Medication Adherence: A Tough Pill to Swallow

KIM MOON - KimPick1 - webresKimberly Moon, PharmD
Clinical Pharmacist

Blue Cross Blue Shield of Michigan David2

David Dadiomov
Doctor of Pharmacy Candidate
University of Michigan
College of Pharmacy


The number of Americans with chronic medical conditions is increasing, which means that chronic medication use is playing a larger role in their lives. The World Health Organization estimates that 157 million Americans will require medications for at least one chronic disease, such as high blood pressure, high cholesterol, or diabetes. Luckily, treatments exist for these diseases that prolong life and improve quality of life as well. Medications can help improve medical conditions when they are taken as prescribed.

Taking medications improperly not only affects people who take these medications, but is also costly for our entire health care system. Medication non-adherence leads to 1/3rd of all medication-related hospitalizations and about $300 billion in avoidable costs. It is clear that medication non-adherence is a huge problem; several common concerns may be responsible for this issue.

“I’m worried about cost”
Cost is an important factor for those that take medications. When people first get placed on medications it is a relatively unexpected cost that they must now budget for. Luckily, many oral medications for management of blood pressure, cholesterol or diabetes are available as affordable generic medications. These medications are on the most affordable level of co-payment on most health plans, but even those without insurance may still benefit from pricing at various pharmacies that offer these medications at a low cost. For those who are prescribed expensive medications, most drug manufacturers have patient assistance programs to help with medication costs for those who qualify. Also, taking a long-term perspective is important. The daily cost of most medications is certainly less than the cost of a hospitalization due to a heart attack, stroke, or dialysis due to kidney damage.

“I’m concerned about the side effects”
No drug is without side effects. Luckily, for most people, side effects are minimal and medications are generally well tolerated. Sometimes certain side effects may prevent people from taking their medications as prescribed. Often a pharmacist’s recommendation on medication use or management of side effects can help alleviate concerns. For instance, certain medications should be taken with food, or at a certain time of day. Other medications may have side effects for the first few weeks, but then go away. It is important to ask questions when being prescribed a new medication and calling the pharmacist with questions about the medication or how to take it. Keeping a clear line of communication is important to medication adherence.

“I take too many pills”
Taking several medications is often discouraging for people, and may make it hard to remember to take them at the correct times. A pill box for each day of the week can help manage medications and at the very least, help see how many doses were missed during the week. Many medications are available in a once-daily formulation or even in a combination with another routine medication to reduce the total number of pills taken per day. Again it is important to talk with your prescribing healthcare provider and pharmacist.

“I don’t feel I need my medications”
People with conditions such as high cholesterol don’t have symptoms, so they could feel medications for this condition are not needed. It is important to remember that medications that lower cholesterol are important in reducing the 10-year-risk of developing a heart attack or stroke. People may not “feel” the medicine working, but research studies show taking medications as prescribed can help reduce risk of heart attack or stroke. Remember: Having high blood pressure or diabetes may not always make you feel like there is anything wrong with you, but these diseases can damage your kidneys and lead to kidney disease that may require dialysis.

Questions to ask the pharmacist:

  • How am I supposed to take this medication?
  • What is this medication used for?
  • How does this medication work?
  • What can I expect with this medication?
  • How will I know this medication is working?


Integrating Community Programs in Healthcare: A Personal Experience of Health Professionals Sharing a Lot More than Lunch!

Michael Malone, MD
Professor of Medicine and Section Head of Geriatrics
University of Wisconsin School of Medicine and Public Health
Medical Director

Aurora Senior Services and Aurora at Home

Two years ago, members of Milwaukee’s Aurora Health Care geriatrics program where I work began doing something different for lunch. The geriatrics fellows (who are learning to be experts at caring for older persons with multiple chronic illnesses) started to share meals once a week with the nurses, social workers, and teaching doctors who also work with the patients we serve. The fellows and faculty enjoyed helping each other overcome struggles in providing “best care” for vulnerable older individuals. Over shared meals, physicians started reaching out to social workers and others at the table to get input, feedback, and recommendations. This was particularly helpful, as many of the challenges our doctors have encountered centered on the social aspects of a patient’s needs and where and how to find appropriate support.

Creating a Network to Achieve “Best Care”
Gradually, we started to use these lunches to discuss cases more formally. We would discuss patient needs in five specific areas: 1) medical needs, 2) medications, 3) social needs , 4) psychological needs, and 5) how patients understood and perceived their own illnesses. The in-person discussions have given our physicians, nurses, and social workers a chance to develop working relationships with one another. We’ve all developed a better understanding of programs provided by the ADRC, and our patients are better served as we work together.

Importance of the Older Americans Act
As I reflect on how our clinic serves older individuals in Wisconsin, I’m struck by the importance of integrating community programs into health care. The Older Americans Act (OAA), for example, provides for caregiver support, health promotion, meals, and transportation for vulnerable elders. Our sharing and learning together during lunch has resulted in a better understanding of the whole person (physical, mental, social needs), and how that person supports and is supported by a community shaped in one way or another by initiatives like the OAA. Reauthorizing the OAA represents an important opportunity to help modernize and improve the aging services network to meet the needs of our nation’s older adults.

