The Dos and Don’ts of Medication Management for Older Adults
Reviewed By: Laureen Lopez Berry, DNP, FNP-C
Multiple prescriptions, busy days, and a tendency for forgetfulness do not mesh well in the world of medication management. It’s quite easy to lose track of which medications you need to take, which you have already taken, and where you placed your medication bottles. Research shows that almost 50% of seniors struggle with managing their medications due to issues with administration, sticking to a schedule, access, and more [1]. Although many can relate to the struggle of properly organizing and managing their medications, it is not a subject to take lightly. Medication management is one of the most important skills seniors can possess to ensure that they properly treat their conditions. This not only keeps seniors healthy and safe but can also impact their overall quality of life and sense of independence. Let’s learn more about the dos and don’ts of medication management for older adults, as well as some tips and tricks for becoming a medication management expert.
Understanding the Challenges: Why Medication Management Gets Complicated
You may think that remembering to take your medication every day is simple enough, but there is often more to it than meets the eye. This can get complicated for several reasons:
- Polypharmacy, or taking multiple medications at the same time, can make managing your prescriptions confusing. Adults over 60 years old who take more than one medication at a time are at risk for drug interactions, oversedation, dizziness that can lead to falls, and other complications [2]. They may also continue to take a medication prescribed to them in the past that is no longer needed, which increases the risks for dangerous health effects [3].
- Age-related factors can affect medication processing. The combination of the natural effects of aging, existing conditions that are more prevalent among seniors, and side effects puts seniors at high risk for age-related medication complications [4].
- Common barriers to medication adherence can make managing medications difficult for seniors. These barriers include a lack of understanding about the prescription and side effects, unclear instructions on administration, improper handling and storing, low health literacy, and a lack of support [5].
- Cognitive changes that often arise with age [6] may increase forgetfulness or a sense of clarity. This can make seniors confused about how to take their medications, where they last put them, how often to take them, and even what conditions they have.
Essential DOs: Medication Management Best Practices
Medication Reconciliation and Documentation
The first step of successfully managing your medications is knowing exactly what you take and for what conditions. To accomplish this, create a complete medication list of every prescribed medication, over-the-counter medication, herbal supplement, and vitamin you take. Include essential information about each medication, including how often it should be taken, for what condition or ailment, and any side effects you should be aware of. Update this list often; add any new medications you start taking and cross off any medications you stop taking.
While creating this list, questions about prescriptions may arise. Contact your healthcare provider for more information about these prescriptions and answers to your questions. You may also find the answer to your question on your prescription, such as the dose prescribed and administration instructions. Although paper prescriptions are traditional, digital medication documentation has become popular in recent years. Electronic prescriptions and digital medication documentation work like physical paper prescriptions, except they reduce the risk of errors due to illegible handwriting, expedite the time it takes for pharmacies to receive and start filling the prescription, and improve patient safety by automatically flagging contraindications between medications within the electronic system [7].
Organization Systems That Work
If your drawers and cabinets are filled to the brim with medication bottles, it’s time to find a more effective organization system. The method of organization that works best for you depends on how many medications you take and how often. Still, people tend to gravitate toward daily, weekly, and monthly pill organizers. Daily pill organizers work best for individuals who take different pills at different times of the day [8]. They typically have three compartments: one for the morning, one for midday, and one for night. You can store all the pills you take in the morning in the first compartment, the ones you take midday in the second compartment, and the ones you take at night in the last compartment. The downside is that you must take the time to fill the daily pill organizer every day before you take your medication.
Weekly pill organizers typically have seven compartments: one for each day of the week. The perk of this organizer is that you only have to fill it once at the start of the week, but the downside is that it may not be suitable for complex pill regimens [8]. Finally, monthly pill organizers have 31 compartments and only need to be filled once a month—but, again, they may not work well for complex regimens.
To ensure you don’t forget to take your medications, it’s a good idea to set up reminders. If you constantly have your mobile phone with you, consider setting repeating alarms or reminder notifications for when it is time to take your medications, and be sure to clarify what medication needs to be taken. Suppose you are not on electronics a lot. In that case, it may be more effective to set visual reminders, such as placing your pill organizer on your nightstand or bathroom counter where you will see it every morning, or placing a sticky note reminder on your fridge. For complex medication regimens, write out the full regimen in detail and place the schedule in a location where you’ll see it often.
