Medication Can be a Blessing and a Curse

Please note: Two recent New York Times articles on this subject are noted at the end of this blog post:

Prescription medications offer the elderly an improved quality of life. But, with medications, as with so many things in life, very often less is more.

Individuals over 65 years old receive a full one-third of all prescription medications and purchase about 70% of all over-the-counter medications. Because of physiological changes, the elderly are at higher risk for adverse drug reactions. Taking numerous medications for one or more chronic conditions increases the risk even further. In fact, studies show that when taking 10 or more medications, the risk of side effects is 100%. While adverse drug reactions are estimated to occur in 2-10% of younger adults that number soars to 20-25% in the elderly.

Among the most common side effects of medications are: cognitive changes, such as confusion, memory loss and sedation; changes in blood pressure; and incontinence or other changes in bladder and bowel functioning. Taking more than three different medications increases the risk of a fall. Some of the changes that may be dismissed as part of aging are in fact the result of the adverse effects of medications.

There are inherent risks in every medication. How does one ensure the greatest benefit from medications with the fewest side effects? ElderCare Solutions suggests taking the following steps:

1. Bring a list of all medications to every physician visit, ask that it be reviewed and keep the list updated. Inform all physicians of all medications that have been prescribed. An increasing problem in medication management has resulted from multiple medications being prescribed by different specialists for concurrent problems.
2. Find out what each drug is intended to do and if there are non-medicinal ways to treat a problem, such as a change in diet or exercise.
3. Ask about possible side effects. Are there any foods, medications or activities that should be avoided when taking a medication, and conversely, can foods or activities enhance a medication’s effectiveness? How long will the medication be needed? How will you know if it is effective in treating the problem?
4. Use one pharmacy and establish a relationship with the pharmacist, often an untapped wealth of information. Make sure pharmacy records are up to date regarding allergies and drug reactions. Ask your pharmacist about prescription drug interactions with over-the-counter medications.
5. Review medications with physicians and pharmacists each time a new medication is prescribed to ensure that the new medication does not adversely interact with others. Review all medications with the physician at each visit and ask if each is still necessary or if a “drug holiday” for one is possible. Medications are frequently added, but not often eliminated.
6. Don’t stop medications without consulting your physician. Some medications need to be gradually reduced to prevent detrimental side effects.

Medical doctors are like all of us and are not immune to marketing. Certain older medications can be just as effective and much less expensive that newer medications. Ask your doctor about generic medication that may be cheaper and /or other medications that may be less costly than the “new and improved” (and more costly) brand.

Of special note is the growing use of “off label” medications. That is, medications prescribed for purposes/illnesses for which the medication was not originally intended and for which its effects and side effects have not been studied in clinical trials. If uncertain, ask the doctor if the medication prescribed has been studied in older adults and for the condition it is prescribed to treat.

Many older individuals ask few questions of their doctor for fear the doctor will think they are “questioning” his or her judgment. Let your elder know you want to be involved to ensure their well-being and your peace of mind.

Responses to medications vary from individual to individual. They are life saving and life preserving in many instances, but they do not come without risks. Family and elder involvement in medication management creates a healthy relationship with your health care provider and in turn can be an important safeguard to ensure against health-threatening drug reactions.

Two recent New York Times articles on this subject include:

September 30, 2010
Novartis Pays $422.5 Million in Settlement
By DUFF WILSON

October 2, 2010
Antipsychotic Drugs: Side Effects May Include Lawsuits
By DUFF WILSON

When Choosing a Care Manager, Choose an Independent Care Manager

As the public becomes more familiar with the value of care managers for older adults and individuals with serious chronic illnesses, more facilities and agencies are touting their care management services.  As in all consumer choices, being informed, discerning and asking the right questions is the key to making sound decisions.

When hiring a care manager, one is hiring an advocate, someone who should have no other interest than the best interest of the individual.  Independent care managers have no allegiance except to the individual and family being served.  They receive no compensation other than for their care management services.  Facilities and agencies that offer and are reimbursed for services, such as caregivers or housing, in addition to care management have a conflict of interest.

