Every year, hospitals and experts deem an extraordinary amount of hospital cases preventable–if the proper medication management had been in place. Medication management is a critical activity of daily living, and supervision is more important than some may think. Nearly 1/3 of elderly home healthcare patients have problems with their medication or are taking drugs not suited to their condition.
Due to the unstructured nature of in-home care, the potential for medication mismanagement is greater than that of other healthcare settings. The unique obstacles to communication that many aides face in an in-home work environment also add to the problem. Unless there is an organized system between workers, the chance for medication error is extremely high.
For many older adults, the ability to remain in their own homes is directly related to how well they can manage their medication. According to the American Medical Association, approximately 40% of seniors age 65 and over take at least 5 prescription drugs on a regular basis. This means that there is a lot to keep track of, and, for one person that may be too ill to manage their own medication, tracking medications is simply overwhelming.
There are a variety of reasons why someone may need assistance with their medication management. It is imperative that everyone involved recognize the signs of potential mediation mismanagement before it is too late.
When it comes to an individual minding their own medication, there are many more pitfalls than people realize. The largest users of prescription medication are older adults, yet they are also the most vulnerable to adverse reactions
The mismanagement of medication usually comes to light at a late juncture, when adverse medication reactions are already taking place. In fact, approximately 30% of hospital admissions with older adults are prescription-drug related, with more than 11% attributed to medication nonadherence and 10% to 17% related to adverse drug reactions (ADRs).
It is at this point that friends and family members often realize the need for a separate individual whose sole responsibility is to keep track of the complex patterns of a person’s daily medication regimen.
In addition, adults discharged from the hospital on more than 5 prescription medications are much more likely to be admitted to the ER and hospitalized within 6 months after discharge. Most of the failure pertains to the reality that several doctors may be involved with the patient, and they may have little to no communication with each other.
A variety of comorbidities usually requires a slew of drugs that may be almost impossible to follow without a dedicated individual assigned to keep track and administer the medication properly.
Changes in the biological makeup of an individual may also lead to an adverse reaction to their drugs. Although someone could be using a substance for years, they may suddenly develop a severe reaction. At this point, a doctor may recommend a lower dosage of the medication or to stop the dosage completely.
Potential for Misuse
Adverse effects are not the only reason why a person may need guidance with their medication management. When left to their own devices, some people simply cannot keep track of the dosages or schedules for their drugs. This is often the first sign of an individual needing more constant care within their home, as medication management is vital to their healthcare.
There are many reasons why a person may misuse their medication, and in the elderly, it is often one of the following:
Memory: An individual is suffering from a form of dementia and simply does not have the capacity to manage their medications in an effective sense. Even if an older adult does not have diagnosed dementia, memory problems are common as individuals age, and even normal memory problem can contribute to accidental drug misuse.
Mislabel: Medications may be mixed up, disorganized, or mislabeled. Pills may be placed in other bottles.
Mistake: One pill may look like another for the individual in need. If left on their own, they may be taking the wrong pill, if not otherwise advised. Problems with vision also contribute to this issue.
Double Dose: Many people with memory disorders often overdose because they have forgotten they already took their medication for the day. This is an important reason to consider medication mismanagement.
The misuse of medication is a huge problem when it comes to in-home care. A professional does not need to provide medical services to ensure an individual is taking their medications properly, which means that an aide can be a valuable resource.
Regardless of whether an individual wants to be guided on their medication management, there comes a point in time when they can no longer be trusted to handle such a responsibility. This type of realization may cause shame, and there may be a backlash when people feel like they no longer have control over these essential tasks of daily life.
Medication interventions need to be tailored to a specific individual’s learning abilities. If the individual is suffering from a disability that impairs their judgment, an intervention may simply be a sit down to explain how their medication will be managed going forward. For individuals who have a deeper sense of independence, this conversation may be a little tougher.
Once an intervention takes place (assuming it is a necessary step) it is time to start organizing an individual’s prescription profile. In order to get on track, take the following steps.
Coordinate: Make a list of all the providers and healthcare team members involved in the loved one’s life and cross-reference the medications with each other. Every medical professional should be aware of what the other is prescribing to create a collaborative network of assistance. Herbal supplements and vitamins should also be considered on this list.
Ask: There is no definitive path to determine adverse reactions, and sometimes when a new medication is prescribed it can induce an allergic reaction. When a new medication is prescribed, the caregiver should be ask about the potential interaction with other drugs and possible adverse effects. A new physician should always see a complete medication history.
Details: It is important to inquire about each prescription. Find out as much as possible, including the name, generic alternatives, purpose, dosage, frequency, and possible side-effects.
Timing: A pill box, daily list, and/or calendar can help a loved one stay on track with what medications they need to take and when.
Routine: Medications should always be taken at the same time each day. Developing a routine and daily ritual to medication administration means that an individual is always taking their prescriptions as recommended. Developing this routine also helps decrease the occurrence of double dosing or forgetting a dosage.
Safety: In some situations, medications should be placed in a locked drawer or cabinet to avoid accidental overdose. Additionally, medications that have expired should be disposed of in the proper means (never throw them away or flush them down the toilet). In addition, emergency phone numbers should be easily assessable. The number of the local police department, as well as the poison control center should be kept handy in the case of a suspected overdose.
The way in which a person is given their medication also plays a role in how well it is managed. When it comes to administering medication, there are a few simple things to remember:
Take as directed: Dosages should never be changed or altered. If cost or side effects are an issue, consult the primary care physician immediately.
Swallowing: Sometimes administering medication may be difficult if it is in the wrong form. Some people may not be able to swallow pills effectively. No tablet or pill should be crushed without consulting a physician.
Clear instructions: When giving medication, it is critical that the person receiving the drug is aware and capable of accepting it. Using simple language like “Here is your heart medication.” Explanations should make the point very clear and alleviate stress.
Refusal: If an individual is intent on not taking the drug offered, it is best to not force the situation, and try again later. If the problem persists, contacting a doctor is the best practice.
In order to maintain medication effectively, keep a clear system of records. Name, date, and dosage should all be noted in a daily journal, as well as any side effects and adverse reactions.
The most effective means to caring for patients at particular risk is accurate documentation and consistent medication review with each encounter. Studies have shown that frequent reviews (often held in conjunction with the physician) result in fewer instances of adverse effects.
Tips for Managing Medication
Managing a slew of prescriptions can be daunting, but it is not impossible. The following are a few tips and tricks to handling a complex list of medications for a loved one:
- All doctors should collaborate and use the same list of medications taken
- The same pharmacy should be used for all medications so that medical history is complete and in one place
- Always follow the instructions on the label/box/package
- Know the side effects of each medication beforehand
- Keep track of expiration dates and discard properly
- Use a pill organizer
The importance of medication management is critical to an individual’s health. As people get older, they cannot afford adverse reactions and side effects. Understanding each drug and how the individual will react is the first step in practicing responsible medication management for a loved one.