Caregivers are often the first line of defense in protecting the elderly and infirm – especially when it comes to making sure medications are obtained and taken properly. Senior citizens are a fast-growing sector of the population, and age often leads to the need for many medications to treat many conditions and chronic diseases. Each of these medications, if taken too often, too seldom, or in the wrong combination may have serious negative outcomes. The latest statistics show that about 100,000 individuals over the age of 65 are taken to emergency rooms across the country annually because of adverse events to the drugs they are taking.
The caregiver plays a major role in ensuring medications are taken properly by those they care for. When patients are on multiple medications, which often look very similar in shape and size, it can become confusing to keep the medications separate and the medication schedule straight. The caregiver can help to keep the medication schedule straight, while also allowing the client to maintain an appropriate sense of independence in managing their medications.
One way to do that is to make sure the patient has a pill box that fits their needs. Specifically, if patients take medications multiple times a day, having a weekly pill box divided into different periods of the day – morning, noon and night—will help to benefit the patient. If the patient only takes medications twice a day, two pill boxes in different colors may help to distinguish the morning pills from the evening pills. The caregiver can help to arrange these pill boxes weekly by “pre-pouring” them with the medications, to lessen the chances of the patient taking the wrong pill or doubling up on a medication. This will also allow the caregiver to be sure whether or not the patient has taken their medications for the day.
Creating habits of when to take medications–either always with morning coffee or before a 7:00 pm program, for example—may help to improve adherence. If more than one caregiver is helping the patient to take their medications, creating a detailed schedule to be “checked off” when medications are given, similar to how a nurse would do in a hospital, may also help to avoid omission or duplication of a medication.
Keeping all current medications stored safely is important to avoid bottles being mixed up and more medications taken than necessary. All medications should be kept in a cool and dry place. If the medication must be refrigerated, it should be kept on a separate shelf or drawer away from food to avoid any accidents. Always check expiration dates of prescription and over-the-counter items, and dispose of any medications that are out of date. You can contact your local pharmacy to determine how to best dispose of expired prescription and over-the-counter items.
A caregiver should be aware of changes in behavior that could be caused by a reaction to a new medication, or signify a new medical condition or infection. Caregivers often know the patient best, and can determine when the patient isn’t quite acting “themselves.” Our elderly patients do not present with disease states the same as younger patients. A patient not wanting to eat breakfast as they always would may be indicative of an infection, side effect of a medication, or worsening of a medical condition. Any changes out of the ordinary for our elderly patients should be brought to their physician’s attention. Always carrying an updated medication list is helpful to identify any medications that may be causing an adverse reaction, and avoid any confusion if there is a transition of care.
The caregiver can also help to ensure the patient is able to obtain medications from the pharmacy. Many pharmacies deliver to those who are unable to leave their house, or will let the caregiver pick up the medications. If the patient is unable to pay for their medications, the caregiver should speak with the patient and, if appropriate, the patient’s doctor or pharmacist, who might be able to resolve any issues with insurance or Medicare. Often, there are less expensive alternatives that are covered under the patient’s drug coverage plan.
Another thing that could be of help to the caregiver and the client is legislation that permits pharmacists to analyze a patient’s medication therapy and recommend ways to optimize health outcomes. In New York, and many other states, we have a program called collaborative drug therapy management (CDTM).
The law, a three-year pilot program, permits a pharmacist affiliated with a teaching hospital and engaged in CTDM to write prescriptions, as long as the collaborating physician is identified on the prescription. The law allows these pharmacists time to spend an hour or more with a patient to adjust medications to avoid an emergency room visit.
Of course this law is good for pharmacists, but it also has strong implications for the elderly and the men and women who care for them. CDTM allows seniors to get special care from highly trained pharmacists who can assist in disease management and ensure appropriate and safe use of medications. The law sunsets in New York this year, and it is in the best interest of the caregiver and client or loved one for the State Legislature to renew and even expand it. If you think all of this seems like it’s placing a lot of responsibility on the caregiver, you are right. As the population gets older, more and more people will need to rely on caregivers, and caregivers will have to take a greater role in the daily lives and well-being of their patients. It is equally as important for caregivers to be concerned about their own health and well-being. Making your own health a priority will allow you to be at your best to care for those that you love.
This article was written by Rebecca Salbu, she is a Certified Geriatric Pharmacist and an Associate Professor in the Department of Pharmacy Practice at Touro College of Pharmacy in New York City. Some of her research interests include geriatrics, Alzheimer’s disease, Parkinson’s disease, emergency room visits by the elderly, and potentially inappropriate over-the-counter medications among the elderly.