Balancing independence and care is a challenging exercise for assisted living communities. And medications for seniors are the most difficult topic to look after in senior care facilities.
Different senior care facilities attract seniors for the freedom they offer. Meanwhile, families and loved ones look for caregivers to provide safe environments. This includes hyper-vigilance of their changing healthcare needs.
Nowhere is more evident than senior medication management.
Why Do Seniors Need Medication?
Activities of daily living and various personal care are staples of assisted living. But medication management is one of the most significant services any community offers.
Almost 60% of assisted living communities offer therapeutic services for Alzheimer’s disease. Similar percentages also have specially targeted programs for diabetes, cardiovascular disease, and depression.
Yet, you cannot effectively manage these severe health conditions without expert help. The National Center for Assisted Living (NCAL) reports that more than 50% of assisted living residents are 85 or older.
Due to this, most assisted living communities do not typically provide pharmacy services. Instead, they rely on the external providers’ expertise to manage the pharmacological needs of the residents.
To top it off, the needs are becoming more complex and risky every day. This is due to the growing acuity level among assisted living demographics. Many assisted living residents today would’ve been ideal candidates for skilled nursing care years ago. But that was when assisted living was not an option. Consequently, most come to these communities in a clinically complex and fragile state.
What’s Going On?
Compounding matters are another form of clinical vacuum. For example, more than 82% of the assisted living caregivers today are aide-level employees.
Baby boomers entering into assisted living are incredibly independent and cognitively strong. This is more than any senior living demographic that has come before.
Ironically, freedom comes at a cost. This has made them more vulnerable for many severe and complex reasons. This is why most assisted living residents consume an average of 12 to 14 medications each day.
Unlike other seniors living in skilled nursing facilities, assisted living residents to take a higher number of drugs for everything. Physicians blame a majority of that on the lucrative marketing and advertising schemes. Most caregivers don’t even know and chart those medications. Unfortunately, some OTC medications can cause severe interactions with prescription meds. Another complication of OTC can be many seniors continuously taking them being unaware that they’ve expired.
A high number of seniors often use multiple pharmacies. This can lead to duplication, overlap and redundancies. And there can be numerous problems from polypharmacy. Yet, you may not even suspect the intensity of the issues.
Retail pharmacies are not subject to the stringent rules long-term care pharmacies are. Moreover, assisted living caregivers in many states to have restrictions. From dispensing medications, exposing residents to several risks from self-administration. Finally, non-covered drugs reimbursements can often be a frustrating and thorny process.
This situation can enhance adverse drug event opportunities. This could lead to issues like higher incidences of falls, dementia, and even fatal consequences. Seniors struggle to coordinate and manage daily doses of medications.
Most Common Medications for Seniors
To understand the severity of ADEs in assisted living, medications are the most crucial topic.
And there are numerous adverse risks for residents taking power painkillers. In 2017, for example, ECRI listed undetected opioid-induced respiratory as a health hazard.
Opioids, antibiotics and antipsychotics are now under mounting scrutiny. One reason is that many are now seen as culprits in costly hospital readmissions. This can expose assisted living operators to a host of problems. Part of the problem with opioids is worse transition management. The first exposure to opioids for many post-acute patients comes from home or hospital before being transferred.
Painkiller abuse, meanwhile, is reaching epidemic levels. A leading healthcare consultancy recently found something unsettling. Nearly 18% of seniors over the age of 65 who suffer from chronic pain are addicted to one or more opioids. Complicating the issue is that many clinicians have unwittingly over-prescribed them. This helps patients manage debilitating pain. Another complication is diversion, a common problem that doesn’t discriminate across care systems.
But then, prescription drug monitoring programs are not adequately in place or completely under-developed.
Other medication management issues in assisted living facilities include the disposal of drugs. Strict rules and regulations have been imposed on hospitals and nursing homes to dispose of unused medications for years properly. Recently, the EPA considered imposing strict restrictions on assisted
living facilities. These providers are pushed back on because of the way drugs are managed in those settings.
Importance of On-Time Medication Intake
A high number of seniors take multiple medications throughout the day. As a result, mix-ups happening can be a very common outcome.
Studies show that 87% of seniors take one prescription drug, 38% use over-the-counter medications and 36% take five or more.
We all know that the correct intake of medicines is essential for treating your loved one’s health conditions.
That’s why it is crucial to managing medications for seniors. And the task is not that complex. You can just put a simple system in place and take care of the basics to avoid common medication mistakes. This includes taking the wrong drug, missing doses, or taking more than prescribed.
Tips for Taking Medications for Seniors
You know which medications would be best for our seniors. But there is more work to do. So here are some tips for taking medication that will make life easier.
Gather all vitamins, medications, OTC meds and supplements into one location
Suppose they’re all stored in different locations. In that case, it’s easy to lose track of the prescribed medication, vitamins, or supplements.
For example, some older adults might keep a few pills in their kitchen. Some keep on their bedside table, and others in the bathroom medicine cabinet.
It’s imperative to include over-the-counter medication. There could still be adverse drug reactions when you combine them with prescription medications.
It is a great practice to gather everything into one place.
That way, you can see exactly what medicine you are consuming. Also, make sure you are not using similar prescriptions for the same health condition. Finally, just know when to dispose of expired medications.
You can increase medication safety by keeping all the pill bottles and packages in a clear plastic storage bin.
Also, you can use a separate bin for their backup medication supply or medicines that you only use occasionally.
