If you have been a regular reader of our blogs, you are well aware that we continually point out that we are an aging society. Because of this, we also point out that given the costs of long term care facilities, more and more older Americans are remaining in their homes with family members or outside home-care providers checking in on them regularly. This blog is aimed at those family members who provide supervision to their elder loved ones who live alone. The subject of this blog is our concern about accidental medication mistakes.
When our office becomes the guardian 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 our staff take very seriously, not only from a legal standpoint but also a moral one.
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 who has been admitted. Recently, there was an incident that elevated our concern for seniors regarding medication compliance, medication errors and interactions.
One of our clients suffered a medical emergency outside of their housing situation which required hospitalization. This client had no immediate family, so our office was asked for information on a number of issues with one of them being an updated medication list.
Upon entering our client’s apartment and gathering the medication bottles, our staff noticed that several bottles had tablets and capsules of differing colors and shapes. We 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.
We used an online medication reference guide to identify the medications the bottle contained. They included:
Bupropion (a psychotropic used to treat depression)
Gabapentin (an anti-convulsant and treats nerve pain)
Fluoxetin (treats depression and panic disorder)
Lisinopril (treats high blood pressure and heart failure)
Risperdone (treats schizophrenia and bi-polar disorder)
Three of the five are considered psychotropics, one having 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 we have encountered this but by far it was the most serious case we have seen. 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.
As stated earlier, 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 our staff visited, besides the jumbled prescription medications, the floor was littered with empty vodka and rum bottles. As if misuse of prescription drugs is not bad enough, adding alcohol to the mix elevates the possibility 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 we 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, states:
“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 bottle to verify that the correct medication is in it. Most pharmacies today provide a patient sheet with a picture of the medication on it. The internet also has some great sites for identifying medications.
Make sure you have the appropriate HIPAA documents in place with your loved ones medical providers and pharmacies so if there is a question, you can get a quick answer.
Talk to your loved ones about the importance of keeping the medications in the original containers.
Make sure the medications are those that belong to your loved ones. Many seniors share medications and this can be a problem since they are prescribed for the specific individual.
Is your loved one taking over the counter supplements? If so, some of these can have harmful interactions with prescription medications. For example, one of the most prescribed medications for seniors is warfarin, a blood thinner. Warfarin is known to have negative interactions with supplements such as CoQ 10, Green Tea, Ginseng, St. John’s Wort and Vitamin E.
Always use the same pharmacy.
Alcohol use should be avoided.
Create a list of medications (see our printout below).
Most pharmacies today provide med packs where all dosages are in one container. This is helpful to all concerned and limits the chances of a mix-up in medication.
Below is a handy medication chart that can be downloaded and printed out. You can list all your medications on this chart and place it on the refrigerator or in a safe place in case of an emergency.
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.
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 through the use of 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.