by Lisa M. Davila, B.S.N., M.S. ~
According to a 2017 report from the Henry J. Kaiser Family Foundation, one in three Medicare beneficiaries has five or more chronic conditions. So it’s no surprise that 40% of adults over age 65 take five or more medications, according to a study published in the Journal of the American Medical Association.
That number only accounts for maintenance medications (drugs taken regularly for a chronic condition). It does not account for other medications taken throughout the year for other reasons, which brings the yearly average to about 15 to 20 prescriptions every year.
What can go wrong
Taking multiple meds each day is called polypharmacy, and it puts seniors at a very high risk of adverse drug events (ADEs). Making matters worse, some people see several doctors or use more than one pharmacy, which can mean interactions may not be detected.
With technological advances such as electronic medical records, electronic prescribing, and printed (not handwritten) patient instructions, you’d think errors would be greatly reduced, but that’s not necessarily the case. “Technology doesn’t remove the human factor,” says Teri Dreher, R.N., B.C.P.A. (board-certified patient advocate), CEO of NShore Patient Advocates in Chicago, Ill., and author of Patient Advocacy Matters: The Ultimate How-To Guide to Protect Your Health, Your Rights, Your Life and Your Loved Ones in Today’s Era of Modern Healthcare (2016, NShore Publishing). “There are individual situations that apply to different patients that may not be accounted for in an automated system.”
This potential for error becomes obvious when you look at the statistics. “The number one reason seniors are readmitted to the hospital within 30 days of discharge is because of medication issues,” Dreher says.
“There’s so much to keep track of after being in the hospital,” Dreher explains. “Studies show that 75% of people do not read their printed discharge instructions. These documents can contain crucial information for safety and aftercare, such as food and drug interactions, and the effect of over-the-counter drugs on prescription medication.”
“Taking a pain reliever such as aspirin or ibuprofen—even if you aren’t already on blood thinners—can cause internal bleeding, and a common antihistamine called diphenhydramine (Benadryl) has been shown to be particularly dangerous for seniors,” explains Matt Narrett, M.D., chief medical officer for Erickson Living.
Not enough time
A hospital staff person may have a limited amount of time to review discharge instructions with a patient. “This lack of time to teach people doesn’t allow for a lack of comprehension or memory deficits that might be under the surface,” Dreher explains.
In addition, people have much shorter stays in the hospital than before. “Years ago, some patients might have been able to remain in the hospital while a new medication such as coumadin was being adjusted,” Dreher says. “Now, however, people are sent right home after being newly prescribed this potentially dangerous blood thinner.”
Or in another scenario, someone who has been taking coumadin for a long time might be hospitalized for pneumonia and go home on antibiotics. “They might not be aware that certain antibiotics can interact with coumadin and augment its blood-thinning action,” Dreher says.
Protect yourself from polypharmacy
You may not have much control over the medications necessary to manage your chronic conditions, or how your body processes them, but you do have some control over the likelihood of ADEs.
“Tell all your doctors and specialists about all medications you take,” Dreher says. “If you are admitted to the hospital, inform the hospital providers too. Include dietary supplements such as multivitamins and herbal preparations.”
Don’t rely on your memory. Keep a list, update it, and always have it with you. “Bring your list to every health care appointment so that different specialists won’t inadvertently prescribe a medication or treatment that may cause a reaction,” Narrett says.
If you are prescribed something new, ask a lot of questions (see below). Read all prescription labels and inspect the medicine to be sure it appears as described on the medication information pamphlet.
Certain people may need further instruction at home until they adjust to a new medication. Have follow-up care in place before you leave. Discharge planners, home health professionals, and R.N. patient advocates can help you set up a medication system at home. “It could be something as simple as a pill box, or we can set up a reminder system for you,” Dreher says.
“Please remember that medication can improve the quality of your health and well-being,” Narrett says, “but you need to take an active role in managing your regimen to maximize the benefit and limit the risk.”
New prescription? Ask these questions
When you pick up a prescription, ask your pharmacist:
• What is the best time of day to take this medicine?
• Does it work best when taken with food or on an empty stomach?
• Does once a day always mean in the morning?
• Does three times a day mean every eight hours around the clock or only while I’m awake?
• Are there any interactions or side effects that I should know about?
Reprinted with permission from the Tribune (ericksontribune.com). If you would like information about Windsor Run, the Erickson Living community in Matthews, NC, please contact a representative at 1-800-357-4492.