Long-Term Care Planning and Prescription Drugs

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Here are some suggestions for safely planning prescription and non-prescription drugs as part of your long-term care planning. Older people take a lot of medications and vitamins, dietary supplements, herbal preparations, and other drug-store items that don't require a doctor's prescription.

Some people mistakenly think that if it's advertised on TV, it must be good for you. If it's new, it must be better. If it's sold without a prescription, it must be safe. If it's “natural,” it must be better than something created from chemicals. If it's been around for years, like aspirin, it can't hurt you.

For all of these beliefs, the reality is: Not exactly. Taking aspirin, for example, is sometimes used jokingly, as in “Take two aspirin and call me in the morning.” But overdoses of aspirin can kill, and even nonlethal doses can cause stomach bleeding and other problems.

Too many drugs for seniors?

With all these drug-promoting ideas in the culture, it might seem as though everyone follows the directions from the doctor, pharmacy, or package label very carefully. Not at all. People get into trouble when they take too many of the wrong medications or skip some that they should be taking and generally adopt a casual attitude about these powerful concoctions.

According to the U.S. Centers for Disease Control and Prevention, more than 700,000 ED visits every year are related to adverse drug events. And a growing epidemic of addiction to prescription medications is taking a toll on all ages across the United States.

Older people are particular likely to be subject to polypharmacy, the taking of a lot of drugs. They see many doctors, who prescribe many drugs without consulting the doctors who prescribed similar or other drugs. People often don't tell doctors about everything they are taking and not taking. When the doctor asks, “Are you taking your medicines?” the answer is likely to be “Yes,” when the reality is “Not so much.”

And the doctor may not ask if you're taking any other medications.” Even if the question is asked, people may answer with what they consider a truthful “No,” because they don't realize that all the over-the-counter items are in fact medications, not harmless concoctions.

It's certainly not patients’ fault if they are confused. Medicines come in brand names (the advertised versions) and generic preparations, which are cheaper but have harder names to remember. Hospitals have their own formularies (list of drugs they use), which may not be the same as the drugs used at home.

Using caution with certain drugs

Recognizing that certain drugs are potentially risky for older adults, the American Geriatric Society periodically updates a list called the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. This list contains 34 medications and types of medications that are “potentially inappropriate” for older people and can be replaced with safer or more effective medications or non-drug remedies. Some drugs are listed to be used only with caution.

The Beers List and other similar lists are not the final word on whether a particular drug is right for you or your parent. The drugs on the list have been approved by the Federal Drug Administration, so they are marketed legally.

But if you are taking one of these drugs or your doctor prescribes a new one, you need to review the choices and any alternatives. One of the drugs that the list says to avoid or use only with caution may in fact be the best choice for your specific condition. But unless you ask, you won't know why the doctor has recommended this drug instead of another one that seems to be less risky.

Getting medications right

You can do many things to make sure that you're taking the right medications at the right time in the right dose:

  • Keep an updated list of all your medications, prescription and OTC, and show it to every doctor at every appointment. Review the list at least once a year and certainly after a hospital stay.

  • Whenever a new drug is prescribed, ask why you should be taking it, what side effects to look out for, whether it interacts with any of the other drugs you are taking, and what to do if you miss a dose.

  • Read the label on the bottle. If the type is too small or the language too dense, ask the pharmacist for an easy-to-read version.

  • Follow the directions, and if you don't understand them, ask the doctor or the pharmacist. Sometimes medical professionals think that directions are clear (“Take this on an empty stomach”) when they are not. Take the drug for as long as you've been told — not for a longer or shorter time.

  • Report any changes in your medical condition, which may be related to a new drug. If the reactions are serious, such as an extensive rash, difficulty breathing, or swelling in your throat, they count as emergencies. Call 911 or go the nearest ED.

  • Throw out any unused medications. Don't give them to anyone else, and don't take medications that were not prescribed for you.

Insurance may cover certain drugs and not others. Even with insurance coverage, drugs can be expensive.

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