Protecting the elderly from medication misuse - includes related articles on proper drug use and a survey on prescription drug use

FDA Consumer, Oct, 1986 by Bill Rados, Dixie Farley

Protecting the Elderly from Medication Misuse

As a person ages, proper health care can become increasingly complicated.

Take medications, for example. About half of us don't take them as directed. Medically speaking, such misuse is called noncompliance--a potential risk to anyone's health.

For the elderly in particular, say many experts, the health risk posed by drug misuse can be great. First of all, older people take more medications than other age groups. Eighty percent of people 65 and older have at least one chronic condition, which often means an extended medication regimen--frequently with several drugs. Studies show that noncompliance tends to increase with long-term drug therapy. This also may increase the opportunity for drug-drug and drug-food interactions and subsequent adverse effects. Also, older people are more prone to have adverse reactions and, when they do, the reactions are likely to be more severe.

Here's a look at how drug misuse may occur, especially in older people, and what can be done to help prevent it.

Taking the drug exactly as prescribed is crucial to its safety and effectiveness. Drug misuse may cause a drug underdose or overdose in a number of ways and for a number of reasons. An antibiotic may be stopped prematurely, for example, because the patient feels better. But if all the illness-causing bacteria aren't killed, the infection could recur, and the bacteria may be drug-resistant and therefore harder to eradicate. Or a patient may mistakenly take a drug twice, at the wrong time, or at improper intervals. Or someone may forget or feel too ill to take a drug or not refill a needed prescription because of a lack of money or transportation to a pharmacy.

A patient may even decide to reduce the drug dosage--against the doctor's instructions--on a notion that it's greater than needed or because of fears about the drug. A patient may go on and off a drug as a "test" of whether the drug is still needed, or a person may increase a dose thinking that, if some is good, more is better.

To take medicine properly, patients need to know how it could interact with foods, beverages--especially alcohol--and other prescription and nonprescription drugs. For instance: The antibiotic tetracycline shouldn't be taken with milk or other dairy products because the drug binds with the calcium in the food and is rendered ineffective. Other drugs, including certain arthritis medications, may need to be taken with food to reduce stomach irritation. A number of drugs can be extremely hazardous if taken with alcohol.

A further problem can arise if several doctors treat the same patient. Incompatible drugs or ones with identical active ingredients may be prescribed, or a drug for one condition might adversely affect the patient's other condition. Meanwhile, the doctors--unaware that other drugs are being taken--believe the patient is properly medicated.

Also, a person should never take someone else's prescription drug: Drugs are prescribed for an individual for a specific medical condition and, even though symptoms may be the same, the underlying causes--and the proper treatments--may be very different.

Because self-medicating with prescription drugs without medical advice can be hazardous, joining the physician and pharmacist as an active partner in one's therapy can be beneficial. The physician is expected to explain the patient's condition and treatment in clear terms, and the pharmacist is expected to explain a drug's proper use, but the patient has a duty, too: giving feedback. This may help identify factors in the patient's lifestyle or environment that might interfere with treatment.

How can a patient become an active partner? There are a number of ways:

* Be sure the physician knows about any nonprescription drugs being taken and about any drugs prescribed by a dentist, another physician, or other practitioner.

* Call the physician, or other health professional, promptly if new symptoms appear. Though they may seem unimportant, the symptoms may, in fact, be adverse effects of a food or drug.

* A patient taking many drugs or taking a drug over many years should periodically ask the doctor for a reevaluation of drug therapy, particularly if some change occurs or if unusual symptoms are present.

* Before an appointment, write a list of questions to ask andlist medical visits elsewhere since the last appointment.

* When a new drug is prescribed, be sure to ask about storage requirements, possible interactions and how to counteract them, adverse reactions and what to do if any occur, changes to expect in such functions as activity level and sleep, and what to do if doses are missed. Ask for written directions if the regimen is confusing or if a current drug is to be taken differently.

* Don't hesitate to ask that instructions be repeated.

* Family and friends can provide important support to a patient's adherence to treatment, especially in long-term illnesses such as heart disease or diabetes. A patient might want someone to go along on a medical visit to take notes or even to help ask questions.