Your Guide to Understanding Medication Management

When illness strikes, understanding your medications is key to managing symptoms and recovering for optimum well-being.

What Is Medication Management?

After a surgery, diagnosis of a chronic condition, or time spent in the hospital for a period of sickness, it’s likely that medicine will be prescribed. Whether this medicine comes home with you or needs to be picked up at the pharmacy, there will be detailed instructions to follow. Medication management is organizing medicines and creating a system so that pills and other forms of medicine are taken at the appropriate times and with correct foods and drinks and not forgotten.

As people age, health care providers may recommend anything from prescriptions to over-the-counter remedies in the form of supplements, liquids, creams, vitamins, eye drops, or pills to improve overall health and even longevity.

While the intent behind medicines is improved health, there can be risks and those increase with the number of medicines and other supplements being taken by an individual.

Understanding Your Medications

An estimated 100,000 Americans ages 65 and older are hospitalized each year for adverse drug reactions, according to a study published in the New England Journal of Medicine, but other sources estimate a much higher number.

According to HealthinAging.org, “People 65 years and older take prescribed medications more frequently than any other age group in the United States. Most older adults take several medicines to treat chronic illnesses. Healthcare providers may also prescribe medications to older adults to help prevent certain illnesses.”

Most of the time, medication can be a considerable benefit to those who have been prescribed a drug by their doctors to help with a specific ailment. Yet medications do have side effects and must be taken properly in order to get the benefits and avoid any downsides.

According to the National Center for Biotechnology Information (NCBI), which is part of the United States National Library Medicine, a branch of the National Institutes of Health, there are “close to 6,800 prescription medications and countless over-the-counter drugs” available in the U.S. as of late 2021. In addition to these, there are “thousands of health supplements, herbs, potions, and lotions used by the public regularly to treat their health problems.”

Not only can mistakes be made when medicines are prescribed, but there can be chances for poor interactions between substances. “Each year, in the United States alone, 7,000 to 9,000 people die as a result of a medication error,” state the authors of the NCBI’s “Medication Dispensing Errors and Prevention” report. “Additionally, hundreds of thousands of other patients experience but often do not report an adverse reaction or other medication complications.”

Not only do these medication mix ups cause physical and psychological pain, the overall cost is in the billions.

Common Medications & Errors

Some medicines are prescribed more often than others.

The Centers for Disease Control and Prevention (CDC) found that in 2016-2017, “Among U.S. adults aged 40–59, the most commonly used types of prescription drugs in the past 30 days were antidepressants (15.4%), lipid-lowering drugs (for high cholesterol, 13.9%), angiotensin converting enzyme (ACE) inhibitors (for high blood pressure, 11.4%), analgesics (for pain relief, 11.1%), and antidiabetic agents (8.8%).”

Also, “Among U.S. adults aged 60–79, the most commonly used types of prescription drugs were lipid-lowering drugs (45.0%), antidiabetic agents (23.6%), beta blockers (for high blood pressure or heart disease, 22.3%), ACE inhibitors (21.3%), and proton pump inhibitors (16.9%).”

There are many factors to consider when taking one or multiple medications.

According to WebMD, age can be a factor in how bodies use and absorb medicines. Changes in digestion and circulation can alter how quickly medicine can travel through the body. However, as people age, it is not uncommon to use more than one medication and it is the combinations of medicines that can be problematic.

Based on insights from many experts, there can be an increased likelihood of the following reactions when medicines are improperly combined:

• Falls and fractures
• Dehydration
• Difficulty carrying out tasks you used to be able to do
• Problems related to thinking and reasoning
• Confusion and decreased awareness of your surroundings
• Nutrient deficiencies
• Adverse reactions or side effects from drugs
• Hospitalization
• Risk of death

There can be confusion over pill quantities, medical history errors, and other mistakes made when people are taking multiple medications.

What Is the Medication Management Strategy?

In order to avoid medication mistakes and adverse reactions, you will benefit from a medication management strategy.

Experts recommend scheduling a medication review with your health care provider, and taking along a trusted family member, friend or caregiver. When asked to list medications, include all supplements, even those not prescribed such vitamins and over-the-counter medicines, as it’s important to know what might be interacting.

