How Medication Management Has Evolved

As seniors age, the number of medications they take regularly tends to increase. Since prescription medications can have dangerous interactions and side effects, medication management is critical at residential care facilities. New tech tools, rising prescriptions costs, and an aging society are all causing medication management to evolve.

How Many Medications Does the Average Senior Take?

As the population ages and more medications are developed, taking multiple medications – called polypharmacy – is becoming more common.

According to Merck Manual, nearly 90% of older adults take at least one prescribed medication regularly, whereas 80% take at least two and 36% take five or more. These figures do not include over-the-counter medications and dietary supplements.

Side Effects and Interactions

If you’ve ever listened to a pharmaceutical commercial or read the fine print on a prescription label, you’ve no doubt noticed a long list of possible side effects.

The FDA warns that side effects and adverse reactions can range from minor to life threatening. Side effects may occur when a patient starts taking a new drug or supplement, starts taking a higher dose of a medication, or stops taking a drug. Common side effects include an upset stomach, dry mouth, and drowsiness.

When patients take two or more prescription drugs, over-the-counter drugs, or supplements, dangerous interactions are possible. GoodRx lists several known interactions. For example, fluconazole can interact with the cholesterol medication simvastatin, increasing the likelihood of side effects. Antibiotics like Bactrim can interact with blood thinners like warfarin, increasing the risk of serious bleeding. Interactions with health conditions and even food are also possible.

Increased Fall Risks

According to the CDC, more than one in four older people experiences a fall each year and one in five of these falls causes a serious injury. Every year, more than 800,000 patients are hospitalized due to a fall injury.

According to Harvard Health Publishing, many drugs can increase the risk of falls. The more medications a person takes, the greater the risk a drug combination will contribute to a fall. Drugs that can contribute to falls include anti-anxiety medications, tricyclic antidepressants, Benadryl, prescriptions used to treat overactive bladders, sleep drugs, and narcotics.

Missed Doses, Double Doses, and Prescription Rationing

Seniors may miss a dose because they forget to take their medication. They may also skip a dose intentionally because they are struggling to afford their prescription medications – a practice known as drug rationing. In research published in the JAMA Network, 20.2% of survey respondents admitted they did not always adhere to medication instructions due to cost.

The problems caused by missing a dose depend on the medication in question and can include withdrawal symptoms. Skipped doses can also impact the condition the medication is treating, resulting in potentially dangerous outcomes.

Problems also occur when people miss a dose by accident and then double up on their medication to make up for it. According to the California State Board of Pharmacy, patients should NOT double up on their medication to make up for missing doses. In addition, people sometimes forget they already took a dose and double up by mistake.

Effective Medication Management

To avoid side effects and complications, seniors who take medications – and especially those who take multiple medications – need safe medication management. At a residential care facility, some residents may self-administer their medication, whereas others may need assistance. Make sure that whether a resident self-administers or needs assistance is noted in the resident file.

If your residents self-administer their medications, the following tips and resources can help them do so safely:

• Include over-the-counter medications and supplements in addition to prescription drugs in your medication management.
• Bring a list of all your medications with you to your doctor’s appointments. Use the Medications Worksheet from the National Institute on Aging to keep track of your medications.
• Talk to your doctor or pharmacist about possible side effects. When you start taking a new drug, ask about how it could interact with the other drugs you take. If you drink alcohol, ask about alcohol interactions, too.
• Follow the prescription instructions. Do not take more or less than prescribed. If you’re worried about the cost, ask your doctor about less expensive alternatives.
• If you miss a dose, call your pharmacist or doctor for advice. Don’t double up on medication to make up for the missed dose.
• If you take multiple medications, use a pill organizer. This can make it easier to track daily doses.
• Use technology that can help with medication management. For example, you can set an alarm to remind you when it’s time to take your medications. Automatic and smart pill dispensers are another option.

If your residents need assistance with their medications, you’ll need to manage their medications carefully to avoid mistakes.

• Keep resident files updated with medication information.
• Document everything related to medication, including prescriptions, deliveries, and administration. Audit documentation regularly to ensure no one is getting lax – for example, by forgetting to initial the administration.
• When new medication arrives, check to make sure it matches the information in the resident’s file. If there are any inconsistencies, contact the pharmacy or prescribing doctor.
• Store the medications in a locked cabinet. Audit the cabinet regularly to ensure no medication is going missing.
• Discuss any issues with the resident’s family. For example, if a resident is refusing to take a medication or complaining about the side effects, you need to notify the family.

Medication management is a crucial part of overall risk management for residential care facilities. Insurance is also critical. Tangram provides insurance for adult residential care facilities through the Personal Care & Assisted Living Insurance Center (PCALIC). Learn more.