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Medication Errors in Senior Care

Medication Errors in Senior Care - Minimizing the Risk in this Population

by Don Drake, Connelly Law Offices, Ltd. 3.7.24

Medicaid Planning Rhode Island

"At Connelly Law Offices, we understand that being appointed as a guardian for an individual is a significant responsibility, and one of the most crucial aspects of this responsibility is to maintain regular contact with the ward and their healthcare and homecare providers to ensure that they are not only physically but also mentally healthy," said professional fiduciary and certified elder law Attorney RJ Connelly III. "Our team takes this task very seriously as we recognize that it goes beyond just fulfilling a legal obligation – it is also a moral obligation. Therefore, we want to ensure that every ward under our guardianship receives the appropriate care and attention required from those healthcare professionals we work with to maintain their well-being."

"One of the many responsibilities of a guardian is to perform a variety of roles to ensure the safety and well-being of their clients," continued Attorney Connelly. "For instance, we often receive calls from concerned family members who have not heard from their loved ones and ask us to facilitate a safety check. In other cases, we may be contacted by hospitals or nursing and rehab facilities requesting information about our clients to help them develop an appropriate treatment plan once they return to their homes. This could involve providing details about their medical history, current health status, providers, family members, and other relevant information. However, one growing concern we have observed among seniors who have chosen to age in place is the issue of safe medication management."

Medication Mix-ups

Without proper oversight, seniors may accidentally take the wrong medication, miss a dose, or take too much of a certain medication. These errors can have egregious consequences and may even be life-threatening. It is essential for guardians and caregivers to ensure that their clients are taking their medications appropriately and to seek help from healthcare professionals when needed.

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Actual photo of med bottle contents

A few months ago, one of our clients encountered a medical emergency while in the community, which led to their hospitalization. Since the client had no immediate family, our office was contacted to help gather some personal belongings and medications for them. As part of this process, we collected the client's medication boxes and bottles so the providers could better understand their medication regimen.

When our staff arrived at the client's apartment, they noticed several bottles had tablets and capsules of varying colors and shapes. Upon investigating further, we opened a bottle labeled "Warfarin," a potent blood thinner, and found five different medications inside. None of these medications matched the prescribed drug listed on the bottle. We turned to an online medication reference guide to identify these unknown medications. They included:

  • Bupropion (a psychotropic used to treat depression)

  • Gabapentin (an anti-convulsant and treats nerve pain)

  • Fluoxetine (treats depression and panic disorder)

  • Lisinopril (treats high blood pressure and heart failure)

  • Risperidone (treats schizophrenia and bipolar disorder)

It came to our attention that all these medications could produce serious side effects if taken inappropriately. This was not the first instance of such a situation, but it was, without a doubt, the most severe case we had ever encountered regarding mixed prescription medications. Our office immediately contacted the healthcare professionals regarding what we found.

An Increasing Problem

"Healthcare providers have told me that medication errors in the home are causing harm to at least 1.5 million seniors annually," said Attorney Connelly. "This is resulting in a cost of over $4 billion to the health care system. The numbers are indeed concerning and alarming due to the sheer number of drugs and seniors involved in these errors."

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Seniors consume medications more than any other group

The National Center for Health Statistics has reported that over 76 percent of adults over the age of 60 take at least two prescription drugs, and 37 percent consume five or more. As seniors live independently for more extended periods, their medical needs increase, and the medications they are prescribed become more complex, leading to more mistakes.

"Inappropriate storage of medicine, difficulty opening bottles, using different pharmacies, and seniors being unreliable reporters about their medications when seeing multiple doctors for specialized healthcare needs are some of the issues that account for the surge in medication errors," stated Attorney Connelly.

Medication misuse can lead to overdosing and possible toxic reactions, which can result in a misdiagnosis of the symptoms. Mixing certain medications can cause memory loss, confusion, changes in mood, and personality presentations that mimic the symptoms of Alzheimer’s disease.

Seniors are at a higher risk of developing dementia-like symptoms because their bodies are not able to process medications as efficiently as younger people. A slower metabolism, less lean body mass, less water in the body, and decreased kidney and liver functions make it harder to eliminate toxins. As a result, drugs can accumulate in the body and, over time, become toxic, magnifying the side effects.

Apart from the issue of jumbled prescription medications, our staff also observed that the client’s apartment was littered with empty vodka and rum bottles. Adding alcohol to the mix elevates the possibility of a fatal outcome.

Putting Safeguards in Place

"In the United States alone, approximately 7,000 prescription medications and an infinite number of over-the-counter drugs are on the market," stated Attorney Connelly. "To add to the complexity, there are also thousands of alternative health supplements, herbs, ointments, and concoctions that people use frequently to alleviate their health concerns. Due to this diverse range of available options, preventing every medication error is nearly impossible. However, certain precautions can be taken to minimize the risk of mishaps."

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Have a conversation

Have a conversation

Discussing the prospect of caring for our loved ones when they are aging or dealing with health issues can be an emotionally challenging experience. This is because it often involves admitting that those who provided for us when we were young and strong now require our support and care. It's a difficult realization to face, as it can trigger feelings of sadness, grief, and anxiety about what the future holds for them and us. However, taking the step to care for our loved ones in their time of need can help improve their physical and mental health and give us more time to cherish the moments we have left with them. While it may be hard to confront the reality of aging and mortality, providing care for our loved ones is a selfless act of love and compassion that can bring us closer together and create lasting memories.