Even particular foods—such as citrus juice and leafy greens—can cause medication interactions, so don’t be shy about sharing such details or asking if you should avoid some foods or change when you ingest them. For example, a person who regularly takes a blood thinner and then takes vitamin E or fish oil could end up with abnormal bleeding.

Many people do not understand what each pill does for them. A medication review is a good time to teach the purpose of each medicine. If an entire care team, including the patient, knows what each prescription does, then all of those involved in the patient’s care know what side effects to look for and report if necessary.

Certain medications, such as blood thinners, can make people less steady on their feet. The pills might make them dizzy or unbalanced, increasing the risk of a dangerous fall. Many organizations have programs that help with balance, where physical therapists focus on increasing strength and balance to overcome any weakness that may cause unsteadiness. But strengthening doesn’t help if the balance issue is from a problem in the inner ear or a medication. Falls are a leading cause of death in people ages 65 and older, and one fall can lead to a broken bone, a need for surgery, and may hasten death.

The end result of an effective medication review should be a current list of medications, who prescribes each one, and the contact information for the health care provider and pharmacist. And don’t just file the list away—bring it to all medical appointments so that it can be determined if there is a risk for a detrimental interaction. Adding a medication to your body, herbal, over-the-counter, or doctor-prescribed, is not something that should be taken lightly.

Medication Reminders for the Elderly

If you are someone who is considered elderly at over age 65 or you care for someone who is in need of elder care, medication reminders can be a part of a plan of care.

Perhaps an illness has made someone weak or forgetful and they are off their usual schedule and sleeping more frequently. They may miss taking important medicines that can help to restore their health and routines as they snooze.

There are different ways to set up medication reminders. You can try leaving sticky notes in places like the bathroom where they are likely to be seen, get a pill reminder app on a smartphone, or set up alarms on a computer or phone that will chime at the time to take a pill.

Or, a professional caregiver can be there to help with a variety of other tasks in the home such as meal preparation, light housekeeping, assistance with bathing, as well as remind someone it is time to swallow a pill or drink a small cup of medicine. Having a caregiver there also means that they can keep track of what medicine has been taken and when so that a health care provider will be assured instructions are being followed in case an issue arises.

Know the limitations of who can help with different medicines. For example, a professional caregiver (who is not a licensed nurse) typically cannot administer medicine but can remind an individual it’s time to take a pill or liquid. If you’re asking, “Can a caregiver dispense medicine?”, the answer is complicated. A caregiver cannot open a bottle of medicine because this is considering administering medication, but a licensed nurse—who sometimes is the caregiver--can open the bottle, hand the medicine over, and even place it in the mouth of the person.

More Than Medication Reminders

When it comes to managing medications, there is more to it than just setting a reminder. There are all kinds of things to stay on top of when taking medicine in order to avoid an adverse reaction or readmittance to the hospital. What is the role of a caregiver in medication management? Below you’ll read about several scenarios in which a caregiver might be able to prevent an error in taking medicines at the wrong time, in the wrong dose, or just plain wrong.

According to the NCBI, there are several causes for medication errors in the home to look out for:

Expired product: this could be because the product was stored improperly (for example, it needed to be refrigerated and was left out on the counter), or it there was a “use by” date and it has passed. Often the details about how to handle medicine are in very small print or not on the package, but in attached instructions. These important details can be hard to see for someone who is living with visual impairment.

Incorrect duration: medicine is prescribed for certain period of time, but when someone continues to take it beyond the recommended time or quits taking it before they are supposed to, there can be a problem.

Incorrect preparation: sometimes medicine requires being diluted before administering and if someone misreads or mis-measures the amount of mixture to add, they can end up with the wrong dosage amount which could lead to unintended side effects or a bad reaction.

Incorrect timing: how quickly medicine is absorbed will depend on many individual factors such as age, but also how recently someone did or did not eat food. This is one reasons that the timing of a medication reminder is important as it may include the timing of other things around the same time.

