My 82-year-old mother lives alone. She takes a lot of medications and I am worried that she might not take the proper pills at the proper times. What can I do?

Dr. John Connolly

Elderly people are most definitely at an increased risk for problems related to the use of prescription drugs, nonprescription (or over-the-counter) medicines, and herbal or other alternative medicines.

The sheer number of drugs they take contributes significantly to problems associated with noncompliance, drug interactions or adverse drug reactions, and the misuse of medications. Physiological changes in the body associated with aging make the elderly more susceptible than others to the undesirable or toxic effects of drugs. In fact, there are some drugs that should not be prescribed to the elderly at all either because they are more toxic than comparable drugs.

While those over age 65 consume one-third of all prescriptions and purchase two-fifths of all OTC drugs, they represent only 12 percent of the population. On average, an elderly patient may get 13 to 14 prescriptions a year and take as many as 4 to 5 medications at any given time. Women tend to have more prescription medicines.

The misuse of drugs may cause urinary problems (incontinence), gastro-intestinal problems (constipation, diarrhea, nausea and vomiting), cognitive impairment (confusion), mental impairment (depression, delirium), injuries (hip fractures), breathing problems, skin rashes, bruising and bleeding, and neurological problems. Among the elderly population, an estimated 30 percent of all hospital admissions and 1 in 1,000 hospitals deaths are directly related to drug toxicity or adverse drug reactions. There are several ways you can help your mother avoid drug-induced medical problems. 

• Make sure that your mother's primary care physician is aware of all the medications she is currently taking. Keep an up-to-date list or even bring the bottles and containers to each medical visit. Be sure that any specialists she sees report back to her primary physician to coordinate her care.
• Ask the physician to provide written instructions for taking each medication and written descriptions of any possible side effects. Remind your mother to report any unusual symptoms to her physician. 
• Make sure your mother understands when and how to administer each medication. If you cannot be with your mother during a medical visit, call the physician or office nurse for these instructions. Ask your mother if she is able to comfortably open and close the containers. You might purchase one of the many containers on the market that organize pills on a daily or weekly basis. 
• Try to use a single pharmacy for all medications so all your mother's prescriptions will be on record. The pharmacist can determine if they can be safely taken together and can answer any questions about the combined use of prescription and nonprescription drugs. Also, many pharmacies provide customers with a toll-free number or hotline for advice. 
• Advise your mother to report to you and her physician any unusual symptoms she may be experiencing. 
• Keep only the medications that are currently being used and have an appropriate expiration date.

Dr. John Connolly is President & CEO of Castle Connolly Medical Ltd., America's "trusted" source for identifying top doctors. He has an extensive background in management and healthcare. For more than a decade, he was President of New York Medical College where he successfully revitalized the school while insuring its financial security. Dr. Connolly is extensively involved in healthcare activities including serving as a director of the New York Business Group on Health, as founder, a director and past chair of the American Lyme Disease Foundation, as a member of the Presidents Advisory Council of the United Hospital Fund of New York, and as a Fellow of the New York Academy of Medicine. He has also served on the boards of two hospitals and as chairman of the board of one, and is currently Chairman of Professional Examination Service, Inc. He also is a frequent guest on regional and national TV and radio shows, including 20/20, CNN and Good Morning America.