The Centers for Disease Control and Prevention (CDC) predicts that, by the year 2030, there will be an estimated 71 million "older" adults accounting for roughly 20 percent of the U.S. Population. In CDC's recently published document, The State of Aging and Health in America 2007, the federal agency further states that these senior citizens are living longer because of, among other things, medications that prevent or cure illnesses and reduce disabilities and death.
Various studies have also shown that as the population ages problems are resulting from misuse, or lack of understanding, of the medications. Seniors are prescribed more medications and typically have more medical-related conditions than the rest of the population.
Medication Interactions
Improper use of medications and undesirable drug interactions can lead to a variety of medical conditions that may go unrecognized or lead to other physical or mental conditions. Falls are a leading cause of injuries to seniors and some of these may be a direct result of medical conditions that may directly or indirectly be related to medications. Deadly falls for senior citizens increased by more than 55 percent from 1983 to 2003, according to a report by the CDC. This report, and updated figures, clearly establish falling as the leading cause of injury deaths among people 65 and older.
What Needs to Be Clarified
Some seniors may not have the mental capabilities to understand why, for what reasons and when they should be taking their medications. When a senior is given a new medication, they, or the caregiver responsible for them, should ask the doctor the following questions:
- Why is the medication being prescribed?
- How long before the medication will make the patient feel better?
- What actions should be taken if a dosage is missed?
- How will the user know that the medication is actually working?
Annual Prescription Review
A Food and Drug Administration (FDA) article, Medication Use and Older Adults recommends placing all of the resident's medications in a "brown paper bag" and taking them along on doctor's visits. FDA recommends that this be done at least annually or when there have been significant changes in prescriptions. Besides prescription drugs, FDA recommends brown-bagging any over-the-counter drugs, herbs, vitamins, dietary supplements and topical treatments – such as ointments and creams.
This practice enables physicians to evaluate potential exposure to harmful interactions among the various medications and other items used as part of a health/pain medication regime.
As-Needed Medications
Questions that a senior or responsible party should ask about medications provided for use on an "as-needed" basis:
- How is the determination made as to when the medication should be taken - what conditions would lead to the resident to take the as-needed medication?
- How often and in what dosage should the medication be taken?
- What action should be taken if the medication does not have the required results or causes an allergic or negative reaction?
Questions for Pharmacists
A pharmacist is an excellent resource for drug-related questions and should be regularly consulted. The following questions should be asked and the answers clearly understood by seniors and/or their caregivers:
- Does this brand name medication also have generic versions?
- Will this new medication have an interaction with the current drug regime or would use not be indicated because of interaction with food, alcohol or tobacco usage?
- When should the medication be taken and in what dosages? Should it be taken with meals, before meals, after meals, etc.?
- What type of side effects may this new drug cause and how can these be recognized.
- Are there any special storage instructions for the medication (kept out of the sun, refrigerated, etc.)
- What is the shelf life of the medication and proper disposal techniques after the expiration date has passed?
A recent New York Times article reports that the average older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications. Taking of multiple medications prescribed by several doctors account for up to 28 percent of hospital admissions of senior citizens according to data from the Assisted Living Federation of America (ALFA). It is imperative that drug usage by senior citizens be closely monitored.
About the Author
Rodger Sack is a Fireman's Fund Insurance Company Senior Risk Management Consultant based in Albuquerque.
