Problems with Medication Adherence with Seniors
In the last twenty years, the amount of seniors taking medication in America has nearly tripled. Almost ninety percent of people age 65 and older take at least one medication daily, with forty percent taking five or more. Twenty percent are on at least ten. Or, rather, are prescribed ten. Because as the amount of medications seniors are prescribed goes up, so too does the phenomenon of medication noncompliance – meaning all those necessary pills might not be taken at all.
Medication noncompliance, also called medication nonadherence, is when a person does not take their medication regularly, accurately, or at all. This can be from a variety of factors, from forgetfulness to outright refusal, but in all cases provides a serious risk for increased health problems. Right now, more than half of America’s seniors admit to medication noncompliance – and two hundred thousand of them are hospitalized because of it every year.
Reasons for not taking medication aren’t difficult to pinpoint. There’s good ol’ stubbornness, for one, although it surprisingly isn’t the biggest contributor. More impactful are the patient’s memory, their level of social isolation, their type of medical issues, and their budget.
Forgetfulness is part of human nature, and can easily lead to a missed pill or two here and there, especially for someone starting a new regimen. This risk only goes up in seniors. Even for those without any form of dementia, short-term memory problems make it difficult to keep track of whether a medication has been taken or not, resulting in both skipped and double doses. Memory care patients naturally have an even more difficult time, especially if they are managing their medications on their own.
Seniors who live alone are also less likely to take their medication as prescribed. Apathy and depression in socially isolated seniors can deter them from “bothering” to keep up with their prescriptions. Even in cases where an individual has every intention of being compliant, the previous issue of forgetfulness can easily intervene, and someone living alone does not have the luxury of another person around to give them the kind of reminders we all need from time to time.
Sometimes, non-adherence is not a result of choice, but of circumstance. A major impediment to compliance can, in fact, be the very medical conditions the medications are meant to be treating. For instance, seniors with vision problems can easily misread labels, and those who have difficulty hearing may misunderstand instructions given to them by pharmacists, nurses, and physicians. A disinclination to ask for clarification prolongs this issues, so that lengthy bouts of time can pass where a senior thinks they are following their regimen, when in fact they are not. There are also a variety of medical conditions – and medications – that cause difficulty in nausea, vomiting, lack of appetite, and difficulty swallowing, all of which affect the body’s ability to take in and absorb medication.
Even if a senior manages to overcome all of these problems, so many times there is one last hurdle in the way: cost. Seniors live on fixed incomes that are often difficult to stretch, and it’s no secret that medication doesn’t come cheap. Medicare doesn’t extend its coverage to all medications, nor to the entirety of their cost, and secondary insurances aren’t guaranteed to, either. An individual can find themselves with a hefty copay on needed prescriptions – or, worse, footing the entire bill themselves. Because of this, seniors may split pills, skip doses, or forego taking their medication altogether. Even seniors who are not low-income may feel disinclined to surrender their money if they perceive the cost to be too great.
So what’s to be done? Well, there may be very little to conquer that stubbornness we first mentioned, but the other issues do have some recourse. In the case of cost, for instance, switching to generic prescriptions can seriously slash the price of a medication, and some pharmacies (and even manufacturers) offer discount programs or financial assistance. As for the other issues – well, there’s hope for that, too.
Difficulty in physically taking a medication can be solved as easily as talking to your physician and asking for another variation – a smaller pill that’s easier to swallow, something that has less side effects, or even just a cheaper option. For those with minor dementia (or everyday memory problems), a pill box is a great resource, especially when paired with an alarm; outside medication management, such as from a loved one or a nurse, provides a more consistent option for those with advanced cognitive issues. This is helpful for socially isolated seniors, as well, as outside assistance can help maintain a helpful schedule.
The importance of medication compliance cannot be overstated. It is critical to maintaining health, happiness, and well-being. With proper consideration and guidance, it is possible for you or your loved one to keep to their medication schedules – and carry on with their lives.
Sources: Aging Care Blog (https://www.agingcare.com/articles/medication-problems-elderly-people-have-146111.htm) and Georgetown University School of Nursing (https://online.nursing.georgetown.edu/blog/improving-medication-adherence-in-older-adults/)
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