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How to Recognize Prescription Drug Misuse in Seniors

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By: Kara Malitsky, Pharm. D., R.Ph., Director of Pharmacy at BCNEPA
July 9, 2013

According to the Centers for Disease Control and Prevention, nearly 9 out of 10 people over age 60 take at least one prescription drug.  And 3 out of those 9 take five or more medications, usually for serious conditions like heart disease, arthritis, diabetes and depression.

When different doctors and pharmacies issue multiple prescriptions, a situation known as "polypharmacy" can occur.  Polypharmacy can lead to overmedication and dangerous reactions, especially in the elderly.  And when over-the-counter drugs are added to the mix, patients are at even higher risk.

Prescription drug misuse, which is not the same as abuse, is defined as non-adherence to prescription directions and can be either willful or accidental.  Misuse can take the form of overdosing, under-dosing, using drugs for reasons other than intended, or combining drugs in ways that cause dangerous side effects.

Why does misuse occur more frequently in seniors?

First, by age 50, most of us experience some vision change.  As we age, our sharpness of vision and focusing power decrease, making it more difficult for older individuals to read the instructions on the medicine bottle.

As we age, we may also experience more serious cognitive and memory issues. Individuals may not remember to take their medications, or may forget that they’ve already taken them. And sometimes overdosing may be a result of thinking that if a little of the drug works well, more will work better.

The complexity of a treatment can also lead to misuse.  It’s more likely that a dose may be missed for a medication that’s taken four times a day versus a medication taken just once a day.

And finally, the cost of drugs may be an issue for many seniors, causing them to take their medications less frequently or in smaller doses than prescribed.

Depending on the drug, the results of misuse can range from a lack of therapeutic benefits to very serious issues, including death from an overdose or a bad reaction.

What are the signs and symptoms to look for?

If you are a caregiver to an elderly person, be very involved in the medication regimen of your loved one.  You can check pill trays for obvious signs like too many or not enough pills left in the container.  You can also look at refill patterns, whether it’s too soon or too late.  Be wary of a request for a refill when you know you've recently been to the pharmacy or received a mail order package.

And be aware of conflicting test results, such as a lab test that shows consistently high cholesterol levels when the individual is on cholesterol medication. 

More serious signs that may indicate misuse include confusion and disorientation, or physical unsteadiness, which can put the individual at greater risk for falls or unable to manage their daily needs. 

Here are some simple strategies that can help:

  • Organize medicines using pill cases and, if possible, pill charts to provide a visual cue for each medication.
  • Fully educate yourself and the patient on each medication and its purpose.
  • Create habitual ways of taking the medication, such as linking it to another action like a regular meal, bedtime or another daily activity.
  • Use automatic refill programs and medication adherence programs to ensure compliance.
  • Engage your clinician during office visits by asking probing questions about each medication, such as side effects, possible drug interactions and required refills.

Blue Cross of Northeastern Pennsylvania is one of many insurers that offer a medication adherence program for certain conditions like diabetes, asthma, high blood pressure, osteoporosis, cholesterol and depression.  If a member does not seem to be getting a prescription filled regularly, our service will notify the member and their clinician so that a discussion can occur.  Inquire with your insurer to see if they do the same.

Knowing the factors related to prescription drug misuse, especially in the senior population, is the first step in preventing it.

Kara Malitsky, Pharm. D., R.Ph., is the Director of Pharmacy at Blue Cross of Northeastern Pennsylvania