Medication management and senior care
Medications are a critical part of maintaining a high-quality life for many seniors. Seniors may take multiple medications for their chronic (expected to last a long time) or acute (sudden onset) conditions. They may also take more than one medication for the same condition — a practice known as polypharmacy.
The more medications a senior takes, the more they are at risk for adverse drug reactions and drug interactions. These risks increase with any over-the-counter medications (OTC) or supplements that are taken.
In this guide, you will learn about the importance of proper medication management and the many resources available to assist older patients with this process.
Too often elderly individuals remain on medications for years or even decades without a physician reevaluating their prescription drug needs. As elderly patients ages, previously prescribed medications may become unnecessary or even cause adverse reactions. This could be due to an overall decline in health, the decline of a certain body system, a change in care goals, or other age-related changes.
When medication effects change
According to the U.S. Food and Drug Administration (FDA), over-the-counter medicines and prescription medicines process differently in the body as a person ages. In addition, changes to the digestive system can affect how quickly medications reach the bloodstream. Other reasons medication effects can change over time include:
- Changes in weight
- Decreases in body fluid
- Increases in fatty tissue in the body
- Changes to the circulatory system
- Slowed liver function
- Slowed kidney function
These changes may affect how long medication stays in a person’s system, how the body processes it, and what dose of medication is appropriate for the intended effect. These age-related medication effects may occur gradually. Individuals may dismiss medication-related problems caused by these changes as part of another concern or simply as a part of getting older. For example, if an individual’s medication is making them feel weak, they may assume they are feeling weaker due to aging and not mention it to their doctor.
However, patients should always report new symptoms to a doctor, whether or not they believe the cause is related to their medication regimen.
Medication management challenges
For seniors, managing medications is often an ongoing process. As an individual ages and their care needs change, their medications will likely need frequent adjustments. There are several reasons why medication management often presents challenges for seniors, including:
- Increased sensitivity to medications or increased side effects (this can lead to medication nonadherence)
- Cognition and memory issues can make it difficult to stick to the prescribed medication dosage or schedule
- Decreases in vision or hearing ability can make it difficult to understand prescription instructions or take medications safely
- Chronic conditions (such as diabetes, high blood pressure, or arthritis) may require a multi-step medication management plan
- Prescriptions from multiple doctors — Side effects, interactions, and medications that are simply not effective may not be spotted when an individual is getting their medications from multiple providers
- The high cost of medications can strain elderly individuals on a fixed income
Talking about medications with a doctor
Talking to health care providers about medications is extremely important. Asking questions, mentioning concerns, and being truthful about symptoms and side effects may all affect how health care professionals prescribe medications. Individuals and their families should be prepared when they visit doctor’s offices, clinics, pharmacies, hospitals, or other settings.
What to mention during an appointment
When talking to a doctor about an illness or injury, an individual should be as detailed as possible and tell the doctor about any conditions they have, any medications they take, and any concerns they have. Some important medication factors to mention include:
- All medications that are being taken — This includes any over-the-counter drugs, herbal medications, vitamins, supplements, eye drops, creams, and ointments in addition to prescribed medications
- A complete medical history, including any current or past conditions being treated by other professionals and any allergies the senior may have
- Eating habits, such as a diet that is very high or very low in any specific nutrients, can impact medication effects — Ask the doctor how these diets could interact with current medications
- Cigarette smoking may affect how many medications work in the body and may interact with others
- Alcohol and caffeine consumption — Both alcohol and caffeine from drinks like coffee, tea, soda, and energy drinks may affect how medications process in the body
- Any physical issues with taking medications, such as difficulty swallowing large pills
- Any memory or cognitive issues related to taking medication, like difficulty remembering to take them or problems differentiating pills
- Any other lifestyle-related medication adherence challenges
Questions to ask about new medications
Caregivers and seniors should ask questions and make sure they understand all prescription instructions. It may help to get instructions in writing and go over them more than once.
Questions to ask about new medications:
- What is the name of the medication?
- What does this medication do?
- How should the medicine be taken?
- How long will the individual be taking this prescription?
- Is there a generic or otherwise less expensive version available?
- Should the medicine be taken with food?
- Is it able to be taken with other prescription or OTC medications?
- What should be done if a person misses a dose?
- Are there any lifestyle changes that may eliminate the need for this medication?
- What is the schedule for taking the medicine?
- If the medication is “as needed” what symptoms should be present before the medication is taken?
