When our office becomes the guardian or conservator of an individual, one of our responsibilities is to maintain regular contact with the client to ensure that they are both physically and emotionally healthy. This is something that I and my staff take very seriously, not only legally but morally.
There are times we receive calls from family members who have not heard from their loved one and ask us to do a safety check. Other times we may receive a call from a hospital or nursing facility asking us to provide some information they may need to develop an appropriate treatment plan for the client. Recently, there was an incident that elevated my concern for seniors around medication compliance, mixing and interactions.
One of our clients suffered a medical emergency outside of their housing situation which required hospitalization. Our office was asked for information on a number of issues and one of them being an updated medication list.
Upon entering our client’s apartment and gathering the medication bottles, I noticed that each bottle had tablets and capsules of differing colors and shapes. I opened one bottle labeled “Warfarin” (a powerful blood thinner) and found five different medications inside, none of which was the prescribed drug listed on the bottle (the photo above is the actual bottle and medications contained inside of it).
The medications inside the bottle were:
Bupropion (a psychotropic used to treat depression)
Gabapentin (an anti-convulsant and treats nerve pain)
Fluoxetin (treats depression and panic diorder)
Lisinopril (treats high blood presure and heart failure)
Risperdone (treats schizophrenia and bi-polar disorder)
Three of the five are considered psychotropics, one having serious abuse potential and another used for cardiovascular stability. All of these medications are capable of producing serious side effects if taken inappropriately.
This was not the first time I have encountered this but by far it was the most serious case I have seen. For me, this begged the question -- just how prevalent is this problem and how does this affect our seniors?
In speaking with some medical professionals it turns out that medication errors in the home cause harm to at least 1.5 million seniors annually at a cost of over $4 billion to the health care system. The numbers are so high because of the sheer number of drugs involved. More than 76 percent of adults over the age of 60 take at least two prescription drugs and 37 percent take five or more, according to the National Center for Health Statistics.
We live in a time that seniors are living independently for longer periods of time while their medical needs grow and the medications they are prescribed are more complex, resulting in more mistakes. Other issues that account for the surge of medication errors include inappropriate storage, problems opening bottles, using multiple pharmacies and seniors being unreliable reporters about the medications they are on when seeing multiple doctors for specialized healthcare.
Besides the obvious problems such as overdosing and possible toxic reactions, there is also a chance that the symptoms caused by medication misuse could result in a misdiagnosis. Mixing certain medications can cause memory loss, confusion and changes in mood and personality mimicking the symptoms of Alzheimer’s disease.
Seniors are especially at risk of developing dementia-like symptoms because their bodies are not able to process medications as well as a younger person’s does. A lower metabolism, less lean body mass, less water in the body, and decreased kidney and liver functions make it harder to clean out toxins. As a result, drugs can accumulate in the body. Over time, this becomes toxic and the side effects become magnified.
One other note about the client’s apartment I visited, besides the jumbled prescription medications, the floor was littered with empty vodka and rum bottles. As if misuse of prescriptions drugs is not enough, adding alcohol to the mix elevates the dangers of a fatal outcome.
Most of us are acutely aware that alcohol can damage the liver, but as we grow older, drinking becomes increasingly associated with heart disease, cancer, diabetes and depression – and for the elderly, it increases the risk of falls and injuries around the home.
As I mentioned earlier, seniors, on average, take multiple prescription and over the counter drugs. When alcohol is added to this mix, seniors are far more likely to experience side effects such as drowsiness, nausea, headaches, fainting, falling, internal bleeding and other stomach problems. Alcohol may even make certain medications less effective.
Aaron White, a neuroscientist who co-authored a recent study about the mixing of prescription and over the counter drugs and alcohol, stated, “Alcohol can increase blood pressure, which could be counterproductive if one is taking medications to control blood pressure. Mixing diuretic medications with alcohol, which is also a diuretic, could contribute to dehydration. Mixing alcohol and other sedatives, like sleeping pills or narcotic pain medications, can cause sleepiness, problems with coordination, and potentially suppress brain stem areas tasked with controlling vital reflexes like breathing, heart rate, and gagging to clear the airway. Alcohol increases insulin levels and lowers blood glucose, so combining alcohol with anti-diabetic agents that regulate glucose levels could cause an undesirable drop in blood sugar. And, over time, alcohol can contribute to insulin insensitivity.”
White’s study estimated that interactions between alcohol and prescription medication may be responsible for at
least 25 percent of all emergency room visits, not to mention the less serious interactions that go unreported.
One other thing about alcohol. Many seniors take acetaminophen for body and joint pain. Here’s something else to consider, chronic alcohol use depletes the body of toxin-fighting glutathione which lowers the body’s defense even against the smallest does of acetaminophen. Even moderate “social drinkers” who ingest “safe” doses of acetaminophen (2-6 pills in a 24-hour period) are at risk for acute liver failure.
So, if you are taking care of a loved one, here are some tips for reducing the likelihood of making a medication mistake:
Check the label to verify that the correct medication is in the bottle. Most pharmacies today list a physical description of the medication on the label. You can also go to the internet and find many reputable sites that can help you identify a medication by the markings and color.
Keep the medications in the original containers
If you have concerns about the dosage or see side effects after the medication is taken, call the doctor or the pharmacist
Read and keep the patient information sheet that is provided with the prescription
Never share or use another’s medication even if it is the same name and strength
Know what supplements are being taken. Many “natural” or over the counter supplements can interact with prescription medications that seniors are taking
Always use the same pharmacy
Alcohol should never be used with medication
Create a list of medications and keep one on the refrigerator and share them with family members and even your attorney if guardianship is in place. This list should include:
Client’s full name and date of birth
The drug’s name
Directions for the medication’s use
What liquids should be used when taking the medication
Pharmacy and health care providers
Family Emergency contact information
Managing medication as a senior and for a senior is a complicated business and mistakes can happen when it is least expected so it pays to be prepared for such an event.
Next week’s blog, titled, “Benzodiazepines – The Other Drug Epidemic for Seniors”, will explore a class of drugs that many say are over-prescribed and under scrutinized.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability using powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.