Make sure proper storage of medication
In general, seniors or caregivers must keep medication in a dry and cool place. So what does this mean?
It means that our everyday medicine storing place, the bathroom cabinet, is certainly not an ideal place to keep medicines. This is because heat and moisture can significantly affect the quality of drugs. And lastly, as any medicine packet suggests, you should always keep them away from children.
Up-to-date medication list: create and maintain
It’s crucial to know the medications your older adult is taking to prevent adverse drug interactions.
That’s precisely why it’s so important always to have an up-to-date list of their medications. So this must be with supplements, over-the-counter medicines and vitamins.
Record the following things:
- Names of each prescribed and over-the-counter medication, supplement, and vitamins
- How often do seniors take each of the medicine?
- What dosage do seniors use?
- The healthcare provider information who prescribed medications
- The purpose of the medicines and their functions
- Whether the medications are short-term or long-term
Pre-sort weekly medications
Staying organized is a prerequisite for a healthy life. The same thing applies to good medication management as well. A pill organizer allows you to help senior loved ones pre-sort their weekly medications.
The best pill organizer for your older loved ones comes with enough compartments to store medicines they’ll need throughout the whole day.
If you need to split any pills, you should do this beforehand and organize them accordingly in the pill organizer. This way, seniors won’t need to fumble with a pill cutter or remember to split pills before taking them.
Ensure clear medication instructions
There is no alternative to following your doctor’s instructions. That minimizes the risk of side effects or reduces the drug’s effectiveness. Also, ensure you and your older adult understand which medications are safe to take simultaneously. This needs to be spaced out to prevent negative side effects.
For example, you need to take some medications after a complete meal. And other medications require an empty stomach to consume.
If you have any uncertainty, don’t be afraid to ask the doctor for detailed instructions and explanations. They know that medications will improve health, and the only way that can happen is with proper intake.
Caution! Things to Watch Out for
Prescription medications that are long-term require on-time refills. Thus, seniors should not run out of medicines and miss everyday dosages.
The most promising solution is to ask the doctor to prescribe a 90-day supply. Then, the doctor can send this through mail-order pharmacies.
Many pharmacies also offer automatic refills and notify you when the prescription is ready for pickup.
There are a few pharmacies with free prescription delivery services, so you won’t have to pick them up.
Any medication has its own set of side effects. For example, they can affect the functions of the brain and cause drowsiness. They can also result in or worsen confusion, especially in people with memory problems like dementia.
They are usually the best choices to help people sleep. These drugs can also help with anxiety. Some common drugs include Ativan, Valium, Restoril, and Xanax.
Non-benzodiazepine prescription sedatives
They are usually prescribed to treat insomnia or trouble with sleep. Common drugs include Ambien, Sonata, and Lunesta.
These drugs are usually prescribed to control complex behaviors in Alzheimer’s.
Seniors with severe depression can also intake these drugs.
Common antipsychotics are primarily second-generation, including Zyprexa, Abilify, Risperdal, and Seroquel.
Anticonvulsants and mood stabilizers
Anticonvulsants are also seizure medications. Depakote or valproic acid is a mood stabilizer that sometimes helps manage challenging behaviors in Alzheimer’s. Neurontin (gabapentin) is another seizure medication to treat nerve pain.
These drugs are super effective against anxiety or depression.
Common drugs include Celexa, Paxil, Remeron, Zoloft, Lexapro, Remeron, Wellbutrin, etc.
Tricyclic antidepressants like Elavil and Pamelor (amitriptyline and nortriptyline) are also anticholinergic. So instead of treating depression, they can manage nerve pain.
Trazodone, an older antidepressant, typically helps in mild sleep aid.
Opioid (narcotic)- the pain relievers
Common drugs include hydrocodone, codeine, morphine, oxycodone, fentanyl, and methadone.
Opioids often cause drowsiness and other side effects. Research linking opioids with falls has mixed results. But CDC recommends that narcotics evaluation can help to reduce fall risk.
This group includes many anticholinergic drugs. Common examples include most over-the-counter prescription drugs and sleeping aids.
These drugs include the following antihistamines:
- Benadryl, “PM” versions of over-the-counter pain relievers (Nyquil, Tylenol PM);
- Overactive bladder medications like Ditropan and Detrol;
- medications for vertigo, motion sickness, or nausea like Dramamine, Antivert, Scopate, and Phenergan;
- anti-itch meds like Vistaril (hydroxyzine);
- muscle relaxants like Flexeril (cyclobenzaprine);
- tricyclic antidepressants and Paxil.
Research linking these drugs with falls has mixed results. Still, because they cause drowsiness and other serious side effects. Experts include them for review when working to reduce fall risk.
They are usually prescribed to treat high blood pressure.
Research linking these drugs with falls has mixed results. But many geriatricians and other experts recommend including these for review.
So, your senior loved one might be currently taking any of the medications for seniors. They can be harmful to them. But it would be best if you did not make any changes without consulting the doctor. It could cause even more harm from suddenly discontinuing a drug.
And even if a drug results in increased risks of falling, it doesn’t really mean that seniors should stop consuming them.
The CDC recommends that seniors should consider medications only when necessary. And whenever possible, they should SWITCH to safer alternatives or REDUCE medications to the lowest effective dose.
Your older adult’s doctor should carefully consider the pros and cons of using a medication linked to increased fall risk.
When one of these medications for seniors is being used, doctors should regularly review the need for and dosage.