The typical older adult (65 years and over) takes between 14 and 18 different prescription medications each year, many of which are prescribed by multiple doctors. So it’s no surprise that polypharmacy (taking multiple prescriptions, some of which may not be helpful) and medication non-adherence (skipping dosages; not taking prescriptions per the instructions) are two major problems among the aging population.
These issues may seem insignificant, compared to some of the other common health concerns of older adults. But non-adherence alone causes about 125,000 deaths a year and is the leading contributor to as many as 25 percent of admissions to hospitals and nursing homes, according to Mindy Smith, executive director of the American Pharmacists Association (APhA). “It [non-adherence] can lead to disease complications, reduced quality of life, increased medical costs and unnecessary medication changes,” Smith says.
Why older adults don’t take their meds
There are a variety of reasons why an older adult may have trouble taking their medications as prescribed, according to Smith.
Visual impairment, whether caused by disease or an age-related reduction in acuity, can prevent a person from reading the instructions on the prescription bottle, or make it difficult to distinguish between pills that look similar. Cognitive issues such as memory loss and confusion can also complicate the prescription-taking process, and sometimes older adults may have trouble physically swallowing large pills.
Beyond physical and cognitive limitations, sometimes an individual will dislike the side effects of their medications so much that they simply cease taking them.
John Schappi had been taking prescriptions to manage his high blood pressure for over 40 years when he finally decided to question whether the benefits he was receiving were still worth the side effects. “Blood pressure management enters one of those increasingly common medical grey zones in which individuals and caregivers have to ask a lot of questions and balance the trade-offs. Do you avoid a heart attack by using drugs associated with an almost equal risk of breaking a hip or injuring your brain?” he writes in “ Why I’m Ditching the Blood Pressure Pills I’ve Taken for 40 Years .”
Using your pharmacist as a resource
Along with the doctor who prescribed the medication, the pharmacist dispensing the prescription is an important resource for preventing polypharmacy and non-adherence in an older adult.
“Pharmacists have expert knowledge in medication therapies and can help patients understand how their medications treat their condition,” says Smith. Physicians and pharmacists can also work together to help a patient manage their medications, so long as the lines of communication between doctor, patient, caregiver and pharmacist are open.
To more effectively streamline the medication management process, thousands of pharmacies nationwide have begun to offer "medication synchronization" programs. These programs enable patients to schedule monthly appointments with their pharmacists. During these appointments, a patient can pick up his or her medications for the month, all at the same time. They'll also have the opportunity to speak with the pharmacist about any questions or concerns regarding their prescriptions.
(The APhA Foundation website offers a tool to find pharmacies in your area that provide medication synchronization services: Locate a Pharmacy)
If your pharmacy doesn’t offer a medication synchronization plan, there are other ways to use the knowledge of your pharmacist to help manage your family's medications.
The so-called “brown bag check-up” involves bringing in all of your medications—both prescription and over-the-counter—to the pharmacist and having him or her make sure that there’s no possibility for adverse interactions between the drugs. Most pharmacies allow patients to schedule appointments for a brown bag check-up.
Pharmacists can also answer key questions about medications such as:
- How often should I be taking this medication?
- Should I take this medication on an empty stomach, with water or with food?
- What are some warning signs that the medication may not be working?
- What are the side effects that I should look out for while on this medication?
- Are there any foods/beverages/other medications that I shouldn’t take while on this prescription?