Helping the elderly remember to take medications can be a daunting task. After all, when you get a call from your loved one’s doctor stating that their blood pressure is out of control or that their diabetes is not being properly managed, it can be pretty stressful. Don’t worry, however – there are a few measures you can take to ensure that the senior you are caring for is taking their prescribed medications both on time and correctly.
Strategies for helping the elderly remember medications include:
- Making a list of the medication. To assist in your senior’s medication management, make a list of all the prescriptions they take, as well as any over the counter medications and supplements they may be taking. It is important to get a list together and keep medications organized, instead of having a random assortment of pill bottles on a shelf or in a zip lock bag. A list is also helpful in a medical emergency because first responders will know what the person is taking, which reduces the chances of drug interactions.
- Having them take their medications at the same time every day. Doing so helps to build a routine. It also removes the need to remember different times for different medications. (An exception would be for a prescription, such as a diabetes medication, that must be taken at a certain time of day.) For example, the senior could take their prescriptions with their morning meals (however, they should avoid grapefruit and grapefruit juice if they do this). Or they might take them after brushing their teeth or before a shower, or even before bedtime.
- Giving them a pill box that’s labeled with the days of the week. A pill box is beneficial in that, if you are able to remove the medication from the original packaging for your senior, they won’t have to open possibly numerous prescription bottles every day. This makes it significantly easier for them to keep up with their medications and when to take them.
- Setting alarms: Having alarms set at certain times will remind the senior when it is time to take a medication. Alarms also help to ensure that all prescriptions are being taken. You can set them via the senior’s smart phone or you can use an automatic pill dispenser that comes with an alarm, like this one from MedELert.
- Asking your pharmacist for reminder tops. Reminder tops are an invaluable tool for helping people remember when they need to take their medication. After being set, the tops will ring at designated times, alerting your elderly loved one that it is time for their next dose.
- Getting a calendar to keep track of medications: Keeping a calendar is a great way to assist seniors (or anyone) with keeping track of medications ans when to take them. They are also handy for remembering when to refill prescriptions at the pharmacy. Be sure to get a list-type calendar or day planner with lines, so there is enough space to record prescription names and times to take them.
Medication Safety For Elderly
Improper use of medications causes 18 million emergency room visits per year.
Zed, Peter J. PharmD, Abu-Laban, Riyad, MD, Balen Robert, M. PharmD, et al: Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study, Canadian Medication Association Journal, June 3, 2008; 178 (12). doi:10.1503/cmaj.071594
Medication safety is extremely important for the elderly. As they get older and begin to take more medications (either prescribed or over the counter), there is a risk that some of the medications will provide an unwanted, unsafe reaction when taken in combination with each other. Here are a few tips to help promote medication safety for the elderly:
- Take medication as directed and prescribed by the doctor. It is very important to ensure that seniors take their medication in the way their doctor has instructed. This means not missing doses or choosing to stop taking a prescription drug without their doctor’s approval. Obviously, medication does not work if it isn’t taken, and chronic conditions like high cholesterol and high blood pressure cannot be managed if medication is not taken regularly.
- Keep a list of all prescriptions, supplements, and over the counter medications. As mentioned previously, it is important to keep a list of all medications, vitamins or other supplements, and over the counter pills (like Tylenol, melatonin, etc) that are being taken. The list should include the name of the drug, the dosage, and the number of times a day/week (or time of day) it should be taken. Not keeping a list can lead to disorganization especially if the senior takes several meds and supplements. Being disorganized could cause health problems as a result of either missing a dose or possible taking a dose more than once. As a cautionary tale – a lovely lady in my dad’s senior housing complex was diabetic. She took a dose of her medication, but later forgot that she took it. Worried about missing the dose, she took it again. Two hours later, after getting no response from her on the phone, her nephew had the facility staff check on her. They found the woman incoherent and semi-conscious in her living room and had to call 911.
- Learn what to do if a dose is missed. Should the senior take the drug as soon as they realize they have skipped a dose or should they wait to take it until the next time they are due to get it?
- Ensure that the senior is informed about the risk of potential interactions. As people age, they are a higher risk for dangerous drug interactions if they combine certain medications, especially if they have a medical condition that makes certain drugs harmful to them. Drug interactions occur when one medication affects how another medication works. Also, certain behaviors, such as consuming alcohol with medication can cause an interaction, as can eating certain foods or drinking some kinds of non-alcoholic beverages with medications. A 2011 study by Bushra, et. al, reported the following interactions:
- Grapefruit juice interacts with almost all drugs by changing how the drug is metabolized, which affects how the liver processes the medication. This increases the risk of adverse effects.
- Sevillian orange, pomelo and star fruit contain agents that inhibit drug metabolism.
- The cholesterol medication, lovastatin, should be taken with food to increase its absorption in the gastrointestinal tract, however it should not be taken with foods that contain pectin or oat bran which can affect absorption.
- High fiber diets can lower the effectiveness of simvastatin, ezetimibe, pravastatin and fluvastatin.
- The blood thinner, warfarin, can be affected by certain supplements and herbs.
