Aging adults are often burdened with health issues and the medications required to manage them. While medication can improve well-being and prolong life, they can also lead to adverse effects and complications, especially with our elderly when taken inappropriately. This is where the 4M framework comes into play. The 4M initiative stands for “What Matters Most, Medication, Mentation, and Mobility”, emphasizing a holistic approach to care for aging adults. In this blog post, we will focus on the second M of the 4M framework – medication. We will provide insights into optimal medication use, high-risk medications, and how family members can offer support to their aging loved ones. As nurse advocates, we help many clients explore and create management plans for proper use of our aging loved ones medications.
Medication Management for Our Aging Adults help our loved ones manage their medications safely, many resources are available, including medication lists, pill dispensers, and medication reminders. Moreover, it’s essential to understand any possible drug interactions when seniors are taking multiple medications and to keep an updated medications list with the dosage and frequency. Family members should also check the labels carefully and make sure that seniors are aware of the potential side effects. Side effects often go unnoticed when it comes to medication and can lead to serious complications.
Polypharmacy:
As seniors age, they become more prone to developing chronic illnesses and taking multiple medications to manage them. Polypharmacy, the use of five or more medications, is common in aging adults, and it can lead to many adverse health outcomes. Therefore, optimizing medication use is crucial in reducing the burden and risks of medication for seniors. A growing body of evidence suggests that reducing the number of medications, known as deprescribing, can improve outcomes for aging adults significantly. Deprescribing is the process of reducing the number and dosage of medications for people who may be on too many. The goal of deprescribing is to minimize the harm caused by polypharmacy and to find medication regimens that are more appropriate for seniors.
Polypharmacy refers to the concurrent use of multiple medications by a patient. Aging adults are often prescribed various medications for multiple health conditions that they may have. However, multiple medications can lead to adverse drug events, medication interactions, and poor health outcomes. It is imperative to deprescribe or review medications that are no longer required or may be detrimental to a patient’s health and well-being.
I remember when my grandmother had a debilitating stroke and went into a nursing home. She was considered “comfort cares” and so most all of her medications were discontinued. She lived another 10 years. This may not always be the case, but you sometimes need to wonder if how much medication is too much? We just want to raise awareness here to look for issues where your loved one might be taking many medications and if you are concerned ask the doctor for a review to see if they are all still necessary.
Sometimes people get into trouble with seeing multiple doctors and clinics and sometimes the different computer systems don’t talk well with each other and things might not show up. It can make it confusing even for the clinics. This then could lead to the next step of deprescribing.
Deprescribing: As individuals age, their ability to metabolize medications decreases, making medication management more complicated. In some cases, it is appropriate to deprescribe, or stop taking certain medications. This process involves working with a healthcare provider to reassess the necessity and potential risks of a medication. Deprescribing can help reduce the number of medications an individual needs to take and reduce the risk of side effects and drug interactions.
High-Risk Medications:
In medication management for our aging adults, we often find medications can have significant cognitive side effects which can interfere with their mentation, such as memory, attention, and concentration or make them outright drowsy all the time. It’s essential to carefully consider the medication and dosage used in seniors to manage any chronic conditions while minimizing the risks of cognitive impairment. Often less is more for our aging loved ones. Also, high-risk medications for seniors can have severe side effects, including falls and confusion. Some of the high-risk medications that seniors should avoid or use with great caution are:
- Anticholinergics: Tricyclic antidepressants (for example: amitriptyline) Amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin >6mg/day (Silenor) Imipramine (Tofranil) Nortriptyline (Pamelor) Paroxetine (Paxil)
- Antihistamines (for example: chlorpheniramine, diphenhydramine older medications or called “First Generation”) Brand names: Allergy Relief, Chlor-Trimeton, Aller-Chlor, Wal-finate, Ricobid H and Diphenhydramine Brand Name: Benadryl
- Overactive bladder antimuscarinics (for example: oxybutynin) Brand Names: Oxytrol · Gelnique · Oxytrol For Women
Benzodiazepines: alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
Opioids: Abstral (fentanyl) Actiq (fentanyl) Avinza (morphine sulfate extended-release capsules) Butrans (buprenorphine transdermal system) Demerol (meperidine [also known as isonipecaine or pethidine]) Dilaudid (hydromorphone [also known as dihydromorphinone])
Other Opioid substitutes that still should be considered with caution: Astramorph PF, Doloral, Doloral Sirop, Duramorph, Duramorph PF, Infumorph, Kadian, M O S, more Dazidox, Endocodone, ETH-Oxydose, Oxaydo, OxyContin, Oxydose, Oxyfast, Roxicodone, more ConZip, Qdolo, Tramadol Hydrochloride ER as well as the Norco, Vicodin, Lortab which are Opioid Hydrocodone Combinations · Analgesic Opioid Hydrocodone and Non-Salicylate Combinations such as with Tylenol.
