The prevalence of drug-related hospitalizations has been reported to be as high as 31%. Many of these were preventable, with one study finding about one third of drug related hospital admissions were definitely preventable with many more potentially preventable. People on multiple medications and older people are more at risk. Older adults are about four to seven times more likely than younger persons to experience adverse drug events (ADEs) that cause hospitalization, especially if they are women and take multiple medications.
Drug-related hospitalization can lead to fatal outcomes and increased length of stay in older patients. Clearly, they have negative consequences on patients and society ranging from increased costs to higher levels of morbidity and mortality, with sometimes long-term effects on quality of life.
After patients leave the hospital they’re particularly at risk for problems, which often land them back in the hospital. In one study, half the patients made medication errors when they went home. Of these, 23% were serious and 2% were life-threatening. Many of these were preventable.
Over 55% of older adults do not properly take their medications.
Common forms of drug treatment noncompliance found in the elderly include:
- Underuse of prescribed drugs
- Overuse and abuse
- Forgetting doses
- Alteration of schedules and doses
- Inappropriate drug discontinuation (found in about 50% of cases, particular in the first year of caring for a chronic condition)
- Taking drugs prescribed for others (about 10% of elders do this)
- Taking drugs not currently prescribed
Why is medication compliance such a problem for older adults?
Data suggest that using three or more drugs a day places elderly people at particular risk of poor medication compliance. As many as 25% of older people take at least three drugs, with many elders taking eight or more (an average commonly found among those who are hospitalized).
Here are some of the common issues older adults have with medication compliance:
1. Changes and remembering instructions after a hospitalization
A large percentage of older adults have issues with medication compliance after leaving the hospital. Despite being given written and oral instructions, less than 1 in 4 remembered getting the written instructions and 1 in 10 did not recall getting any information. Understandably, this is a stressful time and the patient may be feeling unwell. Even if their memory is generally good, many find it difficult to take in and recall information at this time. Additionally, this is a time when most patients get at least one new medication so they’re having to remember something new at a transitional time.
2. Short-term memory
Without any kind of memory aids, it may be difficult for any of us to keep up with a medication regimen that includes multiple doses at different times of day. Elders often forget if they have taken medications, leading to either underuse or overuse.
3. Understanding about need and proper usage
Sometimes the person does not understand why they need a medication or stop taking it because they feel better when they should continue. Other times, an elder may take more medication without consulting a doctor first.
4. Volume/complicated regimen
Medication compliance is much tougher for those on multiple medications, which we know is quite common in elders. Additionally, the more complicated the directions are, the more likely the person will make an error.
5. Medication costs
Medications can become quite costly and many elders are living on a fixed income. Even if they “can” afford the medications, the cost may become a barrier if they don’t really understand the need or think they can skip doses, for example.
6. Side effects
If the patient experiences side effects, they might discontinue the medication or reduce the dosage. Sometimes an elder becomes afraid that the side effects will affect their ability to remain independent.
Along with memory issues, other challenges may make medication compliance difficult. For example, an elder who does not have manual dexterity to easily open pill bottles needs a different solution. Also, quite often, reading the instructions and even the name of the medication is difficult. If an elder is struggling with mobility or handling their ADLs, medication compliance may also suffer as they try to manage getting through their day.
Other issues may come into play, such as mistrust of medical professionals/medications and various fears. And, substance abuse and addiction have become more significant in the older population as well.
Help with Medication Compliance
Given these statistics, medication compliance is a key component of an evidence-based home care program like EasyLiving’s. Not taking medication properly is likely to land elders in the hospital and can quickly start a descent into needing more help and having more problems. When we can address medication compliance, we can keep elders out of the hospital...and healthy, happy, and safe where they want to be.
How does home care support medication compliance?
A home care program addresses the very problems mentioned above. Prescribing a medication is only step one in healthcare. Too often, that’s where it has stopped. And, thus, treatment has often been ineffective.
A home care medication assistance program helps: 1. Assess potential issues with taking medications properly and provide solutions. 2. Assist with medication setup to make things easier for the client to stay compliant. 3. Monitor medication compliance, side effects, and potential adverse events. 3. Advocate and coordinate with medical providers to reduce medication conflicts and ensure the best treatment options for the individual. This can include discussing ways to simplify the medication regimen.
For example, when we help a client with medication compliance, we often find their pills in complete disarray. They may be taking old medications when a new one has replaced it. And, though they may have a “system” for taking their pills, it is often clear that their system is prone to errors. We have an array of solutions to fit the person’s needs, which may include setting up and filling a pillbox for them and electronic reminder systems.
Also, monitoring helps spot any issues before they become a 911 call. We can see if the elder is struggling and work on solutions. Our team can address cost concerns and identify programs to help. Because we are there in the client’s home and develop a relationship with them, they will often open up to us about concerns, fears, side effects, etc. Our care managers will contact the providers so these issues don’t wait until the next appointment, when it may be too late.
Our clients, their families, and their doctors see the results. EasyLiving’s 30-day client hospitalization rate is under 2%. Meanwhile, the national and local average is over 15%. Clearly, proactively addressing medication compliance can make a difference.
Learn more about at-home support for medication compliance. Let us help your loved one stay safe, healthy and happy!