- Vegetables that are high in Vitamin K (including broccoli, Brussels sprouts, kale, parsley, and spinach) and eaten in high quantities can change medication levels in the body. Here is a personal story – a patient of mine just told me about the passing of her father. He had been taking warfarin, and her sister – unaware of the potential for drug interaction and trying to keep him healthy – put him on a diet high in kale and spinach. He died of a stroke, brought on partly by the “healthy” vegetables which decreased the effectiveness of his warfarin blood thinner, leading to a blood clot and stroke.
- MAOI medications (antidepressant medicines) can cause a hypertensive crisis if taken with matured cheese, ripped bananas, red vine, yogurt, shrimp paste and salami.
- Anti-hypertensive medications should not be taken with orange juice because it has been shown to inhibit intestinal absorption. The senior also should not eat licorice candy or extract or drink licorice tea while taking a blood pressure medication because it has been shown to increase blood pressure.
- Milk products and calcium and magnesium supplements can reduce the effectiveness of antibiotics. Even adding a small amount of milk to coffee or tea can severely impair the drug’s absorption.
- Azithromycin (an antibiotic) absorption is decreased by 43% when taken with food.
- Coca-cola actually significantly impact (raise) the absorption of the pain medication, ibuprofen. Seniors should reduce their dosage if they drink Coke around the same time they take ibuprofen.
- Having caffeine at the same time as using a bronchodialator (asthma inhalers) containing theophylline increases the risk of drug toxicity.
- Prescription antihistamines are best taken on an empty stomach.
Elderly Medication Management Options
As people get older, taking medication seems to become a way of life. According to dailycaring.com, studies have shown that about 87% of seniors take at least one prescription drug, while 36% take 5 or more, and another 38% take over the counter medication.
With such a high percentage of seniors on medications, it is important to take measures to manage their prescriptions. Here are a few tips from dailycaring.com for elderly medication management options:
- Gather all medications, including over the counter medications, vitamins, and supplements into one centralized location. Keeping medications scattered in different locations of the home can cause seniors to lose track of prescriptions and miss doses. Try to mitigate this by keeping them all in one place.
- Make sure medications are stored properly. This is important to keep the medication safe for use. In general, prescriptions need to be stored in a cool and dry place to ensure optimum shelf life. Also, heat and moisture can negatively affect drugs, so they should not be stored in the bathroom in a medicine cabinet. *Note: If directed by your senior’s physician, make sure that certain drugs are kept in a refrigerated location.
- Create and maintain an up to date medication list. This is to prevent drug interactions. Knowing exactly what medications are in the home and what they are treating is crucial to medication management.
Medication Checklist For Seniors
Even the most independent of seniors can struggle with medication management. There can be too many things to keep track of and several different times for taking several different medications. In most cases, drugs names are too difficult to remember. Honestly, these problems can affect anyone. I can hardly remember the medication names for what I have to take for old injuries.
It is critical, however, for people to be able to keep them straight, especially if their prescriptions come from more than one doctor. We have all read stories about people who see several doctors and end up taking medications that react with each other because the physicians were unaware of what the other doctors were prescribing. A comprehensive medication checklist can save your senior’s life.
Here is a checklist for seniors to help them remember their medications:
- Maintain an updated medication list
- Translate handwritten prescriptions onto the list so they are legible
- For each medication, write the condition it is treating on each medication bottle
- Use the same pharmacy whenever possible to avoid drug interactions between prescriptions
- Understand the potential side effects of each medication and monitor for any possible drug or food interactions
- Put in place an easy way for managing medications on a daily basis – use a pill box, an alarm system, an app on the phone or some combination of these.
There are also a few things that need to be on a medication checklist to ensure that the elderly are taking their medications safely. Here is the information that should be included in a medication checklist things, according to caregiveraction.org:
- Name of drug for both generic and name brand medications
- Start and stop dates for time limited prescriptions (such as antibiotics)
- What the pill/capsule/liquid looks like – is it a pill or capsule? A liquid? What color is it? If it is a pill, what shape is it? Big or small?
- A record of any side effects experienced after taking a medication
- What condition the drug is treating
- Instructions for taking the medication – take it with food? Take it on an empty stomach? Take it at bedtime?
- When to take the medication
- What not to do when taking the medication
- Any over the counter medications and supplements, along with their doses
- Allergies to medications, along with any other allergies
- Drugs to which you experienced a negative reaction (couldn’t tolerate it) and what that reaction was (i. e.: “Keflex reaction – rash”)
- Recently completed prescriptions
- Name and contact info of the prescribers (physician, physician assistant, nurse practitioner, etc.)
- Name and contact info for the pharmacy that filled the prescription(s)
- Take this comprehensive medication list with you when you go to the doctor
- Keep a smaller, limited list of your medications in your wallet. Include just the drug name, dosage, and the amount taken daily, along with the pharmacy phone number. This will be invaluable if there should be a medical emergency because first responders will know what they can and cannot give you.
