoms that could result from stopping an antidepressant medication abruptly include crying spells, extreme restlessness, dizziness, fatigue, and aches and pains. These withdrawal symptoms are known as “antidepressant discontinuation syndrome,” Dr. Potter said.
Resources: For more on depression and treatment options, visit the National Institute of Mental Health.
The risk: Until a few years ago, anxiety disorders were believed to decline with age. That’s because older patients are less likely to report psychiatric symptoms and more likely to emphasize their physical complaints. But experts now recognize that aging and anxiety are not mutually exclusive: Anxiety is as common among the elderly as among the young. In fact, many older adults with an anxiety disorder had one when they were younger, according to the Anxiety and Depression Association of America.
Doctors often prescribe lower doses of medication for older adults than they would for younger adults as changes in aging bodies can affect the way medications are eliminated from the body and how the body reacts to a given amount of medication. Ensuring that a medication is at the right dose and not adversely interacting with other medications is important to long-term health and safety.
Be on the lookout: Potential side effects and problems of some of these medications could include stomach upset, insomnia, constipation and blurry vision.
Solutions: Family members may need to make sure that their senior loved one’s medication side effects and other issues encountered during treatment are reported to a health care provider and managed promptly.
Resources: For more about treating anxiety, check out the Anxiety and Depression Association of America at adaa.org.
Overall Considerations for Rx Success
The following are some overall tips for family caregivers to help their senior loved one alleviate any risk of having potential medication management issues.
- Watch out for signs of:
- Complacency such as the potential disconnect between a doctor’s orders and the senior who thinks he/she is accurately taking medications or doesn’t feel at risk.
- Problems from multiple medications. Multiple diseases and conditions, along with a variety of medications, could spell real trouble for an older adult. While family caregivers should strive to give their senior loved ones as much independence as possible in managing their medications, safety should remain the main goal. Some tips to help achieve this goal include:
- Persuade the senior to be safe. You may need to try to convince the senior of a better system of medication management. For example, a family caregiver might say: “I care and want you to get better. I know you’re a smart person, but the potential for mistakes really scares me. Please do this for me.”
- Focus on medication management. In addition to regular communication with all applicable doctors and specialists, consider obtaining a medication organization service like Simple Meds℠ (not currently available in Canada), which sorts medications into clearly-labeled dose packets, to help your senior loved one stay on track with his/her prescribed medication regimen.
- Maintain regular communication with medical professionals and help the senior to understand—and follow—doctor’s orders. Make sure seniors know the medications they are taking and why. Keep a list of current medications, noting who prescribed them. Ask the doctor to check that the medications are not adversely interacting with one another. Update the list annually or any time a new medication is prescribed.
- Give or get help. If a condition such as Alzheimer’s disease or another form of dementia exists, provide more help for the senior to remember to timely and properly take his/her medication(s) or employ a caregiver to provide medication reminders.
- Appoint a single point of contact. Designate a single provider to keep track of the “big picture.” Appointing one medical professional, such as the senior’s primary doctor, to monitor the senior’s overall health could help to minimize the potential for medication mistakes.
- Remember to acknowledge and consider the senior’s wishes. Seniors with very complex health problems should be given the opportunity to say what is important to them, and have their doctors aim to reduce the number of medications based on that decision as appropriate.
- Consult with your senior loved one’s medical providers about any specific concerns or questions regarding any medication and the senior’s ability to successfully manage his/her medications.
Next Step: Talk to Your Loved Ones
Now that you’ve learned a little more about medication risks and solutions, it’s time to talk with your loved ones about next steps. We put together a brief resource to help make the conversation go smoothly.
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