People age 65 and over buy more than 25 percent
of all prescription medicines and 30 percent of all nonprescription
(over-the- Counter) medicines sold in this country. Older
people are more likely than younger people to have long-term
illnesses such as arthritis, diabetes, high blood pressure,
and heart disease that require taking medicines on a regular
basis. Because older people often have several different
health problems, it is common for them to take several different
medicines.
When compared to younger people, older individuals
tend to be more sensitive to the effects of many drugs.
For example, a drug such as Valium (diazepam) may stay in
an 80-year-old body four times as long as it does in a 40-year-old
body. The liver and the kidneys break down and remove most
drugs from the body. As people age, these organs may not
work as rapidly as they used to, and drugs may leave the
body more slowly, sometimes causing side effects. So, when
drugs are prescribed over the phone or by a physician who
does not know the older person well, ask to be sure it is
the proper dose for an older person.
The doctor and pharmacist should be informed
about all medicines that the older person is taking including
nonprescription medicines. These include
The doctor needs this information because
nonprescription medicines can interact with each other as
well as with prescribed medicines in ways that could be
harmful to the patient. They can also cause side effects
that the doctor may have to treat. It will be helpful to
the doctor, in making diagnoses, to know all the medicines
that the patient is taking.
Pharmacists are able to give you information
about side effects of medicines and even how they can interact
with each other. Ask the pharmacist for this information
and ask any other questions you have about the medicines
when you have prescriptions filled or refilled it
may prevent a serious problem.
Your goals are to:
If in addition to these symptoms, the
person begins to have difficulty breathing or if there
is swelling in the throat, take the person to an emergency
room or call 911.
When symptoms are not an emergency
but should be reported
While some side effects from medicines happen
immediately, others happen slowly over a period of days
or weeks, or even months. What may seem to be a new health
problem or a worsening of an existing condition may be a
reaction to a medicine. The following symptoms may develop
over time as result of taking certain medicines and should
be reported to the doctor:
Here is an example of what you
might say when calling
"Hello. This is Ellen Smith. My mother
is Ann Smith, a patient of Dr. Miller's. My mother has had
severe nausea for the past 12 hours. Two days ago she started
taking Indocin for her arthritis. Dr. Miller prescribed
it. Do you think it could be causing the nausea?"
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Keep a record of all medications taken.
Make a list of the all the medicines that the older person
takes. Include prescription and nonprescription medicines.
(Personal medication record books, sometimes called 'medication
passports' are available at no cost at some pharmacies)
Write the name of each medicine, the doctor who prescribed
it, what it is for, the amount taken, the possible side
effects, and the times of day it is taken. The older person
should keep a copy in the medicine cabinet and in his or
her wallet or pocketbook. You should keep a copy too. This
record should be reviewed with the doctor at every visit
and whenever a doctor prescribes a new medicine.
Ask about drug allergy bracelets and necklaces.
Drug allergy bracelets can be bought in many pharmacies.
These are small metal bracelets than can be worn over the
wrist or hung on a necklace. For example, a bracelet might
say "allergic to penicillin." Custom medical identification
bracelets or necklaces are also available, for a fee, by
mail. Some pharmacies will have the application forms. Customized
bracelets can tell medical personnel, such as ambulance
workers, about the person's medical conditions, allergies,
medicines, and special needs, such as blood type and if
the person has a living will. In some instances this information
will be provided to health care workers after they call
a telephone number imprinted on the bracelet.
Ask the doctor or the doctor's staff
to review all medicines and explain the reason for each
medicine at least once a year. As new medical problems
occur, new medicines will be prescribed. Sometimes this
is done without a complete review of medicines that have
already been prescribed. Also, new information about side
effects may become available about drugs the older person
is taking. Therefore, it is important that medicines be
reviewed regularly.
If possible, use only one pharmacy.
This way, the pharmacy will have all of your prescription
medications and drug allergy information on their computer.
This will be helpful when the pharmacist checks for drug
interactions as you get new prescriptions filled. Tell the
pharmacist the medical problems that the older person has.
Medicines taken for one problem may make another problem
worse and the pharmacist may notice this, if it has escaped
the doctor's attention.
Make sure you understand the label that the pharmacy
attaches to the medicine. Labels can be hard to read
and difficult to understand. Ask the pharmacist to explain
the information on the label including expiration date,
number of refills (if any), and directions for use. If the
information is vague, ask for an explanation. For example,
if a label says "Take 3 times a day" does that
mean every 8 hours? Does the patient need to be awakened
promptly to take the medication? Should it be taken with
meals or an hour before meals? What should you do if a dose
is skipped? Can it be taken with other medicines?
