Senior Health

"Safety First" With Medications

Older adults often take a number of medications including prescription drugs, over the counter medications, vitamins, herbal supplements, personally concocted home remedies and more. Though medications often provide powerful benefits throughout the lifespan, natural age-related changes and challenges cause differences in how drugs are absorbed, metabolized and excreted. The mix of aging and medications pose increased risk for adverse drug events (ADE) including reactions, interactions, over-dose, poisoning and even death. The following facts remind us of the seriousness of safety issues posed by the older adult-aging-medication connection:

Medicines and Older Adults

50.5 million (91%) use at least one med regularly.
40% take five or more prescription drugs.
13% of the U.S. population takes 34% of all prescription meds and 30% of OTC drugs.
40% cannot read and interpret a prescription label.
67% do not understand the information provided (e.g., inserts and information sheets that accompany meds) about their prescriptions.
Nearly one half use one or more OTC med or dietary supplement.
More than half use five or more prescription, OTC med or dietary supplement.^{1, 2, 3}

The CDC considers ADEs, to be a "large public health concern".⁴ Annually, ADEs cause significant problems for older adults and many challenges to the health care system including:

177,000 older adult visits to emergency departments.
Older adults are almost seven times more often admitted to the hospital for medication problems.
$887 million for treating medication errors in Medicare enrollees.⁵

Health professionals need to be hyper-vigilant in recognizing age-related factors that contribute to the increased potential for "medication mishaps" in older adults (e.g., complicated regimes, discomfort asking questions, lack of med. knowledge, living alone, memory problems; poor vision and unsafe habits - alcohol use, sorting, taking).⁶ As a reminder, we share the following evidence-based guidelines to help enhance medication safety for older adults: ⁷

Guidelines for Professionals

Make medication safety a High Priority.
Encourage patients to take an active roll and be "partners" in their care.
Increase communication with patients and encourage patients to communicate more with care providers.
"Brown Bag" review (suggest patients bring meds in original containers) for checkups.
Educate on medications at each visit.

Specifics for Prescribers

Follow established guidelines on appropriate prescribing for older adults (Beers, Revised Beers).

Decrease polypharmacy ("Brown Bag" review helpful in clinical decision making).

Avoid prescribing medications that may adversely affect functional status and interfere with sleep/activity.

Use information technology (e-records and e-prescriptions)

Each visit with a health professional needs to include education about: the 5 Rs (right drug, right time, right place, right amount, and right route), reporting side effects immediately, and keeping an updated list of medications (e.g., wallet card).

Recommended Resource - Evelyn's Pick

Evidence based assessment tools for use in medication management with older adults. Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (See Parts I & II) - www.consultgerirn.org/topics/medication/want_to_know_more.

References

1. National Council on Patient Information and Education (NCPIE): Medication Use Safety Training for Seniors. MUST for Seniors - www.mustforseniors.org/facts.jsp
2. Qato, DM, Alexander, GC & Conti, RM, et al. (2008). Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. Journal of the American Medical Association, 300 (24): 2867-78.
3. U.S. Food and Drug Administration (FDA). Medicines and You: A Guide for Older Adults - http://www.fda.gov/Drugs/ResourcesForYou/ucm163959.htm
4. Center for Disease Control and Prevention - http://cdc.gov/ncidod/dhqp/ps_forAdults.html
5. Institute of Medicine. (2006). Preventing Medication Errors. Report Brief - www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf
6. Bergman-Evans, B. (2006). Evidence-based guideline: Improving Medication management for older adults. Journal of Gerontological Nursing, 32(40), 6-14. - www.guideline.gov/summary/summary.aspx?doc_id=6222
7. Ibid

GERO GEMS are a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues affecting health care professionals and our society as a whole.

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Last Reviewed: Jun 12, 2009

Evelyn L. Fitzwater, DSN, RN
Associate Professor Emerita
Associate Director, Center for Aging with Dignity
College of Nursing
University of Cincinnati