Seniors Need More Medication Reviews

December 11, 2019

Two Studies Demonstrate Older Adults Need More Medication Information and Reviews

It has been a busy week for studies focusing on complex care in older adults.  Two new studies provided some insight on the amount of medications older adults use, and the problems they are having with these medications.  Here are links to the articles:

Let’s review some of the information in both of these articles and why they support more medication reviews in older adults.

Polypharmacy in Canadians with Diabetes

The first study looked at the medications being used by older adults (66-75 years) with type 2 diabetes in Quebec between 2014-2015.  There was some interesting points from this study:

  1. The average older adult with type 2 diabetes was taking an average of 12 different medications
    • The most common medications were to prevent cardiovascular disease(91.3% of users) and to manage diabetes (84.5%). Other medications included central nervous system agents (79.8%) and GI-related medications (47.2%).
  2. Close to 90% of older people with type 2 diabetes take at least 5 different medications and 59% used 10 or more medications
  3. Being male and having cardiovascular disease were directly related to the number of medications taken

Interpretation

There is good, bad and ugly with this study.  The good is that many of these patients are being treated with guideline recommended medications (e.g. antihyperglycemic agents, statins, ACE inhibitors/ARBS).  The bad is the pill burden for these patients can be overwhelming and thus leading to potential issues (e.g. drug interactions, adverse effects, adherence problems).  The ugly is the real concern about deprescribing as the person with diabetes ages, he/she may no longer benefit from this intense treatment.

Older Adults and the Ability to Self-Manage Complex Drug Regimens

Dr. Jennifer Watt shared this newly published paper on Twitter. What is fascinating with this study is that it followed older adults (55-74 years) over a course of 9 years.  It assessed the older adult’s ability to self-manage complex medication regimens.  Here are some key findings from this study:

  1. At the beginning of the study, the average person made 2.9 dosing errors (out of a possible of 21)
  2. At the end of the study (9 years later), the average person made 5.0 errors (out of a possible 21)
  3. Limited literacy, meaningful cognitive decline, number of chronic conditions and number of baseline errors are predictors of future dosing errors
  4. People will commonly overcomplicate their drug regimens.  At the beginning the average person took their medications six times per day.  At the end, this increased to an average of 6.3 times per day

Interpretation

Older adults commonly make mistakes with taking their medications.  These errors will normally worsen over time.  Patients will also take very complicated administration schedules that can be very difficult to follow, contribute to errors and affect overall adherence.

Putting it All Together

Older adults with complex comorbidities (like type 2 diabetes) are taking many different medications per day.  These patients are commonly experiencing an increasing number of medication errors and are not optimizing the way they take medications.  These errors generally worsen over time.

Addressing this Issue

I think that these errors can be effectively managed through a number of strategies:

  1. Increased funding for clinicians to review medications and optimizing schedules
    • This can ensure the patient has optimized administration of their medication to minimize the difficulty of taking complex regimens
  2. Payment for blister packaging services
    • Blister packaging simplifies administration and can reduce error rate
  3. Work with caregivers to ensure that errors are minimized.  Some caregivers will not be aware that this is an issue
  4. Promotion and payment for deprescribing assessments
    • A review of a patient’s regimen and condition to determine the need for deprescribing can be very time consuming.  Payment for this service can promote clinicians to undertake this evaluation frequently to reduce the patient’s pill burden as they age.
  5. Lobby for additional services that can improve the way older adults take their medications