10 Tips for Elderly Medication Management: A Guide for Caregivers

“To us, medication management is part of our early warning system,” says Hashmi.

Each year, about 350,000 people are hospitalized after visits to the emergency room because of adverse drug events, according to the Centers for Disease Control and Prevention. Older adults often take multiple medications, vitamins, and supplements to treat different symptoms and health conditions, and this can increase their risk of medication mix-ups. In some cases, these simple mix-ups can become dangerous and even fatal. The regular use of five or more medications is referred to as polypharmacy.

Other factors that increase the risk of health problems related to medication mismanagement in older adults include:

• Drug interactions. Certain medications cannot be taken together or with specific foods or drinks. For example, alcoholic drinks and citrus fruits alter the effects of some medications. In some cases, taking multiple medications can raise the risk of falling and fall-related injuries — such as hip fractures.
• Multiple health conditions and multiple doctors. Seniors who have more than one health condition or who see multiple doctors may be prescribed more medications than they need if their care isn’t carefully monitored and coordinated. Mental illness or memory problems can also lead seniors to take more medicine than they need.” If someone is struggling with their medication, such as forgetting to take it or taking the same medication twice, then that to us is a sign that something more may be happening with their cognition, and we need to evaluate that,” Hashmi says.
• Discontinuation of treatment. Older adults may unintentionally forget to follow their doctor’s directions. Others who take several medications may deliberately choose to skip doses, not fill prescriptions, or discontinue treatment for financial reasons.

While polypharmacy is a growing problem as the U.S. population ages, there are steps you can take to help your loved one get organized and practice better medication management.

Let our care assessment guide you

Patients taking several medications for diverse medical conditions may hoard them. And, cost concerns a leading reason — seniors don’t want to “waste” their unused pills, so they hold on to them in case they “need them again.” But this is a very dangerous game to play. The dangers of hoarding, sharing, borrowing, or misusing prescription medications are serious, and the following may occur:

• Allergic reactions
• Dangerous interactions with another medication
• Drug addiction
• Overdose
• Causing new health problems
• Worsening existing health problems
• Masking true symptoms that need to be treated

If a senior in your life is receiving similar prescriptions from different physicians, hoarding prescriptions, self-medicating, or misusing opioids and other types of medications, then you may need to step in, but do so cautiously. Many seniors think that hoarding, sharing or borrowing medications is acceptable behavior. Rather than lecturing them, or forcing them to involuntarily hand over their store of pills, work on educating them about the dangers associated with PMHBS. Also, ensure their doctor or pharmacist is aware of what’s going on.

Follow Hashmi’s tips to help your aging loved one prevent medication-related health hazards:

