Medication Misuse: A Growing Concern for Aging Population
Liu, William P., Aging Today
At age 79, Mrs. R is frail and lives alone with multiple chronic diseases. Her condition is adequately managed by eight daily medications, but her caregiver recently alerted me to Mrs. R's sudden, unexplained mood changes, marked by increased irritability. Mrs. R also increasingly complains of fatigue and bouts of dizziness. Although I determined that she does not consume alcohol, I decided to conduct a medication assessment. The dose of every medication she was taking seemed appropriate for her age and condition, and there was clinical justification for each medicine. No drug-drug interaction of any clinical significance was evident.
What was puzzling is that Mrs. R had not previously complained of fatigue or dizziness in recent months. So, I went a step further and conducted a pill count. Only then did I noticed large disparities in the quantities of remaining pills in her bottles, in spite of her having filled them on the same date and in the same quantities, and despite similar dosing instructions. Clearly, with some of her prescription drugs, Mrs. R was exhibiting some classic signs of misuse. Frequently, these signs will go undetected or will be attributed to a disease state, such as Alzheimer's or Parkinson's. Such diagnoses are sometimes correct, but in Mrs. R's case, any disease diagnosis would have been incorrect.
MISUSE IS COMPLICATED
The federal Center for Substance Abuse Treatment states in its Treatment Improvement Protocol series (TIP Number 26) that prescription medication and alcohol misuse affect up to 17% of people ages 65 and older in the United States. This number will grow: The U.S. Census Bureau forecasts that the 65 and older group will swell from the current 13% of the population to a projected 20% between 2011 and 2030.
The phenomenon of medication misuse is more complex than simply taking too much or too little of prescribed medications. Misuse can involve taking medications at the wrong time of day or not satisfying a medicine's requirements to fast or to take it on a full stomach. In addition, there are the complicating possibilities of clinically significant drugdrug, drug-food, drug-supplement or drug-herbal interactions.
Medication misuse among older adults is a matter of growing concern because so many elders have chronic illnesses and are likely to use more medications, often for the long term, compared with other population segments.
Elders who are ill or have chronic conditions benefit significantly from taking medications-and risk the most from failing to take them properly. Essentially, though, medications are a double-edged sword. It is incumbent, therefore, on healthcare practitioners to redirect older adults who have strayed from the proper use of drugs back to compliance and adherence.
A key risk factor for medication misuse in the rapidly aging population is polypharmacy, the use of many medicines simultaneously. As the number of medications an elder consumes increases, so does the chance of clinically significant drug-drug interactions. Older adults in cognitive decline will risk misunderstanding and confusing their medication instructions; for them, polypharmacy can make medication management a daily challenge.
Healthcare professionals also need to consider related psychological and social issues. An article in U.S. Pharmacist (2007; 32:6) states, "Older adults are predisposed to many different types of psychological issues, such as the loss of family members or friends, decreased social status and/or professional identity, loss of mobility, problems with self-care, poor eyesight/hearing, lack of transportation and financial problems. These situations have the potential to reduce self-esteem, induce a sense of hopelessness, isolation, loneliness or boredom and potentially lead to depression."
This article cited an analysis by Anil Gehi of Mount Sinai School of Medicine and colleagues, published in the Archives of Internal Medicines (Nov. …