Safety with Medications for Your Aging Parents
Are you aware of the medications your aging parents (or clients) are taking?
Are your parents (or clients) experiencing unnecessary side effects or contraindications from the medications they are taking?
Are the medications your parents (or clients) taking out of date?
The questions posed above are just a few of the more relevant issues to delve into when reviewing medications for your aging parents or elderly clients. Poly-pharmacy is a growing problem for the elderly population. The majority of elders over the age of 65 are taking over five medications a day. In my practice as a home health nurse I have had patients who were prescribed more than 20 medications.
First: Make a list of all prescribed medications, over-the-counter medications, and supplements being consumed by your parents or clients. Make sure each parent has a copy of the list in their wallet or purse, post a copy on the refrigerator or cork board, keep a copy for yourself, and make sure that the list is reviewed at every doctor appointment for accuracy of the medications, the dosage, the instructions, and that it coordinates with the medical provider’s records.
In the event of a hospital admission, or Emergency Room visit, be sure a copy of the list is added to the chart.
If a new medication is prescribed ask the dispensing pharmacist to review the list of medications to be sure that there are no possible adverse effects from adding the new medication. The pharmacist may find some areas of concern and will work with the medical professional to decrease any possible risks. If at all possible use the same pharmacy consistently to fill medications because this makes the review process easier and you, your parents, or your client will have a better chance of building a solid relationship with the pharmacist and pharmacy staff.
As mentioned above, I have had patients who have been prescribed over 20 medications. One profoundly rewarding experience was to assist a 92 year-old gentleman in decreasing that number from twenty-three medications down to eight. When we got him down to those eight medications he started sleeping longer, awoke refreshed, was no longer craving sweets, was steadier on his feet, and regained some of his former sharp wit and dry sense of humor. His dry mouth disappeared and his bowel elimination became more regular. Not all reduction in the number of medications will have such profound results, but it is worth attempting under the watchful eye of a collaborative pharmacist and a willing medical provider.
Here is a link to a medication journal for use in keeping track of medications:
Second: If your parents or clients appear to be experiencing unwanted side-effects or contraindications speak immediately with the doctor and be able to describe in full detail what is occurring. Do not stop medications without discussion with the professionals beforehand. Some medications can cause severe problems if stopped “cold-turkey” rather than tapering the dosages down.
If you do not live close to your parents and are unable to assess their response to medications then you will need to have collaborative and trusting discussions with them about their medication regimen and how it makes them feel. Trust and understanding are the most valuable tools you have in these discussions. If your parents or clients trust you they are more likely to share adverse events or reactions with you.
Please emphasize with your parents and clients that it is in their best interest to be honest with their medical providers and pharmacists about any previous adverse reactions, allergies, the amount of alcohol they consume, any illicit drugs they use, and to divulge completely all medications, over-the-counter aids, and supplements they consume. Some people are reluctant to talk about the supplements or OTC items they take, but if the doctor and pharmacist are not aware there can be unwanted events that could have been avoided.
There is a tool called the “Beers Criteria” used to rank a number of drugs for use by seniors and apply them to categories of safety vs. risk. Ask the medical provider if he/she is aware of this tool and if they use it when prescribing medications to elderly adults. If you are afraid to ask the medical provider then ask the pharmacist to do it and to collaborate with the medical provider if the medication is shown to be high risk for the elderly population.
Just because a drug shows up as being high risk on the “Beers Criteria” doesn’t mean that the medical provider will always avoid using it in the elderly population. The risks and benefits need to be weighed before such a decision can be made. This is where the trust and collaboration between the patient, the medical provider, and the pharmacist plays an essential role in the proper treatment of illness and diseases found in the elderly population.
Third: When in your parent’s (or client’s) home sit with them and go through the pillboxes, pill bottles, medicine chests, and anywhere else they keep their medications. Evaluate expiration dates and discuss with them their process for getting refills of medications. If you find outdated medications, OTC bottles, or supplements put them to the side. These medications need to be discarded in the safest manner possible.
The old way of discarding out-dated medications was to flush them down the toilet. This has been modified over the years as many municipal water districts have found traces of medications in their water. Each state has different protocols for discarding outdated medications. Call your local pharmacy and ask them how they would have you handle it. If they cannot provide an answer then call the state Board of Pharmacy. The number should be listed in the phone book under the State Government section. If they cannot provide an answer then call a local hospital, home health agency or durable medical equipment company and ask them if they will allow you to discard the outdated medications in their hazardous waste.
When discarding outdated medications it is best to crush them with a rolling pin or mortar and pestle so they cannot be identified. Be sure to peel all labels from the bottles that would identify names, addresses, and the medication. This is an effort to prevent theft of sought-after pain medications used by individuals to get an illicit high. Dispose of the bottles separately from the labels. Better yet, burn or shred the labels.
In the event there is no way for you to dispose of the outdated medications through a hospital or other agency you can use the following method as a last resort. Mix the crushed medications in with coffee grounds or dirt. Put the mixture in a sturdy plastic container such as an empty bleach bottle. Label the bottle with a red marker indicating that it contains hazardous waste. Tape it securely shut with duct tape and put in the regular trash can.
Some communities have certain days where outdated medications can be turned in at the courthouse or local police station. You may contact your community, or county, social service director to see if such a thing is available in the area where your parents or clients live. You could also be a catalyst for change and set up such a program as a volunteer effort and provide education to the community at large.
In our next post we’ll continue this discussion around medication safety focusing on liquid and injectable medications as well as some other relevant topics.
Do you have a story or question you’d like to share? Please feel free to comment below.