Older patients who are disabled or without access to transportation may also lack social support, such as having a family or friend to pick up their medications and refill requests promptly. Those who have mental or physical disabilities may not be able to adhere to high-maintenance medication regimens, such as those requiring frequent glucose checks and stringent dietary restrictions to avoid dangerous drops in their blood sugar.
Age-related changes add another layer of complexity. Declining or compromised kidney and liver function may hinder the speed by which medications are cleared from the body, causing medications to last longer and increase the risk for side effects.
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Triboletti cites other age-related changes, such as additional sources of complexities. For example, factors such as increased fatty tissue, decreased bodily fluid, and overall weight-loss can alter the volume of distribution, warranting the need to adjust medication doses.
Special populations, such as homebound patients—both young and old—may face a greater risk for adverse drug events associated with complex medication regimens. Frequently, these individuals live with multiple chronic conditions and take multiple medications to treat each condition, increasing the risk for complications and costly medication regimens and poor medication adherence.
Collaboration Is Key
Melissa Morgan-Gouveia, MD, a geriatrician with Christiana Care Health System’s Department of Medicine who specializes in home-based primary care with Christiana Care’s Visiting Nurse Association says that open lines of communication between all healthcare providers involved—including caregivers—is imperative to improving the patient experience and outcomes.
She cites the increased potential for OTC drug interactions as an example. Many OTC medications are combination products with multiple different medications, which can increase the risk for unintentional overdoses of medications such as acetaminophen.
Triboletti agrees. “Communication is key, and pharmacists are in a unique position to provide accessible and consistent medication support,” she says. “Conversation with patients and caregivers are important to help identify concerns, barriers, and underlying causes for nonadherence.”
Hagarty emphasizes the importance of reviewing medications with the patient can help increase their understanding. Doing so could potentially improve patient adherence while facilitating the pharmacist’s ability to identify opportunities to optimize their medication therapy. Examples of this include discontinuing unnecessary medication and duplicate therapy, identifying new drug interactions, and finding solutions to barriers to access such as transportation or cost. Sometimes, healthcare providers must adjust the solutions to suit the patient’s environment.
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“Home health providers should identify the over-the-counter medications a patient is taking when conducting a medication review, including asking about medication bottles seen during the visit that the patient may forget to mention such as the over-the-counter sleep medication on their nightstand,” Morgan-Gouveia says. “They alert the patient’s primary care provider [and the pharmacist] about any over-the-counter medication a patient is taking that is not on their medication list.”
Technology: Help or Harm?
Healthcare is no stranger to new technologies designed to engage users—in this case, patients. While some stereotypes regarding senior citizen’s affinity for and ability to use technology persist, internet use among senior citizens is on the uptick. The number of senior citizens who own smartphones more than doubled from 23% in 2013 to roughly 50% in 2017, depending on the age range, according to a report from Pew Research. As many as 59% of senior citizens aged 65 -69 years reportedly owned smartphones and 49% of 70- to 74-year-olds owned smartphones in 2017. While lower, those numbers still remain relatively high for the 75+ group: 31% of 75-79-year-olds owned a smartphone and 17% of seniors aged 80 years and older having owned smartphones in 2017.
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