Seniors struggle with complicated regimens

Sheer number of drugs taken impairs compliance

A high number of hospital admissions for the elderly are due to problems with medication compliance. Because confusion or lack of understanding can cause seniors to take their medication incorrectly, education plays a vital role in senior medication compliance, says Nina Resch, PharmD, primary care clinical pharmacist at the Veterans Affairs Medical Center in Albuquerque, NM.

"I make sure seniors keep an updated list of their prescription medications, herbal supplements and vitamins, and over-the-counter medications and show that to their physician and pharmacist. Many people have multiple places where they get their care, or they may not pick up all their prescriptions from the same pharmacy," says Resch. The list helps to prevent duplicating prescriptions or mixing medicines that would cause drug interactions.

Linda Mosel, MSN, RN, CS, geriatric clinical nurse specialist at Good Samaritan Hospital in Dayton, OH, encourages seniors to put all their prescription medications and over-the-counter drugs into a paper bag once every three months and review them with their pharmacist or physician. The hospital frequently sponsors brown-bag medication chats with the pharmacist. The pharmacist goes over the medications on an individual basis and helps participants troubleshoot their regimens if they are having problems.

The sheer number of drugs elderly patients take is one of the major barriers to compliance, explains Mosel. They may take one 30 minutes before meals, one with meals, one two hours after meals, one three times a day, and another every six hours. "The medication regimens are very lifestyle-prohibitive. We need to simplify the regimen for them and get them on long-acting drugs that are once-daily doses, if that is possible, and really look to see if they can be taken off some of the medications," says Mosel.

Using pillboxes and sticky notes

If the medications are a must, it’s important to help seniors fit them into their lifestyle. Pillboxes work well, especially those that separate the various doses for each day, says Resch. However, it is important to teach patients how to use the pillbox correctly, rather than just hand them one.

If patients have difficulty differentiating among colors such as blues, greens, violets, whites, and yellows, pillboxes won’t work well. Instead, help them make a calendar-type chart so they can mark off when they take a dose of medication, or have them write sticky notes, says Mosel.

Also, go over patients’ daily routines with them to determine what they do on a regular basis, so the activity becomes a prompter for taking medicines. "If patients brush their teeth twice a day, certain medications could be kept near the toothbrush, or if they have coffee each morning, medications could be kept with the coffee," says William A. Hopkins, PharmD, professor at Mercer University School of Pharmacy in Atlanta.

During the day, when patients often are away from the house, they can set their watch alarm as a reminder, suggests Resch.

Address barriers to learning

None of these methods will work if there is a memory problem, so barriers to learning must be assessed up front. Ask about hearing and vision problems, language barriers, and religious beliefs. To assess for knowledge, ask patients to explain their medications, including why they take them and how they take them, says Resch. (For more information on asking the right questions to improve medication education, see article, below right.)

Often, other disciplines will need to be called upon to overcome barriers to medication compliance. For example, a patient may refuse to take a narcotic for religious reasons, believing these drugs to be addictive. If the physician can’t persuade the patient to take the drug, a chaplain could be called in to explain that in this case the drug is not addictive, says Karen Pegram-Felix, RN, a nurse manager at New York Presbyterian Hospital in New York City.

If the patient is having trouble swallowing the pills, an occupational therapist would be asked to do an assessment, says Pegram-Felix. Pills can often be crushed and put in apple sauce or mashed banana to improve compliance.

When patients are being discharged from the hospital on a complicated medication regimen, it is important that education take place throughout the hospital stay so patients are prepared to take the drug properly when they go home. "Each time nurses give a patient medication, they go over what it is for. They also show them the pill so they recognize the color and shape," says Pegram-Felix. At discharge, the education is reinforced with preprinted medication sheets that describe the medication, how to take it, and side effects it might cause.

For more information on education for better senior medication compliance, contact:

William A. Hopkins, PharmD, Professor, Mercer University School of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341. Telephone: (770) 986-3256. E-mail: Hopkins_b@mercer.edu.

Linda Mosel, MSN, RN, CS, Geriatric Clinical Nurse Specialist, Good Samaritan Hospital, 2222 Philadelphia Drive, Dayton, OH 45406. Telephone: (937) 278-2612, ext. 2884. Fax: (937) 276-8269. E-mail: lmosel@shp-dayton.org.

Karen Pegram-Felix, RN, Nurse Manager, Five Central Greenberg Pavilion, New York Presbyterian Hospital, 525 E. 68th St., New York, NY 10021. Telephone: (212) 746-5932. Fax: (212) 746-4386. E-mail: kfelix@nyp.org.

Nina Resch, PharmD, Primary Care Clinical Pharmacist, VA Medical Center, 1501 San Pedro S.E., 119, Albuquerque, NM 87108. Telephone: (505) 256-2757. Fax: (505) 256-2789.