In a previous blog, I discussed the dangers of medications and falling
. Equally hazardous to one’s safety is medication non-adherence, which is a fancy term for not taking medications as prescribed by a doctor. A recent report indicated that elders who sometimes neglect to take their medications experience a 50% greater risk of falling compared with those persons who take medications as directed.
The outcome for elders who do not follow their doctor’s orders for medications is generally not good. In some cases a disease continues to progress and becomes worse. In other situations, the ability to function normally or maintain balance is impaired. In both instances, medication non-adherence can lead to a fall (remember that falls are often the first sign of an underlying health problem).
Up to 90% of all elders on Medicare take prescription medications, and at least 50% of those take 5 or more drugs daily. The problem is that up to 60% of these Medicare participants don't take the medication according to the doctor's orders. When doses are skipped, or too much medication is taken, the results can be fatal. Because medication non-adherence is common and preventable, elders and their caregivers need to be aware of common factors causing non-adherence and how to remedy the situation.
What is Medication Non-Adherence?
Non-adherence happens every day and includes behaviors such as:
• Skipping a daily dose of a prescribed drug.
• Failing to pick up a refill of an existing medicine or a new prescription at the pharmacy.
• Deciding for whatever reason to stop taking a drug or taking more medication then directed.
Here’s a short quiz to check yourself or a loved one for medication non-adherence. A person has low medication adherence if he or she answers yes (*) to any of the following questions:
• Do you ever forget to take your medications?
• Are you careless at times about taking your medications?
• When you feel better do you sometimes stop taking your medications?
• Sometimes if you feel worse when taking your medication, do you stop taking it?
(*) A “no’ answer to each question signifies good adherence.
Reasons for Non-adherence
There are many reasons why elders fail to take their medication as prescribed:
• Lack of understanding of medications and their health benefits.
• Cost of medications and financial challenges of paying for them.
• Health problem doesn’t get better with the prescribed medication.
• The cure is worse than the problem; if a medicine creates ill effects, many people stop taking the drug.
• A lack of symptoms that cause the elder to think that they’re okay and no longer need to take the medication.
• For elders who have vision problems, not being able to read small print on labels or distinguish between pills can lead to potentially dangerous misuse.
• Elders who suffer from dementia or Alzheimer's disease may forget to take their medications, causing them to skip doses. The reverse is also true: if they can't remember whether they took their medication, they might take it again, causing overdose.
• Hearing problems can hinder an elderly person's ability to hear medication instructions that the doctor or pharmacist is saying.
Preventing Medication Non-Adherence
Strategies aimed at helping elders take their medications as prescribed include:
Develop a Routine
Take medicines at the same time(s) each day. It will help to link taking medications with something else one does around the same time(s) each day, such as brushing their teeth.
Help the Medicine Go Down
If a person has problems swallowing pills, ask the doctor if the medication is available in some other form, such as a liquid. Some medications can be crushed and mixed with food. However, no pill or tablet should be crushed without first consulting a doctor or pharmacist. Crushing some medications may cause them to be ineffective or unsafe.
Following the directions of the medication is important to ensure safety. Take only the recommended dosage at one time and finish the entire prescription if instructed. Ask the doctor or pharmacist whether certain foods or drinks should be avoided while taking the medicine.
Medicines affect people differently. Let the doctor know if the medicine doesn't seem to be working or if it is causing problems. Don’t stop taking the medicine on your own. Under no circumstances should one change dosages or stop taking a medication without first consulting the doctor. .
Keep Drugs Separate
Keep medications in their original containers. Do not mix different medications together in one container. This will avoid mix-ups.
Watch Expiration Dates
When a medication reaches its expiration date, discard whatever is left in the bottle. Contact the doctor for a refill if necessary
Rely on Helpers
• Ask for large print. If an elder has vision problems, ask the pharmacist for medications labels in a larger print size.
• Use a pill organizer. There are many types of products available: computerized pill box dispensers that ring a designated number if the pills have not been taken, watch alarms and necklaces that chime a reminder.
• Get instructions in writing. If an elder has trouble hearing, it’s wise to get written instructions (in large size font) about how to take the medication. Also, if a person doesn’t understand or hear what the doctor or pharmacist is saying, don’t be embarrassed to ask them to repeat it.
Key steps to ensuring successful medication adherence include:
• Use only one pharmacy so that the pharmacists can be more familiar with all the individuals’ medications.
• At least twice a year, ask the doctor to review all medications and check the appropriate dosage of each medication, and discontinue any unnecessary ones.
• Let the doctor know if the medicine doesn't seem to be working or if it is causing problems. Remember to check with the doctor first before stopping any prescribed medication.
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org
Click here to read Dr. Rein's article, "Medications & Disorders that Increase the Risk of Falling."
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