An agency that provides caregivers has a strong interest in keeping their staff and revenue flow in place, even when the “fit” between available caregivers and clients is not right.  Additionally, they may have incentives to provide more costly care than is necessary.  Most independent care managers will choose from a variety of care services with whom they are familiar to find the best and most cost effective match for the individual and the situation for which care is needed.

Facilities (independent, assisted living or nursing homes) have institutional constraints and preferences.  Those considerations can unnecessarily narrow the focus and options in problem solving and may conflict with the best interests and desires of the individual. An independent care manager will consider the facility and will also question assumptions and the status quo to advocate for the needs of the individual.  They will encourage creative problem solving that focuses on the strengths, abilities and possibilities that can satisfy all of the client’s needs.  A well-informed and experienced care manager can look to resources outside of the facility to improve or remedy a care problem to benefit the facility and the individual.

When investigating care management services, inquire about competing or conflicting interests that may influence recommendation or decisions.  To avoid the potential for such conflict, an independent care manager, who does not benefit financially from any referrals made, whether to a provider, a home care agency, or a nursing home, is the best choice.

Sexuality and Older Adults

“They tell you they are going to lay out all the cards, but you find out that all the cards are not face up.” Vince is talking about his interaction with caregivers since his wife was diagnosed with Alzheimer’s. He is referring to the lack of openness about how his and their sexual lives will change as her disease progresses. This lack of openness and information left him feeling isolated, frustrated, and, at times, guilty.

For the elders in long-term facilities, physical expressions may be interpreted as sexual by the caregiver who then reacts with distaste or reprimand. Stereotypes confine our view of the elderly: one is either a “cute (i.e. asexual) old man” or “dirty old man.”

Stanley, a dapper 91 year-old, was admitted to the nursing home. The staff teased about “finding him a girlfriend” but when Stanley touched the staff during care, they decided he had a problem worthy of a staff conference. During the discussion, someone asked if anyone had mentioned this concern to Stanley and the staff responded with surprise, “well, no.” Soon after, Stanley was told the staff had a problem with his touching and his desire for physical contact needed to be addressed differently. He responded, “Okay, I won’t do it,” and there was no more problem. When an elder makes sexual advances toward caregivers, a direct, non-punitive, and caring statement is often all that is needed.

Assumptions that the elderly are not sexual, coupled with the reluctance of many professionals to address sexuality, leave many elders feeling like Vince and Stanley. Sexual references and images abound in our society, but frank and candid discussions are in short supply, especially for elders.

While physical changes of aging influence sexual behavior and responsiveness, research tells us that most older people remain interested in sex. There’s no reason, based on age alone, that individuals cannot enjoy sex throughout life. Research on age-related changes in sexual function is sparse, but generally sexual function in late life correlates with behavior in early years. Individuals with a high sexual interest and activity retain these in older age, although patterns of expression change.

Older individuals grew up in a time when sexual issues and questions were not readily addressed, and they rarely raise the subject of sex. Most older individuals are relieved to be given the opportunity to express their needs and concerns, but many are not provided factual information about the normal changes in sexual response that accompany aging. Ignorance of these changes can lead to anxiety, depression and feelings of inadequacy.

In addition to normal changes in sexual behavior, physical health problems and the disease itself and/or treatment of it can alter sexual function. Certain medications can decrease sexual function, while others can increase sexual interest. The single most common sexual problem for elder adults is lack of an available partner – as a result of a death or an illness that affects physical or cognitive functioning.

The awareness of sexual health as an important component of well being, a source of intimacy and pleasure, no matter the age, is vital for those involved in the care of the elderly. Consider biases and stereotypes. Seek information and counsel from professionals who are open, frank and comfortable in addressing sexual issues. For more information, call the professionals of ElderCare Solutions at (630) 416-2140.