Managing Your Loved One's Medication: Tips for Family Caregivers
Here's how to help older patients manage their medication.
Jan. 31, 2011— -- Adults 65 and older use more medicine daily than any other age group in the United States, accounting for 34 percent of all prescription medication, according to the National Council on Patient Information and Education. For the elderly, especially those who suffer chronic conditions that require multiple medicines, managing prescriptions alone can be extremely difficult.
Family members and caregivers can assist their loved ones by helping them keep track of their medications and make sure they're taken at the right time, and in the correct dosage. Between 40 and 75 percent of older people do not take their medications correctly, according to the council.
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Taking more pills than one needs, or taking more than five pills a day is referred to as polypharmacy. It is an "increasingly common and overlooked problem for many patients," Dr. Caleb Alexander of the University of Chicago's Department of Medicine said.
"Patients and caregivers and physicians alike need to be vigilant that each prescription medicine has a clear purpose, that benefits outweigh potential risks and costs, and that [the treatment] is viewed with the patient's goals of care and well-being in mind," he said.
James Wooten, a pharmacologist from the University of Missouri-Kansas City School of Medicine and a proponent of patient education, said asking questions is one of the most important ways to manage treatment. "Information is power," he said, "and you're more likely to use something correctly if you know why you're using it."
Experts specializing in eldercare gave their best tips for the more than 65 million family caregivers in the United States to help their loved ones manage their medication:
Make A List
The easiest way to keep track of your medication is to write down the name and dosage instructions for every drug you're taking, including over-the-counter drugs and herbal supplements.
"About half of all people taking prescription medicine are also taking an over-the-counter therapy or dietary supplements simultaneously," Alexander said. "These add to the pill burden and can increase polypharmacy."
Making sure every prescribing physician is fully informed of all medications helps prevent potential fatal drug interactions. Adverse drug events cause more than 18 million emergency room visits each year and, according to the Centers for Disease Control and Prevention, older patients are twice as likely to visit the ER because of adverse drug events.
Put a copy of the medication list somewhere easily accessible; on the refrigerator or bulletin board in your wallet, and hand out copies to relatives, friends or a trusted neighbor. That way, a copy will always be available in case of an emergency. Update it regularly. You can make your own list, or use online applications and templates such as those from AARP.
Talk To Your Doctor And Pharmacist
Your physician and pharmacist "should be able to explain to you whatever you need to know," Wooten said. "Don't be afraid that you can't understand something."
Good questions to keep in mind include: How does the drug work? How do we monitor if the drug is working or not working? What are potential side effects? How do I know if I'm experiencing a side effect? Is this a brand name or generic? Will a generic work in place of this brand name medication? Is this medicine safe to take with the other drugs I'm currently on?
Nearly 90 million people -- half of all U.S. adults -- have difficulty understanding and acting on health information, according to the National Council on Patient Information and Education. This is especially true of the elderly; almost 40 percent of them are unable to read a prescription label and 76 percent are unable to understand information given to them.
If you can, accompany your loved one to a physician's visit, or ask to speak with the physician or pharmacist over the phone to learn about the treatment.
One of the most important questions to ask your prescribing physician is, "What is this medicine for?" Asking questions "decreases the likelihood of writing prescriptions without full knowledge of therapies being used," Alexander said.
Said Wooten: "Make physicians say exactly why they're writing prescriptions," and ask if the new medicine is related to the drugs you're currently on. Drugs sometimes create the need for another drug to manage side effects, called cascade polypharmacy.
Make sure you know which medicines are meant to take every day, or which you can take as symptoms arise, Alexander said, in an effort to minimize both the pill burden and economic hardship.
Minimize Medications If Possible
"Doctors and patients alike are sometimes too quick to reach for the prescription pad in order to treat symptoms, when an non-pharmacological treatment could make more sense," Alexander said.
Ask your prescribing physicians if it is possible to minimize the number of different pills you're taking, or at least limit the number of medicines taken twice a day or more frequently. "Adherence [to treatment] decreases as the need to use the medicine twice or more frequently each day increases," Alexander said. Likewise, the more pills you take increases the risk of nonadherence.
Use the 'Brown Bag' Method
One-third of older patients -- many with three or more chronic conditions -- have not talked with their prescription provider about all their medications within the past year, according to the National Council on Patient Information and Education.
Organize Your Medication
One way to ensure your physician knows what medicine you're taking is to bring it with you to your appointment. Putting each drug in a bag "really makes people look in the medicine cabinet and say, 'What is this for?'" Wooten said.
Medicine means every treatment or therapy you take; over-the-counter drugs, herbal therapies, vitamins and supplements, and prescription medication.
"For some reason, people think that something you buy at a grocery store isn't a drug, but it is," Wooten said, "and your physician needs to know about it."
Pill Boxes Work Best
Experts agree that simple pill boxes are one of the most effective ways of organizing treatments, with labeled compartments for each day of the week, and even several rows of compartments for medication taken multiple times a day.
"They can dramatically simplify the process of taking prescription medication," Alexander said.
The challenge with pill boxes is "they have to be filled correctly, and they take the organization and discipline to use them," he said.
If filling the pill box is too much for your loved one, try to fill it yourself or have a trusted neighbor or relative stop by and help keep the medicine organized.
Develop Good Habits
"Developing some regular habits when one takes medicine is important," Alexander said.
Try taking medicine while brushing your teeth or right when you wake up or go to bed.
"If you take your medicine habitually alongside something you regularly do, it links the two actions" and makes it easier to remember to follow your treatment, Alexander said.
Use One Pharmacy
Turning to one pharmacy for all of your prescriptions can help prevent drug interactions and make getting refills easy.
Most pharmacies offer automatic refills, sometimes with phone reminders that it's time to pick up your medicine.
Some pharmacies also have computerized programs for dispensing medication that alerts pharmacists to potential drug interactions. "Take advantage of the technology available," Wooten said.
Your pharmacist can also become an important resource; don't be afraid to ask your pharmacists questions about your medication or refills, or about over-the-counter treatments.
Maintain Dialogue With Your Loved One
You can help your loved one adhere to their treatment and avoid negative medication situations, whether you live next door or across the country. "A simple query is often enough to detect signals of potential problems," Alexander said.
If you're able to visit your loved one frequently and supervise treatment, some things to think about include signs of pill hoarding, a lot of medicines that appear to be lying around but not completed or used, or evidence that refills haven't been picked up on time.
Talk to Your Loved One
Do you notice problems in your loved one's organization in other aspects of their life? If they're falling behind on paying their bills, unable to drive safely or shop for themselves, those may be signals they might have trouble following their medical treatment, Alexander said.
If they're taking more than five medicines a day, it might be time to step in and help them stay organized.
It's OK to Be Overwhelmed
Alexander said he tells his patients they're not the only ones who have trouble keeping up with treatment or staying on top of multiple therapies. "I tell them many of my patients have trouble taking their medicines each day," he said, and then asks if his patient has any problems at all with their medication.
"As a loved one, as a caregiver, it's important to de-stigmatize the societal problem," Alexander said. "Setting a tone that's supporting and coming from a point of advocacy rather than criticizing the patient or passing judgment is important."
For more tips and information for family caregivers, turn to resources such as the National Family Caregivers Association, AARP and the National Council on Patient Information and Education.