Last Updated: April 4, 2013
We all know about the rising costs of health care, and how
expensive prescription medicines can be, especially for seniors.
But do you know how much it can cost if you don't properly take
According to government estimates, each year in the United
States more than 125,000 people die from a failure to properly take
their medications, adding approximately $100 billion in preventable
additional hospitalization, emergency room, and repeat physician
visit costs to the health care system. At least 10% of all hospital
admissions are a result of this problem. For seniors, the
statistics are particularly alarming:
- Up to 23% of nursing home
admissions may be due to an elderly person's inability to
self-manage her prescription medications at home.
- Over 21% of all drug-related health complications are caused by
patients failing to adhere to their medication regimens, whether by
accident, negligence, or intent.
- 58% of all seniors make some kind of error when taking their
medications, with 26% making mistakes with potentially serious
- In studies of elderly patients on long-term
cholesterol-lowering statin therapy, researchers found that 57% had
stopped taking them after 6 months, and 74% had stopped by the end
of five years.
There are lots of reasons why people neglect to take their drugs
properly. The most common reason is that they just forget, which
seems innocent enough. The average senior takes about seven
different medications (both prescribed and over-the-counter) every
day, so it's little wonder that it can be difficult to remember and
keep track of them. However, the consequences can be deadly if
forgetting leads to taking the same medication twice and
overdosing. And skipping a dose by accident might not seem to be
such a big deal, but in many cases it is absolutely crucial that
doses be kept on as regular a schedule as possible. For example,
missing doses of anti-hypertensives can produce a dangerous
"rebound effect," in which blood pressure can rise even beyond what
the levels were before the patient started the medications.
Numerous devices and strategies have been developed to help
seniors keep track of their medications. You can find some of the
relatively inexpensive "reminding gadgets" at your local drugstore,
devices that help you organize your pills and/or remind you when to
take them with visual and sounding alarms. You can also find very
sophisticated reminding/dispensing systems that can cost hundreds
of dollars, as well as services that will telephone you to remind
you. Even the drug companies themselves are getting into the act,
as some have set up free programs in which company representatives,
usually a nurse, will contact patients who are taking their
proprietary brands of medications and encourage them to finish and
refill their prescriptions.
There are some potential pitfalls with these approaches to
medications management. Some studies have found that reminding
services had an almost insignificant effect on whether someone was
more likely to take their medications as prescribed. Some of the
devices and systems are bulky and complex and difficult to
negotiate, or conversely too simplistic to deal with regimens that
may juggle upwards of ten medications during the week. And all of
these devices, systems, and programs assume that the patient can
still organize, manage, and use them on her own, which can be a
challenge for some seniors.
It always helps to have a caregiver present who can ensure that
someone is taking his prescriptions on time and on dose, but that's
not always possible. Some retirement
communities and most assisted living
communities provide senior living with medications management as a
service to their residents, which may be a good option for those
who don't have family members nearby to check on them for their
medications (among other things). But even the best care and the
most vigilant monitoring will be undermined if the patient himself
is not willing to take the medications.
You might find it strange or foolish that someone would
intentionally disregard the importance of taking medications, and
yet it's a common problem. For example, people may think that they
feel better and discontinue treatment prematurely. Or perhaps the
medicine doesn't seem to have an immediate effect so they decide
it's not working and stop. Or perhaps it seems to work very well so
they decide to take more of it per dose, or the prescribed dose
more often. Or they stop because there may be bothersome side
effects that they don't like, or because they just don't really
believe that they actually need the medications. Or they may find
the costs too burdensome and try to "save" the medication by taking
it less often. Do any of the above examples describe your situation
or that of your loved one?
The reasons for "noncompliance" (as it's known in the medical
world) can be as varied and individual as each patient, but when
people willfully change their dosages or discontinue their
medications, it's usually not because they're uncooperative or
"just stubborn." Instead, it's usually because they don't fully
understand how the medications work and what the health
consequences are when you don't follow the regimen correctly or
discontinue it altogether.
Patient education is not as simple as it sounds, because the
responsibility lies as much with the patient as with the healthcare
professional. People need to become more actively involved with
their own healthcare, but that doesn't mean deciding things on
their own based on erroneous beliefs or limited information. What
will make a difference is proper communication of all your
questions and concerns when a doctor prescribes something for you.
Don't just wait for the doctor to tell you how and when to take it,
because they won't always tell you everything you need to know.
Here's a short list of basic questions to always ask:
- What is this medication called?
- How does it work?
- What are the possible side effects?
- Exactly how many times do I take this every day and at what
- Are there any dangerous interactions with other drugs or with
- How long do I have to take this?
- How do I store it?
- How much does it cost (with or without insurance)?
People are often reluctant to demand a detailed explanation of
their medication regimen for various reasons. They may be afraid of
appearing pushy, or of questioning the doctor's authority. Or they
may be afraid of appearing uneducated or unsophisticated. Or they
may still be mentally processing the diagnosis (which they may have
just received a few minutes before) and are filled with anxiety.
All of these are understandable and reasonable fears, but it may
help to either call the doctor (or the nurse who works with the
doctor) afterward so that your
questions can be answered.
The importance of taking medications properly cannot be
overemphasized, because the consequences of not following a
prescribed medication regimen are especially serious for seniors,
but it's not just about possibly losing one's life because of drug
complications or mistakes. With each hospitalization and emergency
room visit that may happen as a result of the resulting declining
health, the risk of being prematurely forced into a nursing home
increases. And that can cause the loss of something every senior
would like to keep for as long as possible-one's independence.