Managing medications

Aging, Fall, 1994

In a recent issue of PARADE magazine, T.V. personality Hugh Downs described a situation with his father that is, unfortunately, becoming familiar to an increasing number of families. When his father arrived for a visit to his Arizona home, Downs was distressed to find him "high as a kite in the morning and suicidally depressed in the afternoon," as a result of negative interactions from several medications he was taking. "He had trouble finding his way home from downtown Phoenix and displayed a couple of mental lapses that caused us to think immediately in terms of Alzheimer's disease. Not so. He simply had become a chemical battleground, and the effect of interacting medicines had produced symptoms of derangement."

Mr. Downs' experience was a dramatic example of how medicines, meant to prolong and raise the quality of life, can lead to serious medical problems in the elderly. Older people suffer more than 9 million adverse drug reactions or interactions annually.

One-fourth of all elderly hospital patients receive six or more prescription drugs. Elderly women take an average of nearly six prescription drugs and three over-the-counter medications at the same time. Nearly 25% of hospital admissions of older Americans are the result of taking prescriptions incorrectly.

A federal law passed in 1990 requires that all pharmacists offer medical information and drug counseling to Medicaid patients. According to the law, pharmacists must ask their Medicaid customers if they want counseling on the drugs they are taking. Since then, some states have mandated that pharmacists counsel all patients, regardless of their income, on how to take the drugs they are given. Most pharmacists will now keep a medication record for their customers and look for potential problems, such as dangerous medicine combinations, unneeded medication, or improper dosages.

Unfortunately, very few consumers are aware of this service. One pharmacy chain in the Washington, D.C., area reported, for example, that only 15% of customers wanted a medication profile when asked, according to Madeline Feinberg, Director of the Elder-Health Program at the University of Maryland School of Pharmacy in Baltimore.

Feinberg stresses that the most important step the elderly can take to avoid adverse drug reactions is to shop at the same pharmacy for every prescription and to ask the pharmacist to keep a medication history.

To help the elderly and those who serve them get a better understanding of the medications they are taking, the Administration on Aging has funded several

programs. Under a 3-year grant awarded by AoA in 1979, the Elderhealth Program trained pharmacy students to present educational programs on proper medication use to groups of seniors. This program continues to be funded, in part, by the Parke-Davis Company and promoted nationally as the corporation's Elder Care program. In addition, the University of Maryland School of Pharmacy produces a wide variety of brochures that address the use of generic drugs, over-the-counter medications, vitamin and nutritional supplements, and lowering high cholesterol. One of the school's most recent publications deals with travel and medications. To receive single copies of these brochures (free of charge except for postage), send a self-addressed, business size, stamped enveloped to Madeline Feinberg, Director, Elder-Health Program, University of Maryland School of Pharmacy, 20 North Pine, Baltimore, Maryland 21201. Large orders may be requested in writing or by calling (410) 706-3011.

AoA has also funded the development of a "brown bag" medicine review program offered through Area Agencies on Aging, State Units on Aging, health care providers, and community groups. In this program, developed by the National Council on Patient Information and Education (NCPIE), older persons are asked to collect all the prescription and over-the-counter medicines they are taking into a bag and bring them to a specified site -- usually a senior center or congregate meal site, where a pharmacist or physician volunteer examines the nedications.

During each review, the pharmacist looks for problem areas in multi-drug use, dosage mistakes, and medicine storage. This review also provides an older person the chance to ask questions about medications to ensure their safe and effective use. The NCPIE recommends such a review be undertaken annually.

The Brown Bag Medicine Review starter kit contains everything needed to conduct a medicine review for up to 50 people. The kit contains a detailed how-to manual, a supply of brown bags, educational brochures, posters for announcing the medicine review, medication review forms, publicity materials, and more. It is available from the National Council on Patient Information and Education for $45 (shipping and handling included). Send payment by check or money order to Brown Bag Starter Kit, NCPIE, 666 Eleventh St., N.W., Suite 810, Washington, DC 20001.

NCPIE also offers over 30 other educational resources to promote improved patient-health care provider communication about prescription medicines. A 4-page Resources List and Order Form is available free by writing to NCPIE at the above address.