By Lon Pinkowitz, EVP FuturAge Consultants, Advisor CCAL
Medication errors are costly and often life-threatening. More than one third of med errors in the US involve patients over 65 for myriad reasons beyond the easy leap to cognitive impairment. Given the reality that elders are often taking at least six to eight medications to address their co-morbidities, the opportunities for medication errors are alarmingly high.
The following list, compiled from over a decade of involvement with aging parents, in-laws, and residents of independent and assisted living communities, though categorized with benign titles, can have serious – even deadly consequences.
The wheel-of-fortune method: My Mother, who remained cognitively sharp until her death at 86, when in her mid 70s and living in Florida, consolidated her seven medications and my father’s nine prescriptions on an attractive lazy-susan storage tray in her kitchen cabinet. My wife and I learned about this during our quarterly visit to Florida when my mother reminded my father that it was time to take his Aricept. Yes, that sense of alarmed consternation you just felt duplicates our reaction to my mom asking a man with Alzheimer’s, albeit early stage, to spin the wheel-of-fortune, find his medication and self-medicate. After we all had an intense conversation about the dangers of this practice, my mother felt we were over-reacting, but agreed that she would at the very least separate his medications onto his own lazy-susan. This began our campaign to have them move to New Jersey to an independent living community near us.
Efficiency trumps sensibility: My father-in-law was living in an excellent assisted living community near us. Although afflicted with Parkinson’s, he remained cognitively bright and analytical. The assisted living offered medication management, which he insisted he did not need. Given the additional expense involved with this service I opted to monitor his self medication by counting his pills every time we visited (4 times a week). Every visit the pill counts were on track. The pills he took three-times a day were diminishing in threes, as were the other medications based on their dosages. One evening we received an emergency phone call that he had been taken by ambulance to the hospital displaying highly erratic vital signs. Once he was stabilized I asked him if he had forgotten to take any of his medications that day. He assured me that just as he always did, he took them all at lunch. “But what about the pills you take at breakfast and dinner?” I asked. He looked at me pityingly for having missed the obvious. “I take all my pills once a day, at lunch; it’s so much more efficient.” We started him on medication management the day he went home from the hospital.
Waste not want not: Having lived through the great depression, our parents were very frugal, at times dangerously so. If my mother received a new prescription, or a new dosage, she remained reluctant to throw out her old prescription. “After all, it’s medicine, not poison; and medicine is expensive.” You can see how this concept leads to emergency room visits.
Self-reporting can lead to self destruction: People in general do not do a very good job of self-reporting medical symptoms, medications they take, and most often supplements they take. The elderly reside at the high end of this spectrum. My mother, returning from a three-day sojourn to the hospital had been given a new prescription for a blood thinner, which I picked up at the local pharmacy. Handing it to my mother I asked if the doctor had advised her to stop taking her daily aspirin dosage, as well as vitamin E. She assured me he had not. “Did you tell him you take them every day?” I inquired. “He didn’t ask”, she explained. I responded in as calm a voice as I could muster,”since they are both blood thinners, there is an excellent chance that you can hemorrhage; please call him.” She did; he said don’t take them; we avoided a potential return trip to the emergency room.
This list could continue ad infinitum. Rather, let’s consider how to diminish the opportunity for disaster. If an elder is living at home, consider medication management devices, or if affordable, a home health care agency that can help with medication management. If in an assisted living community, be sure to investigate their medication management services. It may help preserve your loved one, and your sanity as well.