Incorrect dose: medications can be underdosed, overdosed and even extra-dosed. There are many ways this can happen and the results can be significant.

Incorrect patient action: medication education is critical the time of prescribing the medicine. This is when it can be invaluable to have a caregiver at the time of discharge or at an appointment with a healthcare provider. If someone is losing their hearing, their vision is deteriorating, or they just don’t feel good, it can be quite difficult to comprehend, much less remember, complicated medication instructions. The lack of comprehension can lead to a medication error.

Known allergen: if someone enters the hospital in a non-communicative state for some reason, doctors may not have the information about allergens that could cause an adverse reaction with medicines. Either for yourself or someone you provide care for, create a list of updated medicines, supplements, vitamins, and any possible allergens that can go with them to a hospital or doctor appointment.

Pharmacist: there can be a breakdown in communication between the prescription being made and being filled as a result of illegible handwriting, details like allergens not being shared, and more. As a result, someone might be prescribed a medication in the wrong dose or improper instructions or some other error. A family member or caregiver can carefully read the details on a bottle or instructions from the healthcare provider.

Distractions: this is actually the major cause of medication errors and shows the importance for medication management. This is more likely to occur in the hospital or rehabilitation facility when a doctor is very busy and multi-tasking. It’s important for caregivers to be on the lookout for signs that their loved one or client is experiencing a bad side effect or having an adverse reaction to a medicine. This can be done by reading about each medication’s known side effects when the person you care for begins a new medication regimen.

Tools for Medication Management

Although a caregiver can provide important safety measures to help avoid medication errors, there are also various tools to use for your own medication management process.

Consider getting some of these items for your own medicines or suggest them to someone you care for who could benefit from improved medication organization.

• Pill organizer: these are available for a week or a month’s worth of pills, with details about day of the week and time of day. It eliminates the need to open a container each time you take medicine and instead can easily open the tab for the day and time. Not all caregivers are licensed to open the containers—or even tabs on an organizer—but they can help by reminding someone and then see if the correct dose was taken.
• Automatic pill dispenser: these come with alarms, clocks, and other feature to make getting the correct medication as easy as possible. A caregiver can help by reading instructions for optimum setup.
• Timer medicine caps: this goes on the bottle of medicine from the pharmacy to be like a stopwatch, recording when the bottle was last opened and when it should be used.
• Medication list: for those who have multiple caregivers as well as those are taking multiple medications, it can be very helpful—and even potentially lifesaving—to have a list of all the current medicines being taken. This should include the schedule, any important details like medicines that cannot be taken together, possible side effects to be aware of and look for, dosages, and when new prescriptions might be needed to so you don’t run out. In the event of an emergency, all who are involved—from transport to the ER to hospital admission to discharge to rehab and back home again—need to be made aware of medicine regimen.
• Apps and timers: smartphones or computers or smartwatches can serve as medication reminders for those who are able to access their own medicines.

Medications and the Elderly

At each stage and age of life, there are different recommendations for optimum well-being and this includes best practices for taking medicines. Just like young children cannot take certain medicines or need adjusted doses, so too do people are enjoying a long life well past age 65.

There can be issues specific to elders when taking medications for caregivers or individuals to consider.

Does a medical condition create difficulty with swallowing? If so, contact the healthcare provider to find out if the medicine is available in a form that can go down more easily such as a liquid instead of pill.

Are you hard of hearing? Ask the doctor or nurse to print out—not write by hand—all instructions and possible side effects for each medication. This gives you a chance to go back and reference the details and possibly share them with others involved in providing in-home care.

Natural changes in the body as it ages can impact how the body breaks down medicines and how long they stay in the body, therefore what the dosage should optimally be for an individual.

Those who smoke and drink alcohol will have to alert their healthcare provider as these substances can impact the effectives of a medicine.

Do you have a complicated medical history? Make sure that medical records are being shared by doctors with referral partners so that important details about past medications can be factored in to any new prescriptions.

Pharmacists, nurses, and other healthcare practitioners will often refer to the Beers Criteria, created by the American Geriatric Society (AGS), to guide them in prescriptions for older adults. “With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month,¹ the AGS Beers Criteria®—a compendium of medications potentially to avoid or consider with caution because they often present an unfavorable balance of benefits and harms for older people—plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate,” the AGS states.