Technology – Smart Pill Dispensers And “Remember To Take Medication” App
Obviously it is not easy to remember every medication that needs to be taken. Thankfully, there’s an app for that too nowadays. Here are a few for you to check out:
1. Medisafe Meds and Pills Reminder App (for desktop, phone, and tablet applications – free): This app is awesome in that it is a simple app that can help manage numerous medications and multiple profiles. The app can also track someone’s prescriptions and remind them when it is time to refill their prescriptions. This helpful little app received 4 and a half stars out of 5 and has good reviews. It is available in both the App Store for Apple products and in Google Play for Android.
2. E-Pill Pocket Pillbox (vibrating pill timer reminder and dispenser): This is a product that is inexpensive and is a modern update on the traditional pill case (it was even featured on Doctor’s TV). The E-Pill Pocket Pillbox comes with four audible 30-second alarms to alert the senior when it is time to take a medication. It also provides a vibration alert at the same time. The snooze feature means the alarms will repeat up to three times. The E-Pill Pocket Pillbox can hold up to 32 aspirin-sized tablets and is small and light enough to fit into a pocket or purse. This handy pill case runs for about $25 (check price online here).
*NOTE: For seniors who have a hard time hearing, E-Pill also has a lockable dispenser with a voice alert that says, “Time to take your medications.”
3. MedMinder: MedMinder is a system for those who want a smart pill dispenser that offers reminders plus mobile alerts. The pill dispenser has 28 compartments (it is a 7 day pillbox), which means it can hold 4 daily doses of medication. When it is time to take a medication, the appropriate compartment flashes a light. If the person doesn’t remove the container, the MedMinder will alert them again with an audible alert plus a choice of digital reminders (text messages or emails) or a phone call. It even has its own cellular connection so that it doesn’t have to be connected to a phone line or internet.
The system can be programmed remotely by a caregiver or the senior’s adult child and can be set up to for remote monitoring and to alert these care providers if a dose is missed. It also generates monthly reports so caregivers can keep track of medication activity.
You can choose the unlocked version, but it also has a version with a safety lock feature so that children looking for candy (or seniors with dementia or Alzheimer’s) don’t eat medication by mistake.
The drawbacks: it not portable, it must be plugged into an electrical outlet. Also, the MedMinder system is fairly expensive and requires a monthly subscription fee of around $45/month (for the non-locking dispenser) to $65/month (for the locking dispenser) as of 2019.
4. PillPack: PillPack is an Amazon service that takes away the need for continually going to the pharmacy to pick up or refill a prescription. This service sorts the senior’s monthly prescriptions (including over the counter supplements) and puts them into easy-open packets. Each packet is clearly labeled with the day of the week and time of day the medication should be taken. PillPack will also handle creams, inhalers, and testing supplies for the senior.
The service and shipping is free – the senior simply pays their regular insurance copays like they do with a physical pharmacy (they will need to pay out of pocket for any non-prescription medications or supplements that they include in the monthly service). Need something ASAP? PillPack also offers 1 day service.
5. MyMeds Medication Management App (for the web, phone, and tablets – free): MyMeds sends digital-only reminders via email, text, or as push notifications to the senior’s inbox. It also allows the senior to connect between their health care team and their family or friends so their medications and doses can be monitored.
6. Did you know that you can get smart tops for your prescription bottles now? Pill Timer Reminder Tops record the last time the prescription bottle was opened and can be set with up to 24 reminders per day (the reminders can only be set to the hour, though – not to a more specific time, like 10:24 a.m.). The alarms repeat daily and the caps run on a LR 44 Button cell (included).
The caps will fit the included prescription bottle, but will also fit on a medication bottle with a “standard 33 mm” thread pharmaceutical closure.
They feature a flashing “missed dose” indicator, but a drawback is that they are not child proof.
Other varieties of Timer Caps have a stopwatch and a digital display showing the last time the bottle was closed. You don’t have to program them or set any alarms – the stopwatch starts automatically when the top is put back on the bottle. This helps seniors avoid taking a medication twice because of forgetting whether they took it the first time. It serves a secondary purpose of letting them know if anyone else has opened the medication (it is a theft deterrent).
Medication Services For Elderly
A few options exist for medication services for the elderly to help them manage their prescriptions so they can be more independent. These come in the form of visiting medication management services in which an aide or a nurse will assist the elderly in taking their medications and organizing them. Also, some in-home caregiver agencies provide medication management as part of their home care service.
You can see which agencies may provide this service by looking up your local Agency on Aging to see what is available.
Medication Management For Caregivers
In addition to the tools and services outlined above, there are a few other ways of providing medication management for caregivers and loved ones:
- Day labeled pill boxes can hold up to a one-week supply of medications. These are typically labeled with the days of the week and the period of the day (morning or breakfast, etc) in which the medication should be taken.
- Blister Packs: These are a relatively new way of packaging medications. The packs are prepared by the pharmacy and each pack contains one day’s worth of pills, or pills to be taken at a certain time, such as breakfast or dinner.
- Alarmed pill boxes: As mentioned in the medication app list, these give an alarm to remind patients of when to take medications.