Medication safety—or lack thereof—among seniors is placing an unnecessary strain on our healthcare system, especially when you consider the correlation between aging and the increasing number of medications taken annually.
Three-quarters of people aged 50-64 use prescription drugs, filling an average of 13 prescription medications annually, while 87% of those aged 65-79 fill 20 medications on average annually.
Of those taking medications, 80% have admitted to making mistakes in medication adherence. Despite the fact that medications help manage illness, increase longevity and enhance quality of life, there’s a noticeable absence of community-based, in-home support to help patients take their medications safely and as directed. Additionally, family caregivers, the cornerstone in providing support and assistance to aging family members, are routinely tasked with medication management for which they have no formal training.
With 90% of seniors wanting to age in place, we need to address concerns and costs related to medication safety, and to develop efficient and effective patient-centered medication management interventions for this population.
(SCAN Health Plan)
Since fall 2016, I’ve overseen an innovative program designed to identify barriers to safe medication use, decrease medication-related problems, increase coordination of care between prescribers and pharmacists and improve self-efficacy and skills in medication management among seniors and caregivers at home. Called Community Medication Education, Data & Safety (C-MEDS), this program serves people aged 55 and older and their caregivers, and is not contingent upon income, insurance or disability. Accordingly, the program found three primary challenges to promoting safe medication use:
Health literacy: Two-thirds of U.S. adults over age 60 have inadequate literacy skills, and family caregivers also often lack necessary literacy skills to manage care recipients’ medications. Most report receiving little or no training in managing medications, despite frequent emergency department (ED) visits and overnight hospital stays by the care recipient.
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Cognitive functioning, vision and dexterity: The physiological consequences of age and increased complexity of care among seniors is a major risk factor. Cognitive abilities, poor vision and low manual dexterity are associated with poor medication self-management.
Medication reconciliation: Studies show discrepancies between medications prescribed and actual medications taken by the older adult can vary between 30% and 66%. One study reported that at two days post-hospital discharge, 64% of patients were taking at least one medication that was not ordered, 73% were not using at least one medication as prescribed and 32% were not taking all the medications ordered at discharge. Additionally, adverse drug interactions between over-the-counter and prescribed medications have been found to happen up to 86% of the time.
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The C-MEDS program has discovered that, despite relatively high rates of healthcare use, this sample of community-dwelling seniors demonstrated significant challenges in medication management, with 58% reporting some level of problems with adherence. While some challenges can be mitigated with a caregiver, that’s not a one-size-fits-all solution. In some cases, caregivers may be able to intervene, but only when the patient is willing and the caregiver is engaged and has the necessary skills.
For older adults, the ability to remain independent and living at home may depend on the ability to manage a complicated medication regimen or have appropriate assistance. Non-adherence to medication regimens is a major cause of hospital admissions, readmissions and nursing home placement. It also contributes to higher healthcare costs. Alternatively, in-home medication safety programs are an important tool to prevent the aforementioned unnecessary hospital admissions, readmissions, ED visits and nursing home stays, while improving quality of life for older adults.
Romilla Batra, M.D., is the chief medical officer at SCAN Health Plan, where she provides physician oversight of clinical programs, ambulatory and complex case management and helps design clinical initiatives that support healthy, independent aging. Follow her on Twitter @batrar or on LinkedIn: Romilla Batra, M.D., M.B.A.