Saturday, April 22, 2017
Do you take your medications as required?
One of the workshops I deliver is about the misuse of medications by Seniors. It is a major problem, not just for seniors but for all ages, yet this is a problem identified as Seniors do not take their prescribed medications as they should. This is identified by the medical profession as no adherence. Adherence can be defined as the extent to which medication administration coincides with medical advice and instructions.
The following is taken from an article from NICE. NICE is an international network of researchers, practitioners, and students dedicated to improving the care of older adults, both in Canada and abroad. Their members represent a broad spectrum of disciplines and professions, including geriatric medicine, gerontological nursing, gerontological social work, gerontology, rehabilitation science, sociology, psychology, policy, law and older adults themselves and their caregivers.
30 to 50 % of the ambulatory population does not adhere with their medication directives and non-adherence can be as high as 60% in the elderly.
Adherence varies with the disease state; number and type of medications taken; characteristics of the patient; the nature of communication between practitioner and patient; and economic factors.
Elderly patients not adhering with medications results in 10% of hospital admissions and 23% of nursing home admissions
Adherence in Seniors may be a result of:
• Not filling the prescription
• Not refilling the prescription
• Prematurely quitting the medication
• Taking more or less of the medication prescribed
• Not taking the medication according to the dosing schedule
• Not taking the medication according to special instructions such as taking on an empty or full stomach (can affect absorption or cause stomach problems)
• Taking medication not prescribed (sharing medication) that do not have symptoms in the early stages of their natural history have high rates of non-adherence because patients assume if they do not have pain or other symptoms they must not be ill
Patient education is critical, explaining in lay language the consequences if the disease is not treated in the early stages. Example: stroke and heart attack for uncontrolled hypertension.
Explaining the pathophysiological change in the body when medication is not taken helps the patient understand the role medication plays in prevention.
Multiple medications with complex dosing or administration schedules can be problematic because the elderly may have memory problems, diminished eyesight, hearing, arthritic hands that make opening bottles or administering medications difficult. Some ways to help would be to
• Counsel family members or caregivers to monitor medication taking if possible
• Use pill organizers that can be filled weekly
• Use special bottle caps and large print
• Simplify the regimen of taking medication by eliminating duplication
• Prescribing extended release medications or medications in alternative formulations that require less frequent administration