Pharmacists can play an important role in helping ensure compliance with prescribed medications, which can help seniors maintain their health and quality of life while aging at home.
Nine in 10 adults 65 years of age and older would prefer to remain at home versus living in an assisted living facility or nursing home, according to a study by AARP. However, due to a variety of physical and/or cognitive impairments, it becomes unsafe for many adults to remain at home as they age.
Poor medication adherence is one of the factors that threatens safety among this population. Studies have shown that medication adherence is common among older adults for various reasons, including forgetfulness, inability to afford medications, a lack of motivation, medication adverse effects, a complex medication regimen, distrust of physicians and/or diagnoses, or a misunderstanding of physicians’ instructions. But poor adherence to medication can worsen seniors’ health conditions and lead to serious complications, as well as decreased quality of life and functional ability.
Pharmacists can play an important role in helping ensure compliance with prescribed medications, which can help seniors maintain their health and quality of life while aging at home. The role of a pharmacist includes improvising technology to track when patients are running low on medication and in need of refills, as well as communicating with patients and physicians when refills are needed.
Often, patients wait until the last minute and cannot get to the physician in time to ensure uninterrupted doses of their prescription. The role of a good pharmacist is to coordinate and manage the timing of refills to prevent this from happening.
Compliance packaging, which helps patients adhere to their medication regimen, is particularly important in the senior population. Putting all the drugs a patient takes in a single package, such as blister packs or pouches, and organizing them by day and time of day helps prevent doubling up on medication or missed doses.
Our pharmacy also finds that reconciling patients’ medications is helpful in ensuring compliance. Many older adults take multiple medications, and we don’t want the patient to run out of their needed medications every few days. Therefore, we reconcile them to a schedule in which patients get all their drugs at the same time every month.
The transition of a patient home from a hospital or skilled nursing facility is an especially stressful time for medication adherence. Patients may leave the facility with several new prescriptions, some of which go unfilled for reasons typically related to lack of insurance coverage or the patient’s inability to pay. Patients may forego the new medications and find old meds at home and take those instead of what was prescribed—and these old meds may have been part of the reason they ended up in the hospital in the first place.
As pharmacists, we must always check the patient’s medication history and confirm that the drugs prescribed in the hospital should be taken in addition to the patient’s existing prescriptions. A pharmacist can prevent errors by questioning any discrepancies and contacting physicians’ offices if there is any duplication of therapy or adverse interactions between existing and new medications.
As continuing care is very important when the patient leaves a skilled nursing facility or hospital, our pharmacy takes patients through a 90-day continuum of care program, in which we monitor them closely. We know that patients who make medication mistakes at this time can wind up back in the hospital.
By following up and communicating with patients through telepharmacy, we help ensure they are stable by inquiring if there are any problems with their medications, such as untenable adverse effects or high costs. We monitor the medication supply to see how many doses the patient has on hand and to determine when refills will be needed.
This is part of how the pharmacist can monitor compliance—if the remaining supply is much lower or higher than expected, this could indicate that the patient has missed doses or incorrectly doubled up on meds.
By communicating with patients and their family members, we can find out whether there are medications that are too expensive and beyond their ability to afford. The pharmacist can problem-solve by communicating with the physician to find alternative drugs, as well as work with the insurance company.
Insurance companies often require that the patient take certain steps, such as trying less expensive drugs, before it will approve a medication. When the insurance company’s policies are impeding the patient’s medication adherence, pharmacists must advocate on behalf of the senior.
Our pharmacy also communicates with seniors through our relationships with adult daycare centers. The centers may have our pharmacist come once a month to answer questions from patients and family members about medication and related topics.
For example, some patients have questions about surgical supplies, such as whether they are covered by insurance and where to order them. The pharmacist may meet with 30 to 40 patients at the facility, who can show the pharmacist the medications they have in their bags, make sure there’s no duplication, and reconcile the medications for them.
By proactively monitoring medication compliance among our senior clients, pharmacists can contribute in a real way to the ability of older adults to remain in the community.
About the Author
Hossam Maksoud, PharmD, is president, founder and chairman of Community Care Rx, a unique long-term care pharmacy with offices in Hempstead, NY, and Totowa, NJ, which provides comprehensive pharmacy services to various types of organizations.