Multi-Medication Drug Regimen
In Older Adults
Often times, prescribers do not pay special attention to people 65 years of age and older and will prescribe multiple drugs without fulling teaching the patient about specific drug usage, and without fully understanding how an elderly person will react to prescribed drugs. People 65 years of age and older frequently have unpredictable responses to medications affecting the liver, kidneys, and brain of the patient. Therefore it is important for prescriber to take the time to explain why the patient is being placed on a medication, evaluating prior medications for drug interactions, and ensuring that the patient knows what signs and symptoms to look for to call the physician if there are any complications. Thus, it is crucial for the patient to have full knowledge of their medications, what they are used for, when to use them, and signs and symptoms of each drug prescribed.
Patient should know:
- Why they taking their medication
- What is it used for
- Side effects
- What time to take medication
- Dietary needs
Ensure that the older adult has health literacy (ability to understand basic health information) is of vital importance. The more the patient knows about his/her care and medications, the better. Ways to ensure health literacy is knowing making sure that health information is easily accessible and understandable.
Ensure adherence to medication regimen is important as well to the health of the patient. Ways to make medication adherence are:
- Making the regimen simple
- Use of daily pill organizer
- Establishing communication between patient and health care provider
- Knowledge of prescriptions
People 65 years of age and older have several barriers that they must overcome when on a multi-medication treatment. One of those barriers is finances; it can be difficult for an elderly patient to be able to afford all of his/her medications. Elderly patients can overcome this barrier by discussing with their healthcare provider cheaper drug alternatives as well as non-pharmacological options. Additional barriers are cognitive impairments and functional impairments. Patients should have a family member, friend, or loved one accompany them to appointments as well sticking to a schedule. This will ensure the patient takes their prescriptions when needed, as well as including others in the care plan on the patient. Patients and families of patients can also look into home health to assist the patient with cognitive impairment with activities of daily living (prescription schedule, cooking, running errands, etc.). Lastly, a huge barrier for elderly patients when sticking to a prescription regimen of multiple drugs is being able to either pick up their prescriptions from the pharmacy, or having a family member, friend, loved one, or home health nurse pick up their prescription. A way to overcome this barrier is looking into having your prescription delivered straight to the patients home. This allows for the patient to not have to go without their prescription due to not have transportation to the pharmacy.
Some barriers that elderly patients must overcome when prescribed multiple medications are:
- Finances-being able to afford medications
- Cognitive impairments
- Functional limitations
- Transportation limitations
A major motivation to adhere to the medication regime that is prescribed to this patient is to manage and prevent any further complications. Older adults tend to have comorbidities and will need to take several different medications to care for these clinical issues. As a result of taking these medications, the patient should have an increase sense of well-being if the medications are working as planned. Another important factor to adhering to the medication regime is that the older adult needs to feel in control of their health. They must be able to make the conscious decision to take these medications, so it is in their best interest to know what each one is for and why they are taking them, so that the patient feels the active role in their health care.
Motivators to adhere to the medication regimen:
- Management and prevention of further medical problems
- A greater sense of well-being
- Feeling in control of their health
In order to make the medication plan the most useful the patient needs to know when to take each medication, if there are any food restrictions, and what each medication is for. To make this plan successful, it is important that a list of each medication (side effects, food interactions, and times to be taken). Using medications that work best for the patient is important as well; the patient should be included in the plan of care to make it individualized and centered around the patient’s lifestyle. Some things to think about when centering the care around the patient is their literacy level, social support, and financial income to pay for the medications.
How to make the medication regime useful:
- Clearly identified medications, times to be taken, food restrictions, and side effects
- Patient involvement in the plan of care
- Using language that the patient will understand
- Patient has social support and is held accountable for taking the medications
- Adequate income to pay for the medications
With several medications at different times throughout the day, the older adult may have some questions pertaining to the medications they are taking. In this instance the older adult is in need of someone to talk to to get a better understanding of what steps need to be taken. The older adult can go into the pharmacy, physician’s office, nursing home staff if this is where they reside, home health nurses that may come by, and even insurance companies if they need help covering the cost of their medications. It is important that the older adult has resources that they can turn to if they have any questions.
Resources that the older adult can turn to for assistance
- Physician who prescribed the medication
- Insurance companies with assistance in paying for the medications
- Nursing homes
- Home health nurses
Atreja, A., Bellam, N., & Levy, S. R. (2005). Strategies to Enhance Patient Adherence: Making it Simple. Medscape General Medicine, 7(1), 4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681370/
Byles, J. E., Cockburn, J., Pit, S. W. (2007). Medication Review: Patient Selection and General Practitioner’s Report of Drug-Related Problems and Actions Taken in Elderly Australians. Journal of American geriatrics Society, 55(6), 927-934.
Marcum, Z. A., & Gellad, W. F. (2012). Medication Adherence to Multi-Drug Regimens. Clinics in Geriatric Medicine, 28(2), 287–300. http://doi.org/10.1016/j.cger.2012.01.008