Medication non-compliance is a significant contributory factor in the morbidity of the Medicare population. The statistics indicate the severity of the problem: 40-75% of older adults do not take their medications at the right time or in the right amount. Medication non-adherence is the cause of 26% of hospital admissions, at an annual cost of 8.5 billion dollars.
The reasons for non-adherence to the medication regimen may include the cost of the medications, inability to obtain medications, lack of understanding of medications prescribed (76% of seniors are unable to understand their medications), and physical limitations that restrict proper medication administration.
The cost of medications in the U.S. is among the highest in the world, and insurance coverage often does not cover the full cost of medications. This leads to many patients attempting to reduce the cost of prescriptions, which results in under usage of medication, potentially causing worsening or exacerbation of the condition for which the medication is prescribed. The most commonly seen tactics for reducing cost used by patients include cutting pills in half, taking medications only once daily when prescribed for more frequent use, taking medications every other day instead of daily, or using old or expired medications, even if not the same drug.
Many of the elderly population also have difficulty obtaining their medications due to transportation issues, inability to leave the home due to health or mobility issues, or requirements by various insurance providers to obtain medications by mail. While the cost of obtaining medications in this manner may be lower, there are often delays from the time a medication is prescribed to the time the patient receives and begins taking this medication. Again, placing the patient’s health at risk for increased morbidity.
It is well-recognized that, while physicians and pharmacists are providing medication information to their patients, the elderly population often still do not understand their medications and the reasons for taking them. This is a result of many factors: decreased cognitive functioning/memory, frequent medication changes, and a lack of a systematic method to manage their medications which allows patients to accurately maintain and update medication regimens at a level appropriate to their condition. Since these patients receive prescriptions/medications from multiple physicians, and the prescribing physicians do not have accurate medication records from the patient, there is increased chance of serious adverse reactions and interactions further endangering the health and well-being of the elderly.
In addition to cognitive limitations, patients may encounter difficulties with the physical management of medications. Fine motor control must be elicited in order to open bottles and pill boxes, as well as handling the pills themselves. Fine motor control may be affected by sensation deficits, pain, limited range of motion, lack of coordination and grip strength. Poor vision may cause patients to mismanage medication as they are unable to read the labels and depict one pill from another. Therapy, including occupational, speech, and physical, can address all of these concerns with individualized evaluation and treatment.
The Infinity HomeCare team has developed a medication management program which addresses all of the common problems with medications and the elderly. It uses a multidisciplinary approach to identification of problems unique to each individual, with development of an individualized plan of care to address the problems encountered, incorporating both patients and caregivers in the development and implementation of a system designed specifically for each patient to manage their medications.
Skilled services provided may include nursing for
medication reconciliation and detailed education on medications,
specifically tailored to the cognitive abilities of the
patient/caregiver. Occupational therapy services will focus on
cognitive impairment and development of a medication
administration plan designed for each patient to improve
compliance, and will also address issues caused by low vision,
impaired manual dexterity and adaptive equipment to enable safe
administration of medications. Speech therapy services may be
provided also, for cognitive issues and any identified
difficulties with swallowing. Physical therapy services may
include assessment of gait, balance and safety within the home.
For financial and transportation concerns, social work will be
involved to address those needs.
If you have a patient that would benefit
from the Infinity HomeCare Medication Management Program, please
contact Infinity HomeCare @ (727) 538-7716.