Start with a List

It is essential that the list is accurate and includes all prescription drugs, over-the-counter medications, and supplements. This is crucial because certain supplements, which may seem harmless since they can be bought without a prescription, may interact with prescription medications, which can result in serious consequences. To illustrate, we will examine some of the most prevalent supplements and prescription drug interactions.

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Read the labels and directions

Read the Labels

It is essential to be aware of the contents of over-the-counter medications that you are taking. For instance, some over-the-counter cold medications contain acetaminophen, a common pain reliever, and fever reducer. However, it is also present in other medications like Tylenol. Without realizing it, a person could end up taking more than the recommended dose of acetaminophen, putting themselves at risk of liver damage. Taking too much Tylenol can be highly toxic to the liver and may even lead to liver failure. Therefore, it is advisable to read the labels of all medications carefully and check for the presence of acetaminophen to avoid any potential harm.

Clean up the Closet

As seniors age, they may develop multiple health conditions that require them to visit different doctors. Each doctor may prescribe different medications for the same or various conditions, leading to seniors having to manage a handful of pills daily. This can be confusing, especially if some of the medications are generics that look different. Seniors may mistake one medication for another, leading to potentially dangerous consequences. Therefore, it is important to keep track of all medications prescribed by different doctors and ensure that they are organized, clean, and easy to access. This can help seniors avoid confusion and take the right medications at the right time. A messy medicine cabinet can lead to accidents, missed doses, and other complications. By keeping track of medications, seniors can stay on top of their health and avoid potential issues.

Use the Pharmacist

It is important to have a comprehensive list of all the medications and over-the-counter drugs that you are taking. Once you have such a list in place, it is advisable to consult with a pharmacist. A pharmacist has the expertise to identify any duplications of prescriptions or over-the-counter medications you might be taking.

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Discuss with the pharmacist

For example, a senior citizen was having trouble sleeping and was taking Tylenol PM. Her cardiologist suggested that she take Benadryl without knowing that she was already taking Tylenol PM. The senior complained of feeling tired and sluggish, which resulted in another doctor's appointment and additional bloodwork. Since a senior's body is less efficient than a younger person's, the excess medication stays in the system longer.

A pharmacist can identify such issues and provide professional advice. Hence, it is always recommended to consult a pharmacist to ensure you take the proper medications and avoid unnecessary complications.

A Fist Full of Pills

As seniors tend to take a large number of medications, swallowing them can sometimes become a daunting task, leading to medication non-compliance. However, there are several alternative solutions to this issue. For instance, certain medications come in liquid form, which can be easier to swallow. Alternatively, some medications can be crushed and mixed with soft foods such as applesauce or pudding, making them palatable.

Do Not Make Changes on Your Own

It's possible that the Tylenol PM and gabapentin your father is taking is making him feel drowsy or that the diuretic your mother takes at night is making her wake up frequently to use the bathroom. However, it's not advisable to adjust the timing of their medication intake on your own, as their prescribed timing may have been determined for a significant reason. Conversing with your healthcare providers is important to ensure that any necessary adjustments are made safely and effectively.

Pill Boxes work

As people age, it's common to require medication to help manage their health. However, taking multiple pills can become a daunting task, especially for seniors who may struggle with mobility, memory, or vision issues. That's where pillboxes come in - they offer a simple, reliable solution to organize and manage medications.

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Pill boxes do work for seniors.

Pillboxes come in various sizes, colors, and designs to meet the needs of different individuals. Some even go beyond the traditional box and incorporate advanced features like alarms and voice reminders to help users stay on track with their medication schedules.

In addition, many pharmacies now offer pre-packaged medications in blister packs or pre-filled cups. These pre-packaged medications simplify the process of taking medicines for seniors, help their loved ones keep track of their medication schedule, and ensure they are being taken on time.

Overall, pillboxes and pre-packaged medications are practical and effective solutions for seniors needing multiple medications. By simplifying the medication management process, these tools can help improve medication compliance and, ultimately, seniors' overall health outcomes.

Seek Outside Assistance

In recent years, home healthcare agencies have become increasingly popular for individuals who require medical assistance but prefer to remain in the comfort of their own homes. One of the primary services provided by these agencies is medication management, which involves filling pillboxes and monitoring medication compliance.

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Home Health Aides can be employed

While private nurses are also an option for medication management, they can be expensive, costing upwards of $100 or more daily. On the other hand, home healthcare providers typically charge around $20 an hour for similar services.

It's important to note that not all caregivers are equally qualified to handle medications. Before hiring a home healthcare provider, one must check what training their caregivers have undergone and what supervision process is in place. This can help ensure that medications are administered safely and effectively, minimizing the risk of adverse reactions or other complications. (Our next blog will discuss issues associated with poorly trained or unqualified home health agencies and how to find the best providers.)

A Final Word

"Proper medication management is crucial in helping seniors stay independent and in their homes for as long as possible; however, managing medication for seniors can be a daunting task, given the potential risks and complications associated with medication errors, adverse drug reactions, and other related issues," said Attorney Connelly. "As a caregiver, it's essential to stay organized, keep track of medications, and stay in touch with healthcare providers to ensure your loved one receives the proper medications at the right time and in the correct dosage. By taking these steps, you can help them maintain their health, independence, and dignity while providing the care and support they need to thrive."

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Please note that the information provided in this blog is not intended to and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise you to consult your attorney, professional fiduciary advisor, or medical provider.

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