Refuse childsafe caps on bottles. Child
safety caps have helped prevent child poisonings, but they
can be difficult to open. If it is too much of a struggle,
the older person may not take the medicine. If children
live in the house or sometimes visit, keep medicines locked
up or on a shelf they cannot reach.
Store medicines in a cool, dry place. Although many
people keep their medicines in the bathroom, its high moisture
content makes it a poor place to keep them. Many tablets
and capsules lose their strength if exposed to moisture
or strong heat or light. The bedroom is usually a better
location. Store medicines in the refrigerator only if instructed
to do so by the pharmacist or if they are labeled "refrigerate."
If you do not know how to store the medicine, ask a pharmacist.
Keep medicines in their original containers.
Mixing different pills in one bottle can be confusing and
even dangerous. Since many medicines look alike, this can
confuse the patient, caregivers, or people who may be called
on to help in an emergency.
Have the older person sit up or stand when taking pills,
and use a half cup of water to wash them down. Water
will help prevent the medicine from sticking in the throat
and causing irritation. If the older person has difficulty
swallowing, ask your pharmacist if the medicine is available
in liquid form, or if it is all right to crush the tablet
and mix it with applesauce or other soft food. Some tablets
or capsules should not be crushed or chewed.
Use a pillbox. You can buy a pillbox
with many compartments at your pharmacy. Some pillboxes
have compartments for 7 consecutive days and for times of
day the medicine has to be taken: early morning, noon, evening,
and bedtime. "Mediset(tm)" is a popular brand
of this type of pillbox. There are also pillboxes with alarms
to notify you when the next dose should be taken (useful
for medicines that require precise timing, such as medicines
for Parkinson's disease). For medicines that cannot be placed
in a pill box such as liquids, cream, and patches
a reminder note placed on the refrigerator may be
helpful. Keeping medicines on the kitchen table with a note
saying when to use them may also be helpful.
Use reminders. A checklist or marking on a calendar
may be helpful to show when medicine should be taken and
when it was taken. Alarm clocks can be helpful or you personally
may have to remind the older person when to take medicines.
Ask about other ways to take medicines.
Few people, young or old, can remember to take a medicine
three or four times a day. If the person you care for has
trouble taking the prescribed medicine, or has trouble remembering
to take the medicine, tell the doctor or pharmacist. They
may know of a similar medicine that is easier to take, or
one that only needs to be taken once a day. Some medicines
are available in the form of patches that are placed on
the skin and need to be changed only every few days; however,
they are usually more expensive than the same medicine in
pill form.
Throw away old medicines. Check the expiration dates
on medicine bottles, and throw medicines away if the date
has passed. It's usually a good rule of thumb to discard
medicines after a year. It is natural to want to hold onto
unused medicines ("just in case"), but stockpiles
of medicines can be confusing and even dangerous. Some pharmacists
highlight the expiration date with a yellow marker; you
can do the same thing at home. This is especially important
for nitroglycerin tablets. Some communities have laws about
how drugs can be disposed of. For example, it is illegal
to flush medications down the toilet in some communities.
Ask your pharmacist if it is OK to flush medications down
the toilet or if you can return the expired medicines to
the pharmacy for disposal.
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Think of other obstacles
that could interfere with carrying out your plan
What additional roadblocks could get
in the way of doing the things suggested in this chapter?
For example, will the person cooperate? Will other people
help? How will you explain your needs to other people? Do
you have the time and energy to carry out the plan?
You need to develop plans for getting
around these roadblocks. Use the six problem-solving steps
in the chapter on "Using the Eldercare at Home book
to solve caregiving problems."
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Checking on results
Managing medications and making sure that they are used
safely is an important part of caregiving. If you do a good
job, you can prevent many problems. Getting the older person
on the right medication schedule can improve his or her
life dramatically. Changing or stopping medicines can sometimes
improve quality of life including becoming more active,
thinking better, and improving sexual functioning. To manage
medicines effectively, you have to be organized, persistent,
and to constantly ask questions. When you see changes in
the older person, always keep in mind that the medicines
he or she is taking may play a part.
If your plan doesn't work
Improperly managed medicines can be dangerous. If, in spite
of your best efforts to use the ideas in this chapter, medicines
are not being managed properly, you should get help. You
may need the help of a home health nurse, or to bring someone
into the home to help manage the medicines, or perhaps this
is a time to consider moving to a setting with more structure
where someone is paid to be responsible for managing medicines.
These range from assisted living settings to nursing homes
depending on the person's needs.
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