MEDS & MIX-UPS
Confusion about doses make the elderly especially vulnerable to drug interactions, side effects and misdiagnosis.
As the body ages, it stores medicines more readily but doesn’t break them down as efficiently. Medications can interact with each other as well as with herbs, vitamin and mineral supplements and other dietary supplements. Maintaining a master list of all your loved one’s remedies—pharmaceutical and natural—is essential to managing them effectively.
When people become caregivers, they usually have no idea how many medications those in their care are taking. And they’re astounded when they find out. They then face the daunting task of trying to coordinate all the dose schedules. Some drugs must be taken in the morning, others at night. Some must be taken with food, others on an empty stomach. It’s no wonder care recipients might confuse or miss doses. Anyone could.
Studies indicate that about one-quarter of all residents of nursing homes ended up there because they couldn’t manage their drugs. Not that they didn’t try. More than likely, they made mistakes that adversely affected their health and possibly endangered their lives.
“These people can cook, drive and manage their money,” says Jack Fincham, PhD, Professor of Pharmacy Practice & Administration, University of Missouri-Kansas City School of Pharmacy. “But they get in trouble because they’re unable to juggle six, eight even 10 medications. And so their conditions deteriorate from good to bad.”
Then, too, their families—the ones who decide on nursing-home placement—may not recognize the difference between symptoms of a disease and side effects of a medication. Nor are they familiar with drug interactions, when one pill can block or overboost the effects of another. But the family members are no more at fault than the care recipients themselves are.
People today are living longer than ever, which is wonderful. But as they get older, they’re more vulnerable to health problems like high cholesterol, high blood pressure, adult-onset diabetes and osteoarthritis. Doctors attempt to manage these conditions with prescription and over-the-counter drugs. And so medicine cabinets are brimming.
For Seniors, A Serious Health Concern
Among all age groups, older people are at highest risk for adverse drug interactions and side effects. One reason is that they take more medications than anyone else. Unfortunately, those in the medical community don’t always communicate with each other to make sure the therapies they’re recommending won’t have adverse interactions with other therapies the patient has been prescribed. That’s why the patient and the caregiver should feel free to ask questions themselves.
Take Action: Round Up The Remedies
One of your most important tasks by far is to put together a comprehensive list of remedies that the person in your care is currently using. These tips can help you do the job quickly and easily:
Contact your loved one’s doctors and pharmacist for complete records of the prescription drugs he or she is taking. You might need the person’s written permission to get these records. Once you have them, they should provide a comprehensive picture of your loved one’s current prescription program.
With assistance from the person you’re helping and other family members, write down all the over-the-counter drugs the person is using, as well as herbs, vitamin and mineral supplements and other dietary supplements.
Ask your loved one whether she has experienced an allergy or bad reaction to any drug. Also find out whether she has been told by a health professional to avoid a particular drug. Knowing what someone shouldn’t take is just as important as knowing what she actually is taking.
Check the person’s medicine cabinet to make sure you’ve documented everything. Look any place she might store remedies, too—such as in the kitchen.
Compile all the information you’ve gathered into one “master list.” Be sure to update it regularly as the person’s treatments change.
Stay on Top of the Regimen
Now that you’ve identified what is being taken, you can turn your attention to “how much,” “when” and “how.” Coordinating this information can help you get organized and ensure proper dosing and safeguard against problems. Just follow these helpful guidelines, developed with input from the National Professional Society of Pharmacists.
Identify the health professional who can answer questions and provide information about the various treatments your loved one is using. Primary care physicians, specialists and nurses are excellent resources. Or the pharmacist might be the most accessible, though you may need to make an appointment to see him.
Schedule a 15-minute consultation with one of these health professionals to go through all of the treatments the person you’re caring for is using. Be sure to take your master list—or even better for this appointment—throw all the pill bottles into one big bag and have this expert scrutinize the entire regimen at once.
Be an active listener. Take notes. Ask whether there are written materials you can have. Repeat any instructions you’re given so the health professional knows you’ve understood.
Ask the doctor to write down the purpose of any medicine on the prescription slip, something as simple as “for high blood pressure” or “for rash.” As long as it’s on the slip, it will be put on the label. Then the bottle is clearly marked for anyone administering that medication.
Ask the pharmacist to include both the generic and brand names on pill bottles. According to Lana Witt, Sr. Clinical Informatics Specialist, EpiCenter at Stanford Hospital, using the generic name ensures clear communication between doctors, pharmacists and other health professionals.
When picking up a prescription, read the label before you leave the pharmacy. Also, look at the medicine in the container. Question any changes in size, color, markings, quantity, dosage or other instructions.
Make sure the person in your care takes prescription and over-the-counter medications according to their instructions. Ask the pharmacist or doctor what to do in the event of a delayed or missed dose.
Throw out any medicines that have become outdated. The expiration date applies only if a drug has been stored properly. Humidity, temperature, light and even air can negatively affect shelf life and potency.
If the person you’re caring for experiences any unexpected symptoms or changes, contact the doctor or pharmacist right away. Once resolved, make sure this information goes into your loved one’s medical records as well as on your own master list.
Purchase a pill organizer that is marked for the purpose of managing medications.
Get a large calendar on which you or your loved one can record each time she takes each of her medications. This can help prevent missed doses or “double dosing” and other mishaps.
Mixing and Not Matching
One of the lesser known dangers of taking multiple medicines is that one pill can inhibit or exaggerate the effects of another. The best way to avoid this problem is to ask questions. The doctor or pharmacist should be able to identify potential interactions between prescription and over-the-counter drugs, as well as herbal remedies, vitamin and mineral supplements and other dietary supplements. And they should be willing to check their references for you if they are unsure.
To recognize all the interactions and adverse reactions that can occur, you’d probably need a degree in medicine or pharmacy yourself. But even with a little bit of knowledge, you can zero in on possible “hot spots” in a treatment regimen.
Doctors and pharmacists readily acknowledge that the elderly population has its own set of risks for drug interactions as well as for side effects. If you’re caring for an older person, don’t shy away from asking pointed questions about the medications being prescribed—for example, whether a particular drug is necessary.
If you suspect a drug of causing side effects (sometimes they dissipate after a few days), ask if the dosage can be decreased. Discontinuing the medicine may not be necessary. Remember that in older people especially, the body just may not process a full dose efficiently.
The line between interactions, adverse reactions and side effects can blur. But for a caregiver, being able to make the distinction matters less than being able to recognize when someone is being harmed by a medicine that is supposed to be helping.
Adapted from And Thou Shalt Honor: The Caregiver’s Companion. Edited by Beth Witrogen McLeod ©2002 by Wiland-Bell Productions. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit www.rodalestore.com. Rodale is not responsible for material content changes that have been made to this excerpt.