Critical DON’Ts: Medication Management Pitfalls to Avoid
There are a few big “DON’Ts” to avoid at all costs when it comes to medication management. First, never adjust your medication dosage without speaking with your healthcare provider first. If you believe you don’t need to take as much (or any) of the medication anymore, speak with your healthcare provider for their professional advice before reducing or stopping the dose [9]. Likewise, always talk to your healthcare provider before increasing the dose, as this can lead to dangerous and potentially fatal reactions [10].
How you store your medications is also an integral part of safe medication management. Each medication has guidelines on storage recommendations, but typically, medications should be stored in cool and dry places, away from sunlight [11]. Optimal storage temperatures range from 59-77 degrees Fahrenheit, and if you store the medication in a temperature outside of this range, you could risk decreased effectiveness [11].
Another major “don’t” is sharing or borrowing another person’s medication. Perhaps you forgot to pick up your prescription from the pharmacy in time, but your friend takes a similar medication. Or maybe you want to save the cost of a doctor’s appointment by borrowing your friend’s medication for a condition you have. Although these scenarios may be tempting, it is extremely dangerous to borrow and share medications. Borrowing and sharing medications can increase the risk for harmful side effects, complications, dosing errors, and a delay in seeking personalized healthcare [12].
Finally, a pitfall you should be aware of is the potential danger of cutting pills. Splitting pills to half the dose is common, but there are a few things to look out for when doing this. First, always check with your doctor or pharmacist before deciding to cut a pill. Some pills are not meant to be cut in half. Typically, only pills with a score line across them should be split, although not all of these are intended to be cut [13]. If your doctor or pharmacist confirms that your pills can be divided, it’s important to use a pill splitter to do so. Never use a knife or try to break the pill in half yourself. It’s always best practice to speak to a healthcare professional about the specific medication before splitting it so they can decide if it’s appropriate and teach you how to go about this.
Working Effectively with Healthcare Providers
Before your next appointment with your healthcare provider, update your medication list and write down any questions you have about your prescriptions. This is the perfect time to clarify concerns about storage, administration, or reducing the amount of medications you take. If you see multiple physicians for different conditions, provide their information to your primary care physician so they can coordinate care and create a medication plan that works best for you.
Technology Solutions for Enhanced Medication Management
In recent years, technological advancements have made medication management easier for seniors. For example, medication reminder apps like Dosecast and medication/prescription management apps like Medisafe help you stay on top of tracking your daily medications and prescriptions, so you can feel confident and organized.
To alleviate the burden of unscrewing bottles of medication with pesky caps, automated dispensing systems make taking medications quick and easy. Automated dispensing systems store and dispense pills as well as track missed doses [14]. As always, ask your doctor which type of dispenser may be right for you. A similar product that may help is a smart pill bottle, which tracks the time an individual takes their medication and provides reminders or alerts when they are late for their dose [15].
Managing Specific Medication Challenges
Addressing Swallowing Difficulties
You should never feel embarrassed to tell your doctor that you have trouble swallowing pills. Many people struggle with this. Up to 40% of adults struggle to swallow pills [16]. There may be alternative routes to swallowing pills depending on the particular medication, such as liquid, chewable, or dissolvable forms.
Never crush up a pill before asking your doctor about it first. They can best advise whether or not this is safe. Crushing certain pills can be extremely dangerous and can even lead to death, as many pills have special coatings that prevent the medication from releasing all at once [17]. Crushing the pill destroys this coating and can allow a dangerous amount of the medication to release.
Work with your doctor and pharmacist to find alternatives or practice techniques that make it easier to swallow your medication. For example, they may suggest practicing swallowing the medication with applesauce instead of water [18].
Managing Complex Timing and Instructions
While some medications may not require specific timing requirements, others have ones you must follow for the medication to work properly [19]. Always ensure you fully understand the timing requirements of your medication before leaving your appointment. Your doctor is there to answer any questions you may have about when to take the medication, how many times a day to take it, if it needs to be taken with food, etc. To adhere to these requirements, set automatic reminders on your phone that go off at the same time every day. You can also utilize smart pill bottles, as mentioned previously, or ask a loved one to remind you to take your medication at the same time.