- Should any foods, drinks, or activities be avoided while taking the medication?
- Will any tests be needed to monitor how well this medication is working?
- What are the possible side effects of this medication?
- When will this medication start working?
How pharmacists can help medication management
Pharmacists are able to provide in-depth education about medications and drug-related problems. They may be able to answer questions that an individual did not ask their doctor or clarify anything they did not understand. Some questions to ask the pharmacist when getting a new medication include:
- Is there written information available about this medication?
- Is any written information available in large print?
- Is the information available in any other languages?
- What is the most important thing to know about this medication?
- What side
- Does this prescription have any refills?
- How should this medication be stored?
- Are easy-open bottles available?
Additionally, if the pharmacy is one the senior has used before, they should check to see if the pharmacy has a list of their other medications in a database. If they do, the individual should ask about possible interactions.
Medication management in long-term care
When an elderly individual is having difficulty taking medications on time every day, they may need professional assistance. There are several options available to assist seniors with medication management, including medication reminders, pharmacy programs, and medication management done by nurses. These assistance programs may prevent harmful medication errors and reduce the risk of medication nonadherence.
At-home systems for medication management
At-home systems may make it easier for seniors to live at home or in independent living communities. Many of these tools make use of technology, such as internet connectivity, to assist in safe medication dispensing. Some of these tools may be available from a local pharmacy or in collaboration with a home care agency. Some available at-home medication management systems include:
- Smartphone apps — There are medication management applications designed for smartphones or tablets that will alert an individual when it is time to take their medications
- Timer medication caps with a digital timer that displays the last time a medication was taken, and how long remains until the next dose — They are often able to send out alert or alarm sounds as well
- Smart pill bottles that not only remind patients to take medication but are able to track and report missed or over-dosages back to caregivers or health providers
- Alarm clocks designed for the purpose of medication management offer large screens and the ability to pre-recorded messages that remind an individual of medication times and doses
- Pill packs packaged, dosed, and labeled for the individual with the medication time clearly displayed
- Pillboxes — In addition to analog features like separate a.m. and p.m. compartments, some pill boxes also have alarms or alerts to help an individual remember to take the right dose at the right time
- Internet-connected pill boxes take medication storage to a new level with features like medication tracking and caregiver alerts for incorrect dosing
- Automatic medication dispensers can be set up weeks in advance to automatically dispense both medication and dosage cups at the right time
- Fully-automated medication dispensers can dispense medications from blister packs as well as individual pills — They often come with missed-dose alerts and other features
Assisted living facilities
In an assisted living facility (ALF), medication may be managed by long-term care facility staff. Some residents will be able to administer their own medication and will keep medications in their rooms. These residents will be frequently evaluated to make sure they are still able to take their medications safely. Staff may check-in and provide medication prompts or reminders to these residents.
In general, residents who self-administer medication in long-term care facilities will need to live in their own room, or with another resident who is able to self-administer medication. Individuals who store medications in their rooms will need to comply with ALF safety rules and
For other residents, medication may be administered by staff. In ALFs, medication is often dispensed by medication aides or technicians. Medication aides are often nursing assistants or personal care assistants who have received extra training to be able to administer medications.
Different states have different laws about who is able to administer medications in ALFs and other facilities and may require different amounts of training for medication aides. A nurse may be on staff or in charge of overall care in some ALFs and may provide supervision for medication aides.
Depending on the ALF and on the specific resident, different levels of medication administration assistance may be provided. Medication may be dispensed to a resident who is then able to take the medications independently. In other cases, medications may be crushed and put into applesauce, pudding, or another food for residents who have difficulty swallowing. Some residents may need full assistance taking medication, and the ALF staff may guide the medication into their mouths or otherwise physically assist them.
ALF staff will be able to monitor the senior while they take medications and watch for any side effects. They will be able to report any difficulties back to the overseeing physician.
Home health care
When an individual is receiving home health care, medication management may be part of their course of treatment. Medication management will be done by a nurse and will vary depending on an individual’s ability level.
For example, in some cases, the home health nurse may instruct the individual on how to take their medication and prepare all their daily doses for them. In other cases, the home health nurse may administer the medications to the individual directly.
Home health agencies may also be also to assist individuals in acquiring an at-home medication system. They may be able to train the individual on how to best use the system. They may be able to load a pill box or other system for the individual so that they are able to take medications throughout the week independently.
