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Medication Use as We Get Older

By Melaine Giordano, MS, RN, CPFT

A pharmacist is going over the directions on a prescription bottle with an older patient. "Be sure not to take this more often than every four hours," the pharmacist says. "Don't worry," replies the patient. "It takes me four hours to get the lid off."

Younger folks can have trouble taking their medications correctly too, but as we get older, more and more challenges seem to arise. Fortunately, there are tools you and/or the older adult in your life can use to make medications easier to handle.

Dealing with dexterity

Arthritis, neuropathy, and other conditions can make medication use, whether oral or inhaled, especially problematic. Some oral medications, particularly the cardiac medications, are very small in size. Inhalers used to treat asthma and other respiratory problems require a lot of coordination to get right. Here are some good ways to deal with dexterity problems:

• Child-proof lids can be altered so that they are easy to open. Or, better yet, ask if your pharmacist can provide a non-child-proof lid for all your medications.
  
  
• Use of a spacer gives you time to properly administer a metered-dose inhaler.
  
  
• When warranted, ask the pharmacist to split medications to make them easier to swallow.
  
  
• Ask the pharmacist for large wide-mouth medicine bottles so you can more easily get the pills out.
  
  
• Place oral medications into a pill cup or small glass to facilitate transportation of the pill to the mouth.
  
  
• If you use a dry-powder inhaler, ask your doctor or respiratory therapist to make sure you are properly opening/loading the inhaler and generating an adequate inspiratory flow.

Here are some helpful tips for people who are visually impaired:

• Use a medication organizer to keep track of your pills, and put larger-type labels on each compartment so that you can read the days of the week and the times of day.
  
  
• Ask a family member or friend to fill the medication organizer each week.
  
  
• Keep a magnifier handy so you can get a close-up look at your pills before you take them.
  
  
• Ask your pharmacist to use different size bottles when dispensing similarly shaped pills.
  
  
• Use "talking pill" bottles. The patient, physician, or pharmacist can record a 60-second message on dosing instructions.

Cognitive problems, whether they manifest in the form of depression or Alzheimer's disease, hinder the ability to take medications properly. Changes in cognition affect a person's thinking, concentration, memory, and behavior. Many medications can cause cognitive changes in older adults; this Beers Criteria list categorizes inappropriate medications for older adults.

Here are some tips for keeping all the prescriptions you take straight:

• Use a medication organizer. These organizers range from 7-day plastic pill boxes to fully automatic pill dispensers.
  
  
• Utilize a medication list to keep track of everything you are taking.
  
  
• A wrist watch that is programmed to alarm (vibration or sound) when medications need to be taken can help you stick to correct medication schedules.
  
  
• When indicated, family or friends should prepare and monitor the pill organizers and other medication aids.
  
  
• Ask your doctor to provide a written action plan that lists medications, dosage and frequency, signs of a flare up, and how to call for help if your condition worsens.
  
  
• Try to fill all of your prescriptions at one pharmacy because it is much easier to monitor medications from one location.