Study: Older adults with chronic illness often struggle to manage several prescribed drugs at a time

Mar 20 2010

People with chronic illness often struggle to manage several prescribed drugs at a time. It's overwhelming when the vials, bottles and inhalers bulge from your medicine cabinet and you're confused about which drug is which, or when to take what.

More medications seem to come with the territory as people get older. "Prescription drug use is heavily concentrated in people over 55 to 65," says Steven Findlay, senior health policy analyst at Consumers Union.

Of older adults, 12 percent use 10 or more medications per week, according to a new report from the Center for Technology and Aging (CTA).

Even though people "know" they should take their pills as directed, for the most part, they don't. But so much is at stake when people mix up their medicines or skip or take incorrect doses, study after study has found.

People who stick with their blood pressure medicines and take them as prescribed significantly lower their risk of heart attack and stroke. For people with diabetes, staying on top of their medication means better blood sugar control and fewer long-term complications - like serious infections and vision problems.

Medications are powerful tools and also pose powerful risks. Every year, anticoagulant drugs - blood "thinners" like Coumadin (warfarin) used to prevent blood dangerous blood clots - cause bleeding episodes, a small portion of them fatal, when people mistakenly take too high a dose. So getting your medication routine down is critically important.

When You Have Lots of Meds

Greg Duggins, a medical biller in Garrison, N.Y., developed hepatitis in the early 1990s. His health deteriorated to the point where he underwent a liver transplant in July 2008.

Duggins realized that after the transplant he would have to take a host of medicines - including immunosuppressant drugs to prevent his body from rejecting the new liver.

"When I was in the hospital [taking my meds] the nurses just held my hand while they quizzed me," he recalls. He was able to repeat their instructions, which included complex schedules to allow him to taper dosages safely rather than stopping certain drugs too abruptly. No problem, he thought.

Then it was time to leave the hospital with his box of medicines.

"When I got home, I realized that I didn't know a multivitamin from an immunosuppressant," Duggins said.

So, How Do You Sort Out Your Meds?

Don't guess when it comes to taking your medication.

Make sure you leave the doctor's office knowing the name of the drug, its strength, how much to take and how to take it. Ask WHY you're taking the medicine, and not only that, what the drug should do and how long it should be before you see results.

While you're in the doctor's office or pharmacy, take notes. Enlist a family member or friend as a second set of ears when you're learning about your meds.

"Before discharge, they asked me to bring a family member," Duggins says. "My sister Linda is a stickler. She took copious notes." about all the drugs he would need to take. Of course, you can take your own notes during an appointment as well.

An online search led Duggins to a program that allows users to create their own drug schedule at home, complete with visual aids to avoid mix-ups. He downloaded a new form and filled in each of his own drugs one by one. Now he has a clear timetable to work from.

"I created an account; that's an option. The first page asked me to list drugs and it showed me pictures and what the drugs are for. The program gives brand names and generic names."

You can access the free MyMedSchedule program online, in English or Spanish.

Behavior changes like people using pillboxes organized by day of the week or time of day - ¬or doctors reducing the number of daily doses or by prescribing multiple medicines with matching time schedules ¬- can help people take their medicines as needed, a recent University of Missouri study found.

A variety of online and electronic tools and aids exist to help keep multiple meds straight: see the sidebar for some examples.

For many people, low-tech methods work every bit as well: jotting down instructions on a notepad or checking off drug dosages on the refrigerator calendar. If you can connect your medication-taking to habits you already have - like taking daily doses when your brush your teeth in the morning - remembering becomes easier.

Do You Still Need This Drug?

Are you supposed to take all these drugs for the rest of your life? Maybe you don't need all of them or you and your doctor have fallen into a habit of automatically refilling them.

Greg Duggins still has his big medicine box but it's no longer as full: he's been weaned off several drugs and now takes "just" six different meds to stay the course.

"If people are taking multiple medications on a regular basis, they need to have an annual check-up," says Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations. In fact, she says, for patients on Medicare, "Those who are eligible will get a comprehensive medication review on an annual basis, starting [this year]. But even if it's not a covered benefit, you need to sit down and have a comprehensive medication review every year."

Taking the complete list of your drugs to your appointments offers an opportunity to raise questions and make sure that the medications you're taking are still right for you today.

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