Proper Use of Medications and Elderly

by Food and Drug Administration (FDA)

A brown paper bag may hold the key to safer use of medications, according to health experts.

"A 'brown bag checkup' is the single best thing that patients can do to avoid medication mistakes and cut down on unnecessary medications," says Douglas Paauw, M.D., professor of medicine at the University of Washington in Seattle. "But I would estimate that only about 10 percent of people actually do it."

The checkup involves putting all of your medications and over-the-counter products in a brown paper bag and bringing them into your doctor's office. The bag should include any over-the-counter or prescription drugs, herbs, vitamins, dietary supplements, and topical treatments such as ointments and creams. "This kind of checkup is a good idea for anyone who takes medication, but particularly for older people who are the most likely to be taking several medications," Paauw says. The average 75-year-old has three chronic conditions and uses five prescription drugs, according to a report from the Merck Institute of Aging & Health.

Researchers at Pennsylvania State University found that when adults ages 65 to 91 were asked to bring in the brown paper bag containing their medicines, the list of medications in the bag was more complete than their official pharmacy records. And people with worse health consistently had poorer matches between the brown bags and the paperwork.

"If not a paper bag, then write out a list and bring that in," Paauw says. You could also share the information with your pharmacist, who can check for drug duplications, interaction problems, inappropriate dosing, and whether each drug is being given for the right indication.

The idea is to have at least one health care professional informed about everything that you take. "This should be done at least every year and preferably more often," Paauw says. "Some of my patients do it at every visit."

When the bottles and tubes are spread out on the table, the picture becomes clear. "When someone pulls out 10 bottles, then something might not be right and we can make adjustments," Paauw says. The doctor can also see that your multivitamin with iron is the reason your thyroid treatment isn't working. "Both iron and calcium supplements can interfere with the absorption of thyroid medicine," says Paauw, who gave a talk on common drug errors at the annual meeting of the American College of Physicians in April 2006.

Stephen Setter, Pharm.D., associate professor of pharmacotherapy at Washington State University in Spokane, says doubling up on therapy is another common problem. "Someone may be taking two products containing acetaminophen," which raises the risk of liver damage. Other common problems include expired medications and medications that are no longer needed, but were never reevaluated.

After you and your doctor settle on what you should be taking, then the next thing is for you to know the name of your medication and what it's for, says Karen Gunning, Pharm.D., associate professor of pharmacy practice at the University of Utah in Salt Lake City. "If an older person has memory problems or difficulty with comprehension, a family member or caregiver could help," Gunning says.

Setter cites an example in which one of his older patients mistakenly thought her glaucoma medication was for treating headaches. "So she was taking her eye medication only when she had a headache, but she should have been taking it every day to treat her eye disease," Setter says. Experts say that it's important to understand your medications because you are more likely to take the medicine correctly, more likely to know what to expect from the medication, and better able to report what you are taking to your doctors and pharmacist.

"Keep the list of medications in your wallet and let a family member know that you have it," Gunning suggests. "Patients should be able to take that list out at the dentist's office, an appointment with a specialist, or in an emergency," she says. "But it's not uncommon for an older patient to come to the hospital and say that their doctor gave them a white pill and that's all they know."

John Lowery, 87, Delphi, Ind., carries his medication list in his wallet, keeps it on his computer at home, and gives a copy of it to his primary care doctor every time he sees her. His oldest son, 65, lives nearby and also knows about the list.

Sticking With the Plan

Setter, a pharmacist who helps older people manage their lives at home, says he often discovers that patients stray from their medication plan and that their doctor isn't aware of it. "I've seen a person's blood pressure go up because the patient hasn't been taking the medication, but the doctor thinks the drug isn't working," Setter says. "So a second medication is added or the dose is increased when the problem is really a compliance issue." Setter says that when this happens, he contacts the doctor and talks with the patient to reinforce the importance of two-way communication.

Robert Ferguson, M.D., chief of internal medicine at Union Memorial Hospital in Baltimore, says that intentional noncompliance with the regimen typically occurs because the patient can't afford the medicine or is worried about side effects. "When noncompliance is unintentional," Ferguson says, "it's usually because complying with the regimen became too difficult. It's so complex that it's too hard to keep it up."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.