In addition: “The AGS Beers Criteria® includes lists of certain medications worth discussing with health professionals because they may not be the safest or most appropriate options for older adults. Though not an exhaustive catalogue of inappropriate treatments, the five lists included in the AGS Beers Criteria® describe particular medications with evidence suggesting they should be:

1. Avoided by most older people (outside of hospice and palliative care settings);
2. Avoided by older people with specific health conditions;
3. Avoided in combination with other treatments because of the risk for harmful “drug-drug” interactions;
4. Used with caution because of the potential for harmful side effects; or
5. Dosed differently or avoided among people with reduced kidney function, which impacts how the body processes medicine.”

The intent with using the AGS Beers Criteria is to create a dialogue between a patient and their healthcare provider, who may be a geriatrician, about any concerns with medicines. It is not meant to deter someone from taking medications that they could benefit from altogether.

Keep in mind that these suggestions are not just for prescribed medicines but also for common over-the-counter medicines like Tylenol too. A good medication management process factors in all medicines, not just those prescribed and filled out by a pharmacist.

Just because someone has been using a medicine for a long time doesn’t mean they still should be taking it in the same doses so when reviewing medications with a healthcare provider, be sure to ask about all medicines.

Be aware of “polypharmacy,” which is the term for what happens after a “prescribing cascade.” When one medication is prescribed to address the symptoms caused by another medication, it is called a “prescribing cascade.”

There are limitations on what a professional in-home caregiver, even those trained in medication management for the elderly, can do in terms of handling medicines and communicating with healthcare providers. As a family member of a loved one who is receiving in-home care and medication reminders from a caregiver, you can ask the caregiver to share notes on any concerns about medicines. The caregiver can be an advocate for the person who is in need of care when they are not able to speak up for themselves and pass on critical observations to concerned family members.

Who is Responsible for Medication Management?

Hiring a professional in-home caregiver for medication reminders can be one aspect of a medication management plan. It is truly a team effort when it comes to creating the plan and continuing to update it.

Those involved in medication management might include:

The patient/client/loved one/yourself, whoever the individual is taking the medicine. A person-directed plan of care is intended to involve the input of the person needing care. In this way, the care is done with them, not just for them. In most scenarios, this person is not passive or silent in sharing how medicines are affecting them or what medicines might be needed.

A caregiver or caregivers. When someone needs assistance with daily activities in life, they may rely on a combination of family members such as a spouse, adult children, friends and neighbors, or others, along with a professional in-home caregiver, or a team of round-the-clock caregivers if 24-hour care is needed. All of these people need to have a solid communication system to ensure that there are not medication errors made as they transition and coordinate care together. Just because a caregiver cannot administer medicine does not mean that they don’t have a valuable role to play in medication management.

A health care provider. How does the patient communicate with their doctor and who else can participate in this? Is it through an online portal or via telephone calls? Are others authorized to attend appointments and take notes?

The pharmacist. Mistakes can be made when prescriptions are filled so it’s important to have a relationship with a reliable pharmacy that someone on the team can communicate with as needed. This person can also be a point of contact for questions about medications and any possible drug interactions or side effects.

All of these people communicating and working together are responsible for medication management, not just one person performing medication reminders regularly.

Why Is Medication Management Important?

Medication management is important because errors can lead to everything from decreased well-being to fatalities. There is a financial cost to medication errors as well, not just for the healthcare system but also for individuals who might be readmitted to the hospital or needing additional treatments as a result of adverse reactions.

It starts with education for those who are taking medicines and their caregivers. Medicines should be taken as prescribed with an eye on whether or not the medication is alleviating symptoms or causing new problems or reducing the effectiveness of other supplements.

When it comes to medications, the more you know, the better.

If you or a loved one has a new medication regimen, or are just questioning if the medicines being taken already are having any benefit, put together a medication management plan. See if hiring a caregiver for medication reminders might help with medication adherence that can improve well-being.