If the healthcare industry tracked the costs of addressing medication related problems (MRPs) it would be the fourth most costly "disease" after cancer, Alzheimer's and cardiovascular disease. This cost reflects only the direct healthcare costs, those costs paid directly to prescribers, hospitals, rehab/emergency care/ long-term care services and for medications, anything billed or paid for by the healthcare system and consumer.
Another huge cost that remains underappreciated is that of caregiver burden. Caregiver burden is the impact on caregivers, families and loved ones as they support an individual in their move through a series of events that requires more and more time, for example: supervision, complex healthcare decisions, possible moves to the hospital or senior housing and more frequent healthcare services.
So why don't the individuals using medications or their caregivers realize the problems of medication use? The answer is not simple. There are many reasons. Our nation is only now "growing older" and it is the ever-increasing numbers of seniors or others taking multiple medications who most often experience MRPs.
In previous decades the great majority of individuals did not age past their 60 or 70's. When they did, many times they were cared for in facilities where staff and consultants focused on the "older patients." Today, there are many older citizens striving to maintain independence in their home for a longer period. Many providers throughout the healthcare system currently do not have an extensive track record of caring for large numbers of seniors and, in particular, the "independent seniors." Healthcare providers are, however, now beginning to connect the experience learned in the concentrated care of the senior in the past years to today's seniors.
The general population or the consumer public, on the other hand, is lagging in their understanding and appreciation of MRP's. It has been my experience that families who have cared for their loved ones over time understand the challenges of medication use, have seen the problems that sometimes occur and either dealt with them or realized that something needed to be done. One daughter of a patient recently commented, "I never really fully understood what you did and would have never really appreciated the great benefit of the services you provide until I had to deal with my mom and her medications and how she responded to them". Nothing teaches like experience.
So, why are medications such a problem? Today's medications are not the simple medications of past generations. Earlier medications were based on active ingredients from plants and the various systems in the body handled these plant based products a little better. The total result of all the medications used gets more complicated the greater number of medications used and how they are used. And remember, in discussing medications, we must always consider all medications used…. prescription, non-prescription, over the counter medications, supplements, vitamins, minerals, "natural products." If a simple food can complicate how we respond to medications, we can expect anything else that we consume to affect medications. The use of medication becomes more and more complicated with each medication added and how each is used.
What causes medication-related problems?
The effectiveness of each medication can be altered by any and/or all of the following:
- How the medication is taken
- Some foods or liquids can improve or worsen absorption
- Some foods or liquids can improve or worsen side effects
When it is taken
- Foods or liquids can improve or worsen absorption
- Foods or liquids can improve or worsen side effects
- When the medication is taken can improve or worsen response to that medication or to other medications
- Can improve or worsen absorption of other medications
- Can improve or worsen elimination of other medications
- Weight and muscle: Fat balance can alter the effectiveness of some medications
- Hydration may affect absorption in the stomach and can change blood levels
- How fast each medication moves through the stomach and intestine can affect blood levelsKidney function affects the general elimination of each medication and can change blood levels
- Liver function affects the general elimination of each medication and can change blood levels
- Genetic makeup may cause individuals to respond to treatments differently
Always read the material (your consumer advisory sheet) provided with each prescription. Check the prescription labels for special priority concerns or advice. Carefully read any information provided with other items consumed for health (non-prescription, vitamins, supplements, etc.).
How to prevent medication-related problems
- Ask questions about using your medications. Be sure that the information provided to you is from a trusted source.
- Be sure that all healthcare providers are aware of any and all products that are being used and not just the prescription or over-the-counter medications.
- Try to use your medications in the best possible way, consistently, over time. If there is a change in the way you feel, assume that the change is a medication side effect until proven otherwise.
Patients and caregivers are the first-line defense in preventing and/or addressing medication related problems, our nation's fourth most costly disease. If we can address/prevent MRP's, we would be taking a huge step in addressing the nation's spiraling healthcare costs, assuring our seniors stay healthier and more independent for a longer period.