By Liz Seegert

Some 45 percent of older adults struggle with two or more chronic conditions such as diabetes, hypertension, arthritis or heart disease. AARP reports that the health ramifications of those with multiple conditions are vast. People coping with several chronic illnesses have more difficulty with activities of daily living, like bathing or dressing, and may struggle to complete simple physical activities like walking up a flight of stairs.

Many are taking multiple medications, often prescribed by multiple providers, who may or may not communicate with each other. Medication management and adherence are important for everyone, but for older adults in particular, it may a key component which allows them to age in place.

Medco, a large pharmacy benefits provider, estimated that in 2009,

• 45 percent of older adults took 4-9 prescription and non-prescription medications regularly,
• 25 percent took 10-19
• 24 percent took more than 20

In contrast just 6 percent of older adults were on a three-pill or fewer routine. Those with multiple conditions are more frequent users of the health care system. They are more likely to be hospitalized, fill more prescriptions and have higher annual prescription drug costs, and have more physician visits, according to the CDC. Out-of-pocket spending is higher for persons with multiple chronic conditions and has increased in recent years. The American Society of Consultant Pharmacists, whose members specialize in medication management for older adults, says that “the nation’s seniors are especially at risk for medication-related problems due to physiological changes of aging, higher incidence of multiple chronic diseases and conditions, and greater consumption of prescription and over-the-counter medications.”

As recently reported in The Wall Street Journal, medication management interventions can reduce hospital readmissions for some patients. Medicare Part D prescription drug plans are required to provide medication therapy management (MTM) programs to help enrollees avoid drug-related problems and optimize medication benefits. Pharmacists work directly with patients and clinicians to optimize intended drug therapy outcomes and avoid adverse reactions.

According to “Patient Safety and Quality: An Evidence-Based Handbook for Nurses:”

• Nonadherence to medication regimens is a major cause of nursing home placement of frail older adults.
• In the United States, an estimated 3 million older adults are admitted to nursing homes due to drug-related problems at an estimated annual cost of more than $14 billion
• Older adults are the largest users of prescription medication, yet with advancing age they are more vulnerable to adverse reactions to the medications they are taking.
• Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication nonadherence and 10–17 percent related to adverse drug reactions.
• Older adults discharged from the hospital on more than five drugs are more likely to visit the emergency department and be rehospitalized during the first 6 months after discharge

Other factors impacting ability of older adults to take medications as prescribed may include:

• Vision problems
• Memory loss
• Cost concerns
• Swallowing problems
• Hearing Loss
• Social Isolation
• Health literacy

Story Ideas

• How do physicians in your community compare with others in the city, state, country?
• What are the most frequently prescribed drugs for older adults?
• How many seniors in your community suffer from multiple chronic conditions, and how many are re-hospitalized due to poor medication management or side effects?
• Are pharmacists filling prescriptions for brand name or generics, and what’s the cost difference?
• Are there programs in your community that help seniors, families or other caregivers with medication management?
• What is being done to educate patients/families about medication management? Are there local programs or services available?
• Health IT for prescription medication management – what apps and other technology are available for patients and families?

Resources

Medication Mangement and Adherence for Older People – a report from the Visiting Nurse Service of New York Center for Home Care Policy & Research

Your Medications: What to Ask – from the AGS Foundation for Health in Aging

How to Create a Pill Card – from AHRQ

Identifying Medications Older Adults Should Avoid: Updated Beers Criteria (2012) from the American Geriatrics Society

This recent story from ProPublica on the billions of dollars wasted on name-brand prescriptions under Medicare.

ProPublica’s Prescriber Checkup – a database of physicians and drugs in Medicare Part D

American Society of Consultant Pharmacists: 703-739-1300

Medicare Part D Claims Data database

2014 drug finder: compare prescription drug costs across all Medicare and Medicare advantage plans

2011 Ambulatory Care Health Data from the National Health Interview Survey