Prescription and over-the-counter medications are used daily by millions of people to treat and manage countless health conditions. Many of these drugs are used to improve quality of life, but these advances in modern medicine also have their drawbacks. Medication-related problems, such as drug interactions, adverse side effects and nonadherence can negatively impact a person’s health and even increase the risk of death.
In fact, poorly managed medication regimens not only have a detrimental effect on patients’ health, but they also increase the burden on family caregivers and result in avoidable health care usage and costs. In a 2018 study, researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California San Diego estimated that the annual cost of drug-related illness and death resulting from nonoptimized medication therapy was $528.4 billion, equivalent to 16 percent of total US health care expenditures in 2016.
Why Are Medication-Related Problems and Costs Increasing?
The answer to this question is not simple—there are many reasons. Our nation is rapidly aging and life expectancy for Americans has been steadily increasing. Today, the majority of seniors are striving to maintain their independence in their own homes. Compared to elders who reside in long-term care settings and are closely supervised, these “independent” seniors are often more difficult to thoroughly monitor for medication problems. Furthermore, many providers throughout the healthcare system currently do not have sufficient experience caring for seniors and their unique needs, especially in such large numbers.
Medications and the ways we use them have changed considerably over the years. Not only are the drugs we take far more complex, but our consumption of them is increasing as well. Polypharmacy (the simultaneous use of multiple drugs by a single patient) is especially common in older adults with one or more chronic conditions. These health conditions and the medications prescribed to treat them have very complicated effects on the human body. Researchers at the Ohio State University College of Pharmacy found that the odds of a patient incurring a medication-related problem increased by 10 percent with the addition of a chronic medication to their regimen. Furthermore, it is important to remember that over-the-counter medications, dietary supplements, vitamins, minerals, herbal products, and even the foods and beverages we consume affect how chemicals work within the body, too.
Education about medication-related problems is also lacking among consumers and the public. It has been my experience that families who have cared for their loved ones do grow to understand the challenges of medication use, but there is a learning curve. Once a family caregiver has stepped in to provide hands-on help, they usually witness an adverse reaction or side effect firsthand or grow concerned about the number of medications their elder is taking. This prompts them to address these issues with pharmacists and physicians who may not have been privy to information about the elder’s health or lifestyle. Educating yourself about the medications you and your loved one take, taking them as directed and openly communicating with health care providers about concerns are the best ways to prevent medication-related problems.
Understanding What Causes Medication-Related Problems
Each medication operates differently within the body, but it is important to understand that the effectiveness of any prescription drug or OTC medicine can be altered by any of the following factors:
- How the medication is administered (orally, intravenously, topically, etc.)
- When the medication is taken (especially in relation to other medication doses and meals)
- Whether a medication is taken with or without food or liquids (this can affect absorption and side effects)
- What other prescription drugs, OTC medications, vitamins and supplements are being taken
- The patient’s body composition (different ratios of fat tissue and lean tissue affect distribution, metabolism and clearance of drugs)
- Hydration may affect absorption in the stomach and can change therapeutic drug levels in the blood
- Digestive issues can change how quickly a medication moves through the stomach and intestines and affect therapeutic drug levels
- Kidney function affects therapeutic drug levels as well as the elimination of some medications
- Liver function affects therapeutic drug levels as well as the elimination of some medications
- A patient’s genetic makeup may cause them to respond to treatments differently
- Age-related conditions and changes in the body can affect how drugs are metabolized as well as the type and severity of side effects a patient experiences
How to Prevent Medication-Related Problems
- Ask questions about each medication. Be sure that the information comes from a trusted source, such as a physician or pharmacist.
- Ensure that all healthcare providers have a current list of ALL medications, vitamins and dietary supplements a patient is taking.
- Use all medications as directed consistently. Organizational devices such as pill boxes and medication reminders can help patients stick to their regimens, especially more complex ones.
- Document all symptoms and address them with a medical professional. Assume that any new changes are a medication side effect until proven otherwise.
- Ask physicians and pharmacists about medication management therapy programs. Seniors who are in Medicare Prescription Drug (Part D) Plans are often eligible for free reviews of their medications and personalized action plans to optimize their regimens.
Patients and caregivers are the first-line defense in preventing and addressing medication-related problems. Responsibly managing medications is a huge step in addressing rising health care costs, helping seniors remain healthier and more independent, and minimizing the burden placed on family caregivers.