Many elderly deal with chronic pain. Make sure before going to Opioid pain medications you have worked with your doctor. There may be suitable times when these medications are necessary. Just be aware that there are added risks with out elderly.
Check with your doctor to see if an alternative to drugs may be helpful or reduce the amount you need to take for comfort. These could include a pain injection (a cocktail of different medications uses to relieve pain often for some type of joint pain. There is ice, heating pad, lidocaine patches placed on the skin for a “numbing effect,” meditation, music, other forms of distraction, some of the anti-inflammatory gels like Voltaren or the generic brands.
Often in elderly patients in the hospital we see scheduled Tylenol working well. Scheduled means they are given at scheduled times and intervals before increased pain gets out of hand. Often if you stay on top of the pain you will need less medication to control it. For example, if on your pain scale of 0-10 Zero is no pain and 10 is the worst pain imaginable for you then you would want to take something to ease the pain say at a pain level of 5. If you wait until 8 or 9 you may have more trouble bringing that pain level down to a tolerable level.
Non-steroidal anti-inflammatory drugs (NSAIDs). aspirin (Bayer, Bufferin, St. Joseph), ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). Some concerns would include gastrointestinal bleeding, worsening kidney function, it could make congestive heart failure worse, elevated blood pressure or even a stroke. You should discuss with your doctor what over-the-counter medications would be appropriate for you to take as needed with your personal health conditions or concerns.
Family members and our elderly should also note that medications such as antidepressants, antipsychotics, and sleeping pills can also have safety concerns. We have some added information in our resource section of this blog post that would be beneficial for a deeper dive into high-risk medications.
Safety Concerns: Medication management can be challenging for aging adults, especially if they are managing multiple medications. Safety concerns include medication duplication, missed doses, and drug interactions. It is important for family members to be aware of these safety concerns and to work with their loved ones and healthcare provider to manage medications safely. There are many sophisticated pill box reminder systems that can be used. Some come with alarms and some even come with apps for your phone so a loved one can know if you have missed taking your medications. HERO and MedaCube are two we are familiar with.
Medication management for our aging adults include a concern for them to be at a higher risk of medication-related harm because of physiological changes in their body and the presence of comorbidities or multiple health conditions. Additionally, medications can be challenging to manage, especially for those with cognitive (thinking) impairments, vision problems, or dexterity issues. It is vital to ensure that medications are stored appropriately, reviewed regularly, and administered correctly to avoid adverse drug events or overdose.
Supporting Aging Loved Ones: Family members can play an important role in supporting their aging loved ones with medication management. This includes monitoring medication use, organizing medications, and communicating with healthcare providers. It is important for family members to be aware of potential side effects and to discuss any concerns with their loved one’s healthcare provider.
Family members should be aware of medication schedules and the instructions given by the healthcare provider. It is essential to ensure that their loved ones are taking medications as prescribed and as directed, following prescriptions, and not combining medications without medical advice. They should be vigilant about any changes in behavior, functioning, or overall health of their loved ones that may be related to medication use. We recommend you get on their patient portal (online chart) sometimes called “My Chart” or “My Care” so you can see up to date information on their doctor visits and medication changes. This can be accomplished with their permission and contacting their clinic.
Conclusion:
The M-Medication of the 4M framework is an important aspect of healthcare for aging adults. Deprescribing, polypharmacy management, identifying high-risk medications, and medication safety concerns are all key considerations. Family members can play an important role in supporting their aging loved ones with medication management. By working with healthcare providers and understanding potential risks and alternatives, we can help optimize medication use and reduce harm and burden. When this whole process becomes overwhelming to you consider outside help. A nurse advocate can come along side of you and your loved one to sort through the medications, put a plan in place to make sure the medication management is going well and to help you review the medication list.
Resources:
https://www.nia.nih.gov/health/taking-medicines-safely-you-age
https://professionals.optumrx.com/content/dam/optum3/professional-optumrx/resources/High_Risk_Medications_Elderly.pdf https://www.healthinaging.org/tools-and-tips/learn-more-ten-medications-older-adults-should-avoid-or-use-caution
