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Too Many Pills for Elders?

As a geriatric care manager, I often find clients who are on the right medications, but they are overwhelmed by the numbers and schedules of their meds.  Older adults consume an average of four or five prescription medications a day along with two more over the counter (OTC) drugs. 

While adults over the age of 65 represent only about 13% of the U.S. population, they consume about 30% of the prescriptions written in America today.  I wrote about this last November, and talked about the potential for drug-drug interactions and the unique challenges to the health of an older person’s slower metabolism and lower hydration.  I also discussed how one of the important tasks for a caregiver is to ask for a pharmacist or geriatric care manager to do a “medication audit” to be assured that the older patient is not at risk for adverse drug events or interactions.

What I did not devote much space to in that earlier blog is how multiple medications very simply present a real challenge to an older patient to keep all those prescription dosing regimens straight.  This often results in noncompliance – or failure to take prescribed medicines – of one sort or another.  Health professionals tell me that the reasons for noncompliance usually come down to:

  • Forgetting – Elderly patients can lose track of all their prescriptions and schedules; it may be cognitive dysfunction or just being overwhelmed.
  • Labeling – Labels may be clear to doctors, but older patients on numerous meds may not track dosing times a day or with or without food and more.
  • Cost – Rather than admit that they choose between food and medications, some older patients may consciously avoid some doses or split pills.

For patients who forget doses, there are pill organizers that can be set up for a week – or even a month – at a time.  The caregiver can step in to organize the medications along with clear instructions on when they are to be taken.  There is a whole host of pill organizers, some with alarms.  Google “pill organizer” and see.

There is a lot of variance in labeling of pills.  In a recent survey of 464 adults aged 55 to 74 years old published in the Archives of Internal Medicine, the patients averaged dosing six times a day for the average of 7 drugs they were taking.  While most drugs could be dosed four times a day at most, patients did not understand their labels sufficiently to consolidate their doses.  There is regulatory movement on rules to standardize and simply prescriptions with universal medication schedules.  You can help an elder by organizing their meds; the fewer times a patient takes medicine (not necessarily the fewer pills), the better their compliance.  

Cost is an issue many elders may not bring up out of embarrassment.  Caregivers, however, can work on behalf of their elder to ask for generic equivalents to branded medications.  Where only branded medications are indicated, question the physicians’ office about manufacturers’ patient assistance programs, especially for patients without prescription drug coverage.  Check the manufacturer’s web site for programs to help defray the full retail cost.  You may also find much better prices on-line or through mail order houses when the prescription is filled for 90-day doses instead of 30 days.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

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