Skilled nursing facilities
In a skilled nursing facility (SNF), medication will always be given by a nurse. The SNF will manage the individual’s medications and handle tasks such as filling prescriptions and communication with the doctor about medication changes. Nurses will bring medications to SNF residents at the times ordered by the doctor and watch while they are taken. They may crush medications to help with swallowing or give medications via IV.
Residents of an SNF will not be able to self-administer medications or keep any medications, even OTC medications, in their rooms. Stays at an SNF are generally meant to be for short-term and acute needs. A resident in an SNF may be on a specialized medication routine, such as a course of antibiotics or a blood clotting medication following surgery.
Before discharge from an SNF, nursing staff will make sure an individual or their caregiver understands all medications and are able to safely and correctly administer them. If the individual is being discharged back to an ALF or to home health care, nursing staff will pass on medication orders and speak
Community medication management
Some individuals may be able to get assistance with medication management from senior centers or day programs. These programs may allow an individual to stay in their own home while still receiving assistance with medications. Programs such as the program of all-inclusive care for the elderly (PACE) have nurses and other professionals on staff to assist with medication management. These facilities may work with pharmacies to provide participants with at-home programs, such as pill packs.
At some senior centers, staff may be able to assist individuals with making a medication plan and management system. They may be able to help an individual organize their prescriptions and medications to avoid confusion. They may be able to help individuals download smartphone or tablet applications or help them find assistance in purchasing another medication management system.
Medication management FAQs
- What can seniors who are not able to take all their medications because they cannot afford them do?
Even with insurance, medication may be very costly. There are many programs that may be able to assist seniors in paying for medications. Some tips to reduce the cost of medications include:
- Ask about senior citizens discounts — In some cases, the individual may need to show identification to prove age in order to access these discounts
- Medication discount cards — They allow individuals to purchase medications at discounted prices once the card is run or scanned. Different cards may have different requirements to sign up, so individuals should research to see which is the most appropriate for them
- Shop around — Some pharmacies may have lower prices than others or offer services, such as home delivery, that may affect the price.
- Use mail order services — Mail order services are generally cheaper than traditional pharmacies but may take a few weeks’ wait time and there may not be a pharmacist available to answer questions
- Buy in bulk — Some medications have a very long shelf life and buying medications in large quantities often allows them to be purchased at a lower price
- Ask about samples — For some medications, a doctor may be able to give samples before a prescription is filled helping seniors try out (sometimes expensive) medications at no cost
- Ask if there is a generic or other less expensive option available — The doctor may not know what a prescription will cost with an individual’s insurance, but they may be able to order a less expensive alternative
- How can seniors make sure they are taking medications safely?
Medication safety is a very important issue for seniors. Some best safety practices for medications include:
- Individuals should only take medications that are prescribed for them. Never take medication prescribed for someone else, for any reason. Taking someone else’s medication is incredibly dangerous and may mask symptoms, making diagnosis more difficult
- Never cut a medication course short — Even if an individual feels better, they should always finish the entire prescription
- Take time to learn about any medications that are prescribed and be sure the individual knows what each pill looks like and how to distinguish it from their other medications
- Take medications with lights to decrease the risk of taking the wrong medication
- Keep medication out of reach of children and pets
- When traveling, an individual should ask their doctor or pharmacy how to adjust their medications for the changes to their routine and diet
- Refill prescriptions as early as possible in case the pharmacy needs a few days to communicate with the prescribing doctor or refill stock
- Make sure medications are organized and stored in a clean, dry, place
- If buying medication on the internet, make sure the website is verified by the National Association of Boards and Pharmacy (NABP) and is marked as a verified internet pharmacy practice site (VIPPS) to ensure the medication being ordered is safe
- Keep track of any side effects and report them to a doctor as soon as possible
- Individuals should attend all scheduled doctor’s appointments and lab visits
- Sort through medications annually and get rid of any expired medications
- Are there any medication management services that are covered by Medicare?
In some cases, medication management is considered a skilled need. In these cases, Medicare will cover the costs. However, as a general rule, Medicare will not pay for long-term services that it classes as custodial care. Medicare does not pay for care in ALFs or independent living facilities.
Individuals may be able to use Medicare supplement plans, or part D, to cover the costs of some medications. Medicare may also pay for items such as pillboxes in some cases. For individuals with a Medicare drug plan, coverage for Medication Therapy Programs may be available. In these programs, an individual will be able to sit down with a pharmacist or other professional to have a comprehensive review of their medications.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.