The Challenge of Medication Management at Home

In the August 2011 issue of Choices, we took a look at ways patients can avoid an unnecessary return trip to the hospital. Now researchers from St. Michael's Hospital, Toronto, have examined yet another problem associated with hospital discharge. In a study examining all hospitalizations in Ontario during 1997 - 2009, the researchers discovered that many patients neglect to take their usual medications during and after their hospital stay. As a result, the patients were at higher risk of complications from their ongoing health problems, which included heart disease, high blood pressure and digestive diseases.

Medication management has become increasingly important as our population ages. The Canadian Institute for Health Information recently released a study on the use of prescription drugs by older adults, which found that almost two-thirds of Canadians over age 65 take five or more medications—and by the age of 85, many are taking up to ten different drugs over the course of a year. This is because seniors are more likely to have chronic conditions that are treated by medications.

Medications can prolong and improve our lives. But they can also increase fall risk, cause depression and confusion, even result in a fatal overdose. The more medications we take, the more challenging it is to ensure all the effects are positive. According to Dr. Angela Juby of the University of Alberta, "Therapy with multiple drugs is necessary to effectively manage chronic conditions; however, it is most important to consider the potential risks, including adverse side effects and interactions between drugs or between drugs and diseases."

Geriatricians suggest that older adults take three medication safety steps:

1. Talk to their healthcare provider about the prescription and over-the-counter medications they take.
2. Take medications correctly—the correct dose, at the correct time interval.
3. Be alert for side effects, especially when starting a new medication.

However, when a senior takes multiple medications, each with its own schedule and dosage, taking them correctly can be a daunting task. Visual impairment and memory loss add to the challenge. Families want to help, but they may live at a distance, or may not be able to provide the level of supervision their loved one needs.

Home care helps seniors manage their medications

At-home senior care may be the solution to promote both safety and independence. Home care agencies know the importance of medication management. According to the Canadian Pharmacists Association, 80% of seniors receiving home care take medications. Senior home health care services can support effective medication management in four important ways:

Help senior clients fill prescriptions. Many seniors fail to fill or renew prescriptions because they can't get to the pharmacy. Neglecting to take their prescribed medications can have serious consequences. For example, studies suggest that seniors who do not take their medications are at a 50% greater risk of experiencing a fall. In-home caregivers can provide transportation to the pharmacy, or pick up prescriptions for clients. 

Remind senior clients to take medications on time, and in the correct way. At home senior care may include medication reminders; caregivers can also help the senior client use prescription memory aids, such as pill organizers, medication checklists, specially packaged doses, or medication calendars. For clients who take pain medications, the caregiver can note whether pain is adequately managed, and be alert that the client might be taking more than the recommended dosage.

Report negative drug reactions. As we grow older, our bodies process substances less efficiently, and drug side effects become more of a concern. According to the Commission for Certification in Geriatric Pharmacy, a startling 17% of hospitalizations of older patients are due to adverse reactions to medications. And sometimes the patient is the last to notice the problem! Trained in-home caregivers are alert for signs of confusion, weakness, depression, or agitation or dizziness.

Encourage senior clients to be physically active and engaged. You might not think of this as part of a safe medication strategy—but studies show that increasing activity can decrease the need for some medications, such as pain medications, antidepressants and even blood pressure medicine. (Note: never reduce or discontinue a medication without consulting your healthcare provider.)

As our senior population grows, it is no coincidence that the field of geriatric pharmacy is also growing. Managing medications helps seniors stay healthy and safe. And when seniors live at home, at home senior care provides peace of mind for senior clients and family alike.

For More Information

Public Health Canada offers an online tutorial for seniors and families, Medication Matters: How You Can Help Seniors Use Medication Safely.

For many seniors, medication is an important part of pain control. The next article, "Examining the Mysteries of Pain," looks at some of the latest findings about chronic pain.