1. Review your aging loved one’s medications with their doctor. Write down or get a printout from the clinician team of the names and dosages of all medications your loved one takes and how frequently they should take them. Include over-the-counter drugs, vitamins, and herbal supplements, too. If your loved one sees multiple doctors, it may be helpful to write down who prescribed each medication and what it treats. “One of the things I think is often neglected in conversations that caregivers can help with is highlighting all of the over-the-counter products that their loved one is taking,” says Hashmi. “The conversation then offers a little bit of guidance on specifically which over-the-counter medications to avoid.”
2. Ask questions and read medication labels. If your parent is starting a new drug, ask the doctor questions, such as how and when to take it and if it should be taken with or without food. Read the medication label thoroughly to understand dosages, and learn about important interactions and side effects. Learning how to read medication labels is important for both prescription drugs and over-the-counter medications.With such small text on labels and packaging, Hashmi recommends keeping a magnifying glass on hand to read the fine print and requesting that the pharmacy increase the font size of any printed materials. These simple accommodations can help reduce the risk of medication misuse.If you have any questions, call your loved one’s doctor or pharmacist.
3. Learn about possible drug interactions. In addition to reading medication labels, ask your loved one’s doctor if certain drugs and supplements on their list shouldn’t be taken together. The more information the doctor has, the more accurately they can pinpoint any potential adverse effects or drug interactions. “Certain medications can be as much part of the problem as they are the solution,” says Hashmi. The answer is to try and take away medications that run the risk of negative drug interactions and to simplify the regimen as much as possible.
4. Understand potential side effects. Ask the doctor about possible side effects before your parent starts taking a new drug. Check in with your loved one, and ask if they’ve noticed any differences in how they’re feeling since starting the new medication. Certain drugs may affect seniors in different ways, including changes in weight, sleep patterns, hunger, or balance. Tell the doctor if your loved one is experiencing any side effects.
5. Ask if the dosage is age appropriate. The way the body processes various drugs changes with age, and seniors can be more or less sensitive to certain medications. This is largely due to decreased function of the liver and kidneys, according to Hashmi. When medications are not adjusted accordingly, continued usage has the potential to lead to a harmful buildup of medication in the system.Seniors may also experience adverse effects or develop new, negative symptoms, such as impaired memory or balance. Double check with your loved one’s doctor or pharmacist to ensure the dosage on the prescription is appropriate for their age. Also, ask if they recommend starting with a lower dose.
6. Be aware of medications deemed unsafe for seniors. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults — put together by the American Geriatric Society — is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective. For instance, older adults may need to avoid commonly prescribed sedatives like diazepam (Valium). When picking up over-the-counter medications, there are several types that Hashmi warns against using without consulting the prescribing physician first: Decongestant medications; cold and allergy medications; any medications with a PM or DM in the name; and sleep-inducing medications. Ask your loved one’s doctor or pharmacist if any of their medications are on the list of medications that older adults should avoid or use with caution.
7. Make your loved one aware of the dangers of self-prescribing. Your aging loved one may be tempted to increase the dose of a certain medication, or they may decide to take their medication more frequently to treat a symptom faster. They may also add an over-the-counter drug to their list of medications to get quicker relief. Self-medicating increases your loved one’s risk of overmedication and drug interactions that can cause serious harm. Hashmi notes that the culture around taking multiple medications is changing and that communication between caregivers and the entire care team is vital in carrying out an effective care plan while advocating for loved ones. It’s essential for caregivers to stress the importance of taking medication as prescribed, but if a medication isn’t providing the expected relief, it’s always safer to call the doctor and ask for advice.
8. Monitor for medication compliance. Medications only work if taken consistently and as directed by the doctor. If your aging loved one is simply forgetful or is having trouble tracking their medications, Hashmi recommends implementing a reminder system. Caregivers will find there are many helpful apps that allow them to create and monitor medication reminders. You can install apps for medication management on senior-friendly smart watches, and these can be helpful for seniors who may not keep their phone on them at all times. Seniors with a cognitive impairment, such as dementia or Alzheimer’s disease, need to have their medications carefully managed and monitored. When taken incorrectly, medications can be harmful or even fatal.
9. Minimize the number of doctors and pharmacists you use. Having a primary care provider — such as a family physician or geriatrician — can help make care coordination easier as they can help facilitate good communication with and among other specialists. If you or your loved one finds that the transitional period from hospital to home may have created some confusion around old and new medications, Hashmi encourages caregivers to communicate with their loved one’s primary care physician and the hospital discharge team as soon as possible. Transitional home care may also be helpful during this time. It’s also best to use one pharmacy for all your parent’s medications. Doing so adds another level of review, helps ensure appropriate dosage, and reduces the risk of adverse drugs effects and interactions.
10. Help your loved one organize their medications. “The role of the caregiver here is to work with us to try and simplify that regimen as much as possible and to try and aid with things in the home that might help with medication management,” says Hashmi. “It could be as simple as a medication organizer or pill box. It could also be something very sophisticated, like a medication dispenser. “Hashmi also stresses the importance of storing high-risk medications in an area that isn’t easily accessible, along with decluttering often. By routinely throwing away expired and old pill bottles, you can eliminate potential confusion and help improve medication safety at home for elderly loved ones.

If you and your loved one need extra help staying organized, there are plenty of tools and devices to keep you on track. Shop around for options to help your loved one stay safe when managing their medications.

A Place for Mom and Cleveland Clinic: Supporting seniors and their families

This article was developed in conversation with Ardeshir Hashmi, MD, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.

References

Interview conducted with Hashmi, A. Cleveland Clinic. August 30, 2021.

Expert opinion on drug safety. “Clinical consequences of polypharmacy in elderly.”

Talk with a Senior Living Advisor

Clinical Epidemiology. “Polypharmacy and injurious falls in older adults: a nationwide nested case-control study.”

BMC Public Health. “Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing.”

Medicine. “Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study.”

Centers for Disease Control and Prevention. “Adverse Drug Events in Adults.”

UptoDate. “Drug prescribing for older adults.”

Agency for Healthcare Research and Quality. “Medication Management Strategy: Intervention.”

National Institute on Aging. “Safe Use of Medicines for Older Adults.”