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What problems your older patients are having (and what you can do about it).
A new study has tracked the rates at which older adults develop difficulty managing their medications and their finances and found that these problems can occur together.
The research, “Difficulty Managing Medications and Finances in Older Adults: A 10-year Cohort Study,” analyzed data from the U.S. Health and Retirement Study (HRS). This is an ongoing national study in which people aged 50 and older are interviewed every two years to determine changes in disability, health, and wealth.
The researchers looked at data from people 65 and older and followed them over 10 years, from 2002 to 2012. As part of the HRS, participants were asked “Do you have any difficulty managing medications?” and “Do you have any difficulty managing your money-such as paying your bills and keeping track of expenses?”
Participants in HRS who reported trouble with either medications or finances at the start were excluded, leaving a sample size of 9,400 patients. The average age of the participants at the start of HRS was 74.1; 56.6% were female.
Researchers found that 15.2% of participants developed difficulty managing medications, while 29.9% of participants developed difficulty managing finances over the 10-year study period. Women had a higher risk of developing difficulty managing medications than men (20.6% compared to 15.6%).
Future planning may be needed
These findings can help guide physicians and health-care professionals counsel patients and their families about planning for future needs. “While advanced planning in late life often focuses on health care and end-of-life preferences, our results highlight the need to counsel patients about preparing for the possibility of losing the ability to safely manage their medications and finances,” the authors stated.
A variety of factors-including stroke, depression, and cognitive limitations- were found to affect the ability to manage medications and finances. “[The] findings highlight the need for clinicians to expand their focus beyond biomedical health, incorporating components of comprehensive geriatric assessment,” the authors state. “Taking care of older people requires a biopsychosocial-integrated view of wellbeing and health status.”
Sunny Linnebur, PharmD, Clinical Pharmacy Specialist at the University of Colorado Hospital Seniors Clinic, told Drug Topics that, while there were no surprises in this research, “these data are very important in quantifying the overall need for medication and financial assistance for older adults in the community. The high percentage of older adults who appear to need assistance with medications or finances over time underscores the need for detection of these difficulties and resources to provide assistance to the affected older adults.” Women may be at a higher risk of developing difficulties than men, Linnebur added.
Nienke Bleijenberg, RN, PhD, lead author of the study, told Drug Topics that the study findings were “a bit worrisome. Are health-care professionals aware of these numbers and are there sufficient resources to help these elders?” she asked. “Early identification and being aware of the risk factors is very important for all disciplines,” she added.
The report also noted that because these results are based on self-reporting by the participants, the actual incidence of difficulty in managing medications and finances is most likely to be even higher. “Protective efforts, such as early identification, awareness, and preventive interventions are needed, as well as policy, research, and funding initiatives to reduce the consequences and burden of these serious impairments,” the authors stated.
Up next: How the pharmacist can help
What you can do
Linnebur stressed that physicians and other caregivers often may not see nonadherence with a medication regimen, but “pharmacists can play a crucial role in detecting nonadherence,” an important part of treating elderly patients.
Chad Worz“Patients aren’t always forthcoming. They want to perform for their doctor, they want their doctor to think they know what they’re doing,” said Chad Worz, PharmD. Worz is the President of Medication Managers LLC, a company that works with elderly and developmentally challenged patients to improve medication therapy outcomes.
Linnebur stressed the need for more direct questions. Pharmacists need to be asking their patients about reasons for nonadherence, she said. “Based upon the reasons, pharmacists should work with prescribers to offer strategies to improve adherence (e.g. pillboxes, alternative medications with less side effects, or lower cost),” she said. “If there are concerns about the patient’s abilities to manage medications on their own, these concerns should be passed on to the prescriber to initiate further workup and support.”
In his experience dealing with elderly patients, Worz has found that being proactive is key. “We have to ask questions instead of waiting for them to ask us questions,” he said. To do this, he recommends asking open-ended questions about their concerns, and also paying close attention to body and facial language. Worz also recommends asking patients to demonstrate how they use devices. He asks patients to show him how they use an inhaler because many patients struggle to use it correctly.
In a busy pharmacy, Worz recommends that pharmacists filter what they ask. “Pick one question that you have time to go through,” he said. Instead of discussing each medication, pick one medication or device that has been problematic and discuss it specifically. The next time the patient visits, go deeper into that product or ask about another one.
However, Worz notes that sometimes a pharmacist or another caregiver can do everything correctly and the patient will still not make any effort. When he notices that a patient is resistant to getting help, he can go to them directly in the assisted living facility. For other pharmacists not in this setting, he says that he would recommend proactively calling the patient to do everything possible. But even with all this effort, the pharmacist must realize that “you’re never going to get everybody,” he said. “We think everyone is desperate to get medical advice, but they’re not.”
In such a situation, after trying everything possible to work with the patient, Worz says that the pharmacist needs to focus on patients who will respond and be more receptive. Linnebur recommends that “In addition to contacting prescribers, pharmacists should work with other health-care practitioners, like social workers and home health nurses, to help patients with medication assistance. Engaging family, friends, and neighbors may also be necessary if the patient is willing to allow others to help them.”
Bleijenberg echoed this call for increased cooperation. “I think that primary care for older people can be improved by optimizing interprofessional collaboration between pharmacists, GPs, nurses and social care […] Professionals should know where they can share their concerns about patients so that those at risk can benefit from targeted interventions.”