With the use of pharmaceutical drugs on the rise, the chance of negative and unintentional drug interactions has increased as well, particularly for seniors with diminishing cognitive and bodily functions.
Misuse of prescription drugs, intentional or not, can lead to dangerous side effects, such as overdose or critical drops in blood pressure, which carry ancillary problems such as falls and other issues.
According to Sonoma County Health Action, an initiative created to improve community health launched in 2007, “Nearly every eight days, a person in Sonoma County dies from an accidental drug overdose. Prescription drug use and misuse is a large contributing factor to this problem.”
Therefore, medication management is important for older adults with more than one prescription or reduced cognitive abilities. There are several management options, from hired professional help to online medication dispensing systems that can be remotely operated by a trained and licensed professional.
“One thing we see that is so common is that when Adult Protective Services gets involved and sends [us] in to assess a situation, it is not uncommon for a nurse to see a shoebox full of medications,” At Home Nursing owner Diane Brabetz said. “Sometimes, it takes hours to go through them all.”
At Home Nursing provides licensed home care to seniors and works with the county to provide both non-medical and skilled nursing needs.
Brabetz said that many of the clients she serves have multiple medications and often they are the same drug with a different name or expired drugs that have accumulated over time and were never properly disposed of.
“The average age of our homecare clients is 83 and it’s amazing how many meds they have and how little they know about them,” Brabetz said. “They don’t know the side effects or that some are different names of the same thing.”
She related a story of a client who had multiple falls after a short hospital stay. “We reviewed his [blood pressure] meds and found he had the same prescription from three different [hospital] departments,” she said. “He kept taking them and kept falling.”
Brabetz said she was able to figure out the situation, adding that it is important to be vigilant when working with multiple medical departments or agencies to avoid such problems.
Colette McGeough, Senior Health Initiative Coordinator for the Sonoma County Health Services Department, said that isolation and aging are factors that can exacerbate the problem of “polypharmacy.” “
As home visiting RNs, we find medication management is a huge problem for many seniors,” she said. “Even when there are no opioids…many isolated seniors frequently have poor medication management skills. When opioids or other central nervous system depressants are added to the mix, altered mentation, balance etc. occurs, which leads to over- and under-use of the medications.”
McGeough added that overdoses can happen when pharmaceuticals build up in aging bodies through physiologic changes that alter the way medications are absorbed, metabolized and excreted “due to changes in the gastrointestinal tract, the liver or decreased renal dysfunction.”
Often, a senior already taking multiple medications will go to an emergency room for pain after a fall and will receive pain medication. When the senior returns home, they will often add that medication to what they are already taking, which can increase the potential for another fall that can be critical.
“The fall/injury potential increases tremendously,” McGeough said. “The next fall episode may result in hip fracture, more pain— more meds—loss of independence and so the cycle continues.”
She added that assessment tools are improving, particularly with the implementation this year of Sonoma County’s Safe Opioid Prescribing guidelines, but monitoring of multiple medications should be a priority for any senior.
“It is also very important to let our seniors know that even though there is an increase in opioid abuses and overdose within the county, seniors still need to have their pain issues addressed and treated appropriately,” she said. “Pain always requires effective treatment and management, otherwise it can cause other debilitating side effects such as depression, elevated blood pressure and poor quality of life.”
To reduce the dangers of poorly managed prescription drugs, McGeough advises contacting Sonoma County Health and Human Services for guidance and communicating with the family provider.
Brabetz suggests planning as a strategy, including setting up medications in multi-day or weekly increments and creating a list for medical providers and family members and one to keep on hand in case of emergency.
“I encourage people to make a medication list so they can have it on hand,” she said. “It has to be current at all times. If you go to the hospital, you have to have it with you. It can have a far-reaching impact.”
By David Abbott, Associate Editor, Sonoma Seniors Today