A wide range of medical conditions are treatable with some form of medication, either over the counter or prescribed by a health care professional. While this represents opportunity for improved quality of life, there can be problems related to many medications that are either taken alone or in combination with other medications.
A typical older adult in the United States takes four to five prescription and two over-the-counter drugs at a time and fills between 12 and 17 prescriptions per year. Older adults use more medicines than any other age group, and are at increased risk of serious adverse drug events for a number of reasons. First, age-related changes in the body can affect the way drugs are metabolized and there is greater variability from one person to another as we age. Second, many older adults live with one or more chronic conditions, take multiple medicines and have more than one prescribing health care provider, which can lead to drug interactions and duplication.
An estimated 50 percent of prescriptions are not taken properly and up to 20 per cent of hospitalizations of those over 50 are due to problems with medications. More than 150 medications commonly prescribed to older adults can cause problems if taken with alcohol.
With so many potential problems relating to medication use among older adults, it is extremely important to have a system for keeping medication use safe and effective. Following are some tips for developing a system that will work for you. If you are struggling to keep medications straight, seek assistance from a health care professional.
Safe Medication 101
What is a medicine?
A medicine or drug changes how your body works, treats or prevents a disease or symptom. When used correctly, medicines can give you a better quality of life and help you live healthier and longer. There are two types of medicines:
Prescription medications are prescribed by your health care provider to treat a specific condition for which you seek help. Some prescription medications are temporary (i.e. antibiotics for an infection) and some are meant to be taken for an indefinite period of time (i.e. to treat a chronic condition like high blood pressure). Over the counter medications (OTC) or nonprescription medications can be purchased at a drug store or supermarket to treat common conditions like intestinal upset, cold or allergy symptoms and aches and pains.
While not considered medications, herbs and supplements play an important role in that they can interact with prescription or OTC medication so those should always be taken in to account. Herbal remedies and supplements are not regulated by the FDA in the same way that drugs are and may can contain unreliable amounts of ingredients.
Allergic reactions and side effects
It is important to know that ALL medicines, both prescription and OTC have risks as well as benefits. The risks increase the chances that something unwanted or unexpected can happen as a result of taking the medicine. Risks can be mild, like an upset stomach or serious like liver damage. Medicines can cause problems even when taken correctly, for instance in the case of an allergic reaction-which occurs when your bodies defense system reacts in an adverse way to a drug.
Common allergic reactions cause rash, itching and hives. More serious symptoms are closing of the throat or difficulty breathing. In addition to allergic reactions, medications have side effects-an undesired effect of a medicine. Some side effects are common and mild, like headache, upset stomach; others can be very rare, as with liver failure. Side effects can occur even when the medicine is taken properly.
Medicine use problems
Medicine use problems are any "bad" things that can happen to you as a result of taking one or more medications and can negate the desired result from the medication. Potential medicine use problems include: Over use-defined as taking more than prescribed or recommended by the healthcare provider or label or taking unnecessary medicines; Under use-defined as taking less that prescribed or recommended amounts, or missing or skipping doses; Not following instructions for use carefully and Drug interactions-which occur when a drug interacts with another drug, food, supplement or alcohol and changes the way the drug acts in the body.
Some examples of common interactions include warfarin (Coumadin) and green leafy vegetables, alcohol and pain medications, and grapefruit juice and some heart medications.
Medicine use problems can happen at any time but are more common when a new drug is added or stopped, when a dose is changed, when alcohol is consumed, or when OTC or herbal supplements are taken without the knowledge of the health care professional or pharmacist.
Avoiding medication use problems
The most important way to avoid problems is to communicate effectively. Ask questions until you are sure you understand the drug, dose, frequency, potential side effects and interactions. Always keep your own updated medication list and take it with you to every visit with a health care professional. Use only one pharmacy so the pharmacy also has an accurate record of all your prescription medicines. Have an annual medication review with your primary health care provider.
For this visit, bring all of your medicines (both prescription and OTC) as well as any and all supplements you take to the visit; review each one to be sure you still need to be taking it and that you are taking it correctly.
Use a medication organizer if you have trouble remembering to take your medications. You can use reminders in the form of written notes or alarms as well.
Know your medications
Always remember that you are an important member of your health care team. Knowledge is power, so know all you can about what you are putting in to your body. Ask the following questions whenever a medicine is prescribed for you:
• What is the medicine used for?
• Is this the best medicine for this condition?
• Is there a non-drug alternative?
• Is this a Brand or Generic medicine?
• Where should it be stored?
• How is it taken?
•What is the dose?
• What time of day is it taken?
• Is it taken with or with out food or other medications?
• What should I do if I miss a dose?
• How long do I need to take the medicine for?
• What are the expected effects and side effects?
• How do I tell if the medicine is working?
• What are the possible side effects and what should I do if I have them?
• What tests or monitoring are needed?
Your medicine list
Always keep a copy of your medication list with you. Be sure it’s current and contains the following information: Name of all medicines-prescribed and OTC (even if you only take them once in a while), any herbal supplements, vitamins and minerals; dosage, how often you take it and why you take it. Bring your medication list with you to every visit with a health care provider and pharmacy. Give copies to your health care provider and a trusted family member or loved one.
OTC medications contain a label that provides standardized information. It is important to read this label and follow all instructions exactly. The label contains the following information:
• Active Ingredient(s): Chemical compound in the medicine that works with your body to bring relief
• Uses: This section tells you the ONLY symptoms the medicine is approved to treat
• Warnings: this section tells you what to avoid and who should not use this.
• Directions: Recommended daily dosage and frequency. Follow this strictly
• Other Information: Tells you additional information such as proper storage.
• Inactive Ingredients: A chemical compound that has no effect on your body.
Prescription medications come with useful information to help you get the best results and avoid problems. Read it carefully. The information sheet tells you:
• What the medicine is used for
• How to take your medicine correctly
• What side effects to watch for and what to do if they occur
• Warnings and precautions
Remember these Three R’s for safe medication use:
Risk- all medications (prescription & nonprescription) have risks as well as benefits; and you need to weigh these risks and benefits carefully for every medicine you take.
Respect- Respect the power of your medicine and the value of medicines properly used.
Responsibility- take responsibility for learning about how to take your medicines safely
Carol Cummings, BSN, RN
Certified Wellness Coach
Brookdale Senior Living
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