Among other objectives, the bill aims to address

  • Elder abuse;
  • The importance of evidence-based care;
  • The effective coordination of services at the federal, state, and local levels; and
  • Several other challenges confronting older Americans and their health providers.

These are topics I hope to discuss at lunch with colleagues for many years to come not only because they are important but also because they can be addressed—effectively, reliably, and equitably—through sustained support of the OAA. I’d encourage you to do some digging of your own regarding legislation that supports older Americans—you might be surprised at just how expansive public support for healthy aging has become, but also how vital it will be to ensure this support not only remains constant but also shifts to reflect new realities as more and more of us turn 65.

The Older Americans Act Reauthorization Act of 2015 was approved by the U.S. Senate last week and has now been sent to the House of Representatives for a final vote.  You can help support swift passage of this important legislation by writing to your Representative to encourage her to stand behind the important services that the OAA provides.  Visit the Health in Aging Advocacy Center for more details.

About the Author
Dr. Malone is the Chair of the AGS Public Policy Committee.

Get Involved: Live Happier Longer

Coleman, Jessica 4x6Jessica L. Coleman, DO
Geriatrics Fellow
Summa Health System
Akron, Ohio


We all know that volunteering for local organizations is a great use of free time. But did you also know that it can not only improve your mood, but also help prolong your life and prevent memory loss?

Volunteering has been shown to be one of the most effective ways for older adults to stay active, learn new skills, make new friends, and be healthier.

Getting involved in your community can be as easy as heading to your local library to read to children after school, volunteering at your local hospital,or joining a service league in your area to meet others who also enjoy giving back.

Consider some of the following ways to connect with and contribute to your community:

  •  Foster Grandparent Programs: Connect with local children who need the love and support of an older adult to guide or comfort them. Work with troubled teens, young mothers, or premature infants—everyone can benefit from having an involved and caring grandparent.
  • Retired and Senior Volunteer Programs: Using the skills and talents you have gained over a lifelong career, serve as a volunteer in your community rebuilding homes, tutoring, or organizing neighborhood watch programs.
  • Senior Companions: Help keep a fellow senior independent and in their own home by assisting with daily tasks such as shopping or paying bills. You can provide respite for caregivers, family members, and make valuable friendships. Continue reading

It’s Not Normal: Falls

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

It is the middle of winter here in Cleveland and we have experienced an unusual amount of snow, sleet and ice. In fact, if you live anywhere with winter, I’ll bet this weather has been challenging. One problem that we see more of in the winter is falls. I ask all of my patients if they have experienced a fall.  Can you  guess the most common answer I get? It isn’t “no”— it’s “not yet.”  Isn’t that interesting? That answer means that they expect to fall sometime. In other words, they think it’s normal. But we are here to find out otherwise!

Falls are certainly common. Most people can tell you about friends or family members who have fallen and suffered a serious injury from a fall, such as a broken hip. Most people also tell me that falling is one of the things they fear the most. The good news is that while falls are common, they are not inevitable. There are well defined risk factors that make it more likely for someone to fall.   And there are also recommendations on how to prevent falls. These recommendations will require you and your healthcare professional to work closely together.

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Caregiving for an Older Adult: Stressing and a Blessing

Clare WohlgemuthClare M. Wohlgemuth, RN, GCNS-BC
Nursing Director, Geriatric Services
Boston Medical Center
Boston, Massachusetts

 If you are helping a family member or friend over age 50 with things such as dressing, bathing, housework, or taking medicine on a regular basis, then you are a caregiver. You are not alone—there are close to 50 million Americans involved in caregiving. Caregivers spend an average of 20 hours each week caring for one (or more) older adults. About one in four of caregivers have been giving care for more than five years. About three in four caregivers work a paying job and spend up to $5000 out of pocket each year to help with caregiving costs.

Caregiving has been a part of community life for a long time. These days, the amount and types of help provided by family caregivers has increased a great deal. This has also raised the costs of caregiving—both economic and psychological. Now, loved ones often come home from the hospital earlier and with more complicated conditions. This means that caregivers often take on many roles in addition to providing companionship and emotional support. Caregivers may give medications, find and coordinate services, and perform basic nursing. They also communicate with healthcare providers, coordinate care during transitions from hospital to home, and advocate for their loved ones during visits with healthcare providers and hospital stays.

Caregivers are at higher risk for symptoms of anxiety and depression because of the burden of these many roles. Their physical health may also suffer. It is normal for caregivers to feel alone and overwhelmed. Caregivers may also feel unable to communicate well with the person receiving care and/or other family members. They also report needing information on how to keep their loved ones safe at home and to find activities to do with them. And caregivers also need resources to help them manage their own stress and make time for themselves.

In our recent study of geriatrics health providers who are also caregivers, we found all of these challenges. Even those most prepared to handle all the different caregiving tasks found it very difficult. If you are a caregiver AND a healthcare professional, you may face additional burdens—and will also benefit from support. [You can click here to read the full study.]

What You Can Do
In order to cope with the demands of caregiving, all caregivers need to get help. It is good to ask questions, and to ask for help! If you are not happy with the answers you are getting, it’s important to keep asking. Also keep looking for the information and support that you need, perhaps from other resources. There are many places you can look to for help: hospitals, your community, and online resources.

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