More prescriptions, greater confusion

Medications improve the lives of seniors, but errors in taking them can be lethal

By Tanika White | Sun reporter

March 9, 2008

Ida Canapp (left), 82, is able to stay in her Parkville home with the help of a nurse, Susan Oberley (center), and aide Rose Davis (right) from MedServe. (Sun photo by Algerina Perna / March 3, 2008)

Ida Canapp insists she would take her five medications and two vitamin pills every day, whether or not a nurse's aide came to her Parkville home to monitor her.

But her niece, Renee Gowland of Monkton, knows this is the dementia talking. "She wouldn't take them. Or she wouldn't know if she was taking the a.m. or the p.m. [doses]."

At 82, Canapp is energetic, hospitable and fiercely independent - with the help of Aricept, a drug that tempers the effects of mild to moderate Alzheimer's disease. But Canapp, who also has diabetes, high cholesterol and high blood pressure, and who takes a daily antidepressant, is like many older people with chronic health problems: She has difficulty keeping up with her many medications.

Medication mismanagement among seniors is a growing problem in the United States. Some experts estimate that half of all seniors mismanage one or more of their medications, and seniors are twice as likely to end up in emergency rooms because of drug safety issues.

As the baby boom generation ages - and older Americans take more medications to deal with chronic illnesses - medical professionals have become increasingly concerned about the issue.

"Not only is it getting worse, it has become one of the major sources of hospitalizations in the country and one of the greatest preventable causes of illnesses - and costs associated with illnesses - in this country," said George Lowe, director of medical services at the Overlea Physicians medical clinic in Northeast Baltimore. About 60 percent of his patients are seniors.

Not all seniors have memory problems as severe as Canapp's. But many have trouble keeping up with prescriptions because they can't see as well as they used to. Or they're confused by taking so many prescriptions, or from following different doctors' various treatment plans, or by multiple instructions on the pill bottles: Take this medicine with food. Take that one on an empty stomach. Take this one three times a day. Take that one twice.

Consequently, many seniors don't take enough medicine or take too much, experts said. Sometimes they skip doses, or stop taking a medication altogether because they just can't figure out when or how to take it. Doctors call this "noncompliance," and say it can lead to additional or more severe health problems in seniors, a loss of independence, sometimes even death.

"It's an ongoing concern," said Todd Semla, president of the American Geriatrics Society. "There are estimates that 50 percent of older people are noncompliant with one or more of their medications."

Medical experts say there are noncompliance problems in all age groups. But seniors seem to suffer from the problem more than others.

"What we have found is that older adults are at a greater risk for having problems," said Dr. Daniel Budnitz of the Centers for Disease Control and Prevention. "They are about twice as likely to end up in emergency rooms with drug safety problems than younger folks. And once they're [in the hospital], they're more likely to have to stay there."

Some problems have to do with the fact that older bodies don't process medications the same way as young ones, experts say.

"As we get older, there are changes in how drugs are metabolized and how drugs are distributed in the body and how we react to those medications," said Ilene Zuckerman, a professor in the pharmaceutical health services research department at the University of Maryland School of Pharmacy. "And older people use more medication; older people have more diseases. So we know that older people do have more adverse drug events."

People over age 65 represent about 13 percent of the population, experts said, but they consume about one-third of all the medication prescribed in the United States. As the elderly population grows - 25 percent will be 65 or older by the year 2040, experts say - so does their medication consumption: In about 30 years, seniors will be taking half of the nation's prescribed medication.

At the same time, according to a 2006 analysis by Medco Health Solutions Inc., a New Jersey-based pharmacy benefits manager company, patients over age 65 have a drug error rate about seven times greater than that of patients younger than 65.

The analysis also reported that one in four seniors received prescriptions from five or more doctors, while one in 20 received prescriptions from eight or more.

"Many of these drugs do have to be given more than once a day," said Christopher Kearney, director of the geriatric care unit at Union Memorial Hospital. "Or they're drugs that can't be given together or that can't be given on an empty stomach or can't be given on a full stomach. It's pretty complex."

Older patients who mismanage their medications many times end up in the hospital because they feel sick or dehydrated, or they become dizzy and fall.

Once a senior is in the hospital, Kearney said, physicians there sometimes change the patient's prescription plan - making medication management even more befuddling.

"Patients are in and out of the hospital setting, and every time they're in, their medications are revised, things are dropped, things are added. Prescriptions are substituted even in the outpatient setting," Kearney said. "So patients are pretty constantly having their drug lists altered. Even if they are equivalent drugs [that are being substituted], it's still very confusing."