Methods for Elderly Medication Management

Senior patients have unique needs that require a hands-on approach from pharmacists. Perfecting that approach is becoming even more important, as the number of elderly patients who are cared for by pharmacists grows. An estimated 10,000 people turn 65 every day in this country, and by 2030, 18% of the nation will be at least 65, according to the Pew Research Center.

“When you look at the older adult population, they represent about 15% of the U.S. population, but they consume 39% of prescription medications,” says Chad Worz, PharmD, BCGP, CEO of the American Society of Consultant Pharmacists, an organization focused on advancing senior care pharmacy. “So not only is this population rapidly increasing in numbers, but they are the population that consumes the most medications.”

This translates to a significant opportunity for pharmacists to help patients better manage their medications, and to demonstrate their value as critical members of the healthcare team, Worz says.

“A pharmacist is a great resource for people who are struggling with how many medications they are taking, the cost of the medications they are taking, and the need for an overall manager of those medications.” 

Senior Challenges

Jeremy Blais, PharmD, district leader in Connecticut for CVS, says previous research suggests that the average senior patient takes between 13 and 19 medications daily-a figure that’s three times the average for younger patients. Blais says patients, especially those who develop ability issues or visual impairments as they get older, have difficulty keeping track.

Steve MacNeill, RPh, owner of Winchester Pharmacy in Winchester, MA, says pharmacists need to take a highly personalized and customized approach for medication management strategies to be effective for each senior patient.

Pharmacists need to fully understand a patient’s living conditions-including issues like whether they are a hoarder, have little outside support, or struggle with memory issues-when designing care plans, he says.

“You have to try to understand where they are coming from first and try to incorporate the program to meet their needs, not telling them how to do it and say you have to follow our process,” he says.

Jeff Kirchner, RPh, CEO of Streu’s Pharmacy Inc., says compliance can be another challenge with this patient population. Most of the elderly population he works closely with believe they are fully adherent; however, they may skip doses from time to time without realizing it.

Senior patients are often also living on a fixed income and may struggle to pay for costly medications, particularly once they’ve reached the doughnut hole, he says.

Strategies to Better Serve

CVS has developed a program called ScriptPath that analyzes a patient’s medication, including chronic and acute medication, and helps pharmacists develop a prescription schedule for patients.

This schedule uses redesigned prescription labels with bright, color-coded instructions that clearly indicate when the medications should be taken.

“The way we designed it, people can actually line their bottles up in their medicine cabinet by time (of dose),” Blais says, adding that the program helps pharmacists set time aside to have more in-depth conversations with patients.
MacNeill uses weekly Omnicell blister cards to help improve medication management for his patients.

“It’s fully customizable, so I can have a patient who takes their meds at 7 a.m., 10 a.m., and noon time, and then a bedtime dose,” he says. “We can put them all on the same card.”

The packaging helps highlight compliance issues and allows for the pharmacist to work closely with a doctor to address any compliance issues that may occur.

For instance, if a patient always forgets to take their 5 p.m. medication, the pharmacist could work with the doctor to discuss changing the dose and having the patient take the medication at 8 p.m. with her other medications instead.

MacNeill says the compliance packaging is hugely successful, with about 85% of patients using the service and an average of 10 new patients a week adding it. Although it’s labor intensive for the pharmacist, he believes it’s a valuable addition.

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Kirchner, who also offers blister packaging, saying it helps promote a pharmacy’s value not only to the caregiver, who may not have to spend time each week preparing medications, but to nurses or staff at assisted-living or long-term care centers.

Reducing the number of trips a patient or caregiver needs to take into the pharmacy, whether it’s through a medication synchronization program or compliance program, is also beneficial for those juggling multiple prescriptions.

A Walgreens spokesperson says their patients can take advantage of prescription refill reminders that can be delivered to a cell phone or email address. Walgreens also provides easy-open caps to patients who need them due to arthritis or other joint conditions.

“We also offer our prescription labels in large print to make it easier for patients to read and adhere to vital prescription information such as directions and warnings,” the spokesman says.

Counseling Issues

Kirchner says pharmacists should conduct a comprehensive medication review to determine what medications a patient is taking and which medications they have been prescribed.

“I think in general, when you are starting to deal with people who are older, there’s a little resistance to change. There’s just a lot of anxiety around change, and I think you need to understand that as a pharmacist. Sometimes it’s going to take more than a couple touches to get somebody to do something. It’s probably going to take more time than you think in terms of conversation,” he says.

Conducting a comprehensive medication review also opens the door for a longer conversation between the pharmacist and patient to learn more about their current habits, lifestyle factors, and level of retention that can help pharmacists better prepare a treatment plan.

It also might bring to light whether the patient is struggling to pay for medication, so that the pharmacists can intervene and try to find programs to help with drug costs or reach out to physicians to suggest lower cost options.

To gain an accurate sense of a patient’s understanding regarding medications and current habits, it’s important for pharmacists to ask probing questions such as what kind of side effects a patient is experiencing, how often they take the medication, when they take their medication, and even how long they’ve been on a drug regimen, says Blais.

Pharmacists need to become the quarterback of complex drug regimens, managing multiple prescriptions and multiple providers to be one central hub where a patient or caregiver can come for complete and clear guidance about their treatment plan.

“That really is what sets our profession apart from a pill dispensary,” Blais says “At the end of the day what makes pharmacists special is they are the front lines of healthcare, nobody in the healthcare system sees a patient more than a pharmacist.”