Likewise, just because a medicine says it should be taken “as needed” doesn’t mean there are no precautions regarding how often you should take the medication. Always read the label of the medication and ask your doctor about how often you should take an “as-needed” medication, how many pills are appropriate in one day, and any other requirements.
You should tie your medications’ requirements into your daily routine. For example, if certain medications need to be taken in the morning with food, it’s best to wake up around the same time each day and eat breakfast before taking your medication. This will ensure that you take the medication at the same time each day and that you don’t experience side effects due to taking it on an empty stomach. Likewise, if you have a busy schedule, create a plan for how you will take your medications on the go so you don’t forget or lose your medications while you are busy.
The Role of Caregivers in Medication Support
Having a caregiver help manage your medication can make a huge difference in the ease of this process. But how much help is too much help? Everyone’s experience is different, and therefore, the amount of help you may need depends on your conditions, lifestyle, and responsibilities. For example, if you have conditions that affect your memory, you may require extra assistance with taking your medications on time every day. Likewise, if you have issues with mobility or dexterity, you may need someone to open your medication bottles and help you take your medications. It’s important to have a conversation with both your caregiver and your doctor about what medication responsibilities you can and can’t handle so that you can make an appropriate support plan.
While your caregiver may be responsible for reminding you to take your medications or being present while you take them, it’s important to maintain a certain level of independence. Although your caregiver may be handing you your medications, try to stay present during the process and understand why you are taking the medication. Make sure to tell your doctor and caregiver about side effects you may experience.
There may be some times in your life when you can handle managing your medications on your own, and some when you’ll need the extra help. Both are okay.
Medication Safety and Emergency Preparedness
It’s essential to be aware of the warning signs of adverse reactions. Common adverse reactions to a medication include, but are not limited to, upset stomach, dry mouth, and drowsiness [20]. While these adverse reactions are common and may not be dangerous, more severe reactions can also occur, like fever, swelling, wheezing, and even anaphylaxis [21]. If you experience an alarming reaction, call emergency medical help immediately. In case of emergencies, it’s smart to carry a list of all the medications you are taking with you at all times. You can keep this list in your wallet or purse.
You’ll also want to consider how to maintain your medication schedule when your normal schedule changes. For example, if you are traveling, ensure you bring enough of your medication with you to last for the entirety of your trip, plus a few extra days. You never know when a travel delay could occur.
Finally, it’s important to understand how to properly dispose of your medications. If you must dispose of your unused or expired medication, drop it off at a drug take-back location or mail it using a drug mail-back envelope [22]. If you are unable to dispose of them these ways, check the FDA flush list and see if your medication is on it. If so, flush the medication down the toilet [22]. If not, follow these FDA directions for throwing away your medications.
Building Your Personalized Medication Management System
Now that you know the dos and don’ts of medication management, assess your current medication management techniques and which areas need improvement. Implementing improved organization and safety habits can take time and support, but they are essential for your health. For ongoing medication management support, reach out to Greater Good Health. We will be there for you every step of the way as you navigate your medication journey.
References:
- https://www.sciencedirect.com/science/article/pii/S1551741123003431
- https://www.hopkinsmedicine.org/health/wellness-and-prevention/polypharmacy-in-adults-60-and-older
- https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults
- https://www.fda.gov/drugs/tips-seniors/you-age-you-and-your-medicines
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11395048/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4906299/
- https://www.adsc.com/blog/how-an-electronic-prescription-works
- https://herohealth.com/blog/medication-management/what-is-the-best-type-of-pill-organizer/
- https://medlineplus.gov/ency/patientinstructions/000616.htm
- https://medlineplus.gov/ency/article/007287.htm
- https://www.baystatehealth.org/articles/medication-storage-temperature-guidelines
- https://bjgp.org/content/74/740/e183
- https://health.clevelandclinic.org/cutting-pills-in-half
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9891784/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9584037/
- https://www.health.harvard.edu/staying-healthy/when-pills-pose-problems
- https://www.medicalnewstoday.com/articles/55205#1
- https://www.health.harvard.edu/blog/two-tricks-make-easier-swallow-pills-201411137515
- https://www.bhf.org.uk/informationsupport/heart-matters-magazine/research/timing-of-medications
- https://www.bhf.org.uk/informationsupport/heart-matters-magazine/research/timing-of-medications
- https://www.mayoclinic.org/diseases-conditions/drug-allergy/symptoms-causes/syc-20371835
- https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know