Medication Management for Seniors

Do: ask questions, take as directed, report side effects or problems with medication, notify prescriber if using “as needed” AKA PRN meds frequently, monitor vitals, if recommended.

Don’t: mix meds with alcohol, skip doses, take less than directed by your provider, or stop taking prescriptions without discussing with the prescriber.

As we age, many of us find we take more medications than we once did. As research into various disease processes progresses, there are drugs available for whatever ails us. Knowledge is power, so educating yourself about your daily regimen is the best route to keeping yourself independent and in control of your treatment and health management.

medication management for seniors in nursing homes -skilled nursing - assisted living facilities

Know what your medications are and what they do

Medications are prescribed to treat a diagnosis; it’s essential to know what your drugs are for. Health conditions change over time, and what once worked well may not be the best choice for you now. Your PCP should review your medications during office visits, and a nurse will reconcile meds when you are admitted to or discharged from a skilled nursing facility (SNF). Take the time to check your med list with your pharmacist, and stick with one pharmacy for your prescriptions for an accurate pharmacist review. 

Common Drug Types Used By Older Adults

Generally, some illnesses are common to older adults, so there are medicines regularly used by the aging population. Every medication has side effects. Some are not even noticeable, and some are initially difficult to tolerate but get better over time. Some side effects are not well-tolerated, and the prescriber will consider alternatives. Typical medications used by older adults manage heart disease, diabetes, pain relief, respiratory treatments, and psychiatric conditions, including dementia.

Allergies and side effects

Again, while most drugs are safe and well-tolerated, some are not. Monitoring your response to medications is as important as recording side effects. Identify if you see any improvement, worsening, or no changes while taking medicine. Intolerance of a drug is not the same as an allergy. Patients often list an “allergy” for a drug that may otherwise have life-saving potential if other medications aren’t working. 

For example, if a patient has morphine on his allergy list, it’s recommended not to give morphine. He becomes very ill and admitted to end-of-life care; then, he developed pain and shortness of breath, which is treatable with liquid morphine (standard for terminal care). Luckily, he is alert and oriented, and he can talk about his morphine allergy and what happened when he took it in the past: if he takes too much morphine, his heart could slow down. 

Unaware that bradycardia (slow pulse) occurs for everyone who takes too much morphine, he had determined he was allergic. Now, nurses can work with doctors to find the right dose to relieve symptoms without significant heart rate changes. Had this patient been unable to respond to questions, he may not have received effective pain relief or respiratory support. 

A true allergy causes anaphylaxis-- a constellation of symptoms like nausea, vomiting, difficulty breathing, and shock. A primary care physician (PCP) can note “intolerance” to a particular medicine within your chart, including describing your symptoms. Most people would accept a drug that causes diarrhea in a life or death situation. 

Vital signs and blood tests

In a skilled nursing facility, nurses check your vital signs--sometimes before administering medications. They will withhold medication if your vital signs are outside the provider’s parameters, usually for cardiac disease. If you are at home, your prescriber might require you to check your pulse or blood pressure before taking your medications. Sudden drops in blood pressure or heart rate after ingesting your pills can occur and cause injuries. People with diabetes should check their blood sugars before using fast-acting insulins to prevent hypoglycemia. Some drugs require lab tests to determine blood levels, including Coumadin (warfarin), thyroid preparations, and seizure medications like Dilantin (phenytoin). 

A drug by any other name is still the same

Generic medications are as effective as their brand-name counterparts and may be much less expensive. Many patients remember medications by color or shape or the number of pills they take. However, telling someone the pink pill is your “back pill” is not safe or helpful, as manufacturers use different colors or shapes. A nursing home patient may be given two or three variations of the same pill within the SNF because the exact dosage is unavailable as a single pill. For example, you might take two yellow pills instead of one blue pill. It’s always ok to ask, but keep in mind that what you get may look not like what you have at home. 

The medications only work when you take them!

You may have trouble remembering to take your pills, especially if you don’t have someone to remind you. Sometimes people take too much medication because they can’t remember if they already took it. Fear not! There are many items available commercially to help you keep track. Your most economical and straightforward solution is probably a “med-minder.” A “med-minder,” or medication reminder, is the unit with little boxes with days of the week, divided into AM/PM, and on occasion, three or four administration times. Patients can fill the boxes once a week, or opt to have a family member or visiting nurse do it for them. Alternatively, pharmacies offer pre-packaged pills in bubble packs or envelopes upon request. Catalogs providing solutions for independent living sell electronic pillboxes with features like automatic dispensing or alarms. Click here for other helpful tips to help you stay healthy.

What’s a PRN?

Medications that are taken as needed or “when necessary,” are called PRN medications (the PRN abbreviation is from the latin Pro Re Nata). PRNs include nitroglycerin, pain relievers, sleep aids, and medications to treat anxiety or allergy symptoms. Nurses advise the physician if the patient needs PRNs regularly. The doctor may decide to schedule the drug, rather than keep it as needed. Alternatively, the prescriber may look at other options to manage the condition. 

Polypharmacy 

Polypharmacy is defined as regularly taking five or more medications; this includes multiple medicines for the same condition. It is prevalent in older adults and special-needs populations. Deprescribing is the current trend as consultant pharmacists review SNF patients’ orders and recommend alternatives. Nurses are also part of the decision-making process, advocating for patients who may be taking unnecessary or unhelpful drugs. Sorting out the side effects for the patient with polypharmacy can be tricky. Consult with your doctor before starting or stopping medications. 

Anticholinergics

A class of drugs that is particularly risky for seniors is called anticholinergics. These are drugs used to treat various conditions, such as an overactive bladder, respiratory disease, and psychiatric illness. Anticholinergics may cause side effects like urine retention, constipation, confusion, delirium, loss of balance with subsequent falls, and dry mouth, among many others. There is some evidence that the incidence of dementia increases with the prolonged use of anticholinergic drugs. These include tricyclic antidepressants, antipsychotics, OTC cold and allergy medicines, and meds to treat muscle spasms, urinary incontinence, nausea, and vomiting.

Narcotics and Benzodiazepines

Pain management is a tricky business. Senior citizens frequently experience pain and inflammation that diminishes their quality of life. There is a fine line between pain relief and the dangers associated with narcotic medications. Physicians who specialize in pain management or palliative care are most qualified to determine appropriate care. Many PCPs will refer to a pain clinic to reduce their liability for bad outcomes and legal complications. 

Medications to treat anxiety, in addition to narcotic pain relievers, can cause a host of side-effects, many identical to those from anticholinergics. Additionally, there is an exponential increase in the risk for falls due to cardiac or neurological changes causing dizziness. A senior who experiences a fall is almost guaranteed to be injured and hospitalized. 

A recent CDC study showed that “the estimated medical cost of falls across the U.S. healthcare system is $50 billion annually. This includes $38 billion paid by Medicare and Medicaid and $12 billion paid by private and other payers.” Hospitalizations often lead to further debility and mortality.

It is a matter of fact that medicines can improve seniors’ quality of life, but care must be taken to ensure safety and efficacy. While doctors, nurses, and pharmacists are the logical go-to people, we must ultimately take personal responsibility for our health and safety. To this end, discussing concerns is taking control of your health and medical care.