How to Prevent Medication-Related Problems


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

Other medications

  • Can improve or worsen absorption of other medications
  • Can improve or worsen elimination of other medications

General health

  • 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.

Lynn Harrelson is a pharmacist who specializes in medication and prescription management for seniors. She provides health care services and information that help individuals remain independent in their homes, retirement and assisted living facilities.

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Gee, you don't say the kinds of things that can happen with OTC and prescribed meds. Drugs meant to stop delusions...can make them worse, for instance. Then the caregiver stands there looking at the bottle wondering if MORE is better to stop the extreme behavior.

Sleepiness...those younger can recognize when a bout of sleepiness is caused by a drug, but the senior might just look dull, depressed, mentally incapable...with dementia. What is the person's true state? and what is dementia? What is "call hospice" decline?

Another thing to watch for is change in taste, from direct contact with toxic tasting powders to pills that actually change sensation of taste. Meds are refused...meals are refused cause you try to hide meds in applesauce. And you think what? They are refusing sustenance, being combative. Nothing is good enough. Who knows where this leads? And refusing food is often thought to be sign to have hospice assessment.

I found that meds can be formulated in oral liquid in special tastes that counteract that med's specific awful taste. A spray, Yo Gabba Gabba, can coat the mouth and tongue to allow meds to slip by unnoticed. A slick spray can be applied to pills for ease of swallowing. There are so many things to consider...and just following the instructions on the Rx bottle is just the start.

It takes a lot of work to keep a senior out of trouble from those very chemicals meant to help them.
When I was a live in supervisor (for the caregiver crew. Elder as 2 person assist)for a 89 year old lady that took several medications, the first thing I did was look on the Internet for exactly what the meds were for, side effects to look for, if they should be taken with food, etc., and how other meds may interact with them. Dr.s make mistakes sometimes, or do not give you enough information, nor the pharmacist. One of the drugs were not working right, and even the nurses could not figure it out. As it turned out, the vitamins she was taking interfered with the medication. I rescheduled the time she took her vitamins, and the med worked fine. Her doctor also prescribed another medication after awhile, and guess she did not check her chart, as this med would interact with another med, and could possibly kill her if she took this new med. I highly encourage everyone to read all about meds their seniors are taking and why. This really helps.
This is a great article. If you do not have knowledge with medications. The best thing to do is have an RN or LVN manage your loved one medications. I am currently going through this with my mother and fighting with my siblings on this subject . I do not have the knowledge base in pharmacology. There are so many variables when taking medication that we dont realize. Remeber knowledge is caring . Bless you all for taking care of your loved ones.