Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

Got a headache, back pain, high cholestrol levels, etc?...then pop a pill.  That is often the "magic" solution in today's health care system.  According to the American Heart Association, 32 million Americans take 3 or more medications daily.  Seniors often take double or triple that amount and sometimes more.  The problem is, is that with all medications come potential side effects and then to treat those side effects people are often prescribe another medication and so on.  Another problem is that seniors often have multiple physicians who often are not aware of what the other physicians' treatment plans are and what medications they are prescribing.  According to Medco Health Solutions, a pharmacy benefits manager, "the risk for drug errors is 7 times greater in seniors than in people under age 65."  CNN.com released an excellent article this week titled "Is Grandma drugged up?"  This article tells a story of a 66 year old woman who was experiencing confusion and slurring of her words.  Her family took her to the emergency room where the possibility of a stroke was ruled out; she was admitted to the hospital and was diagnosed with Alzheimer's Disease.  Her children believed that the diagnosis was incorrect, as she has been functioning independently.  They took their mother to a geriatrician at the University of Oklahoma for a second opinion, where they were told that she most likely did not have Alzheimer's Disease but was overmedicated.  Dr. Jerry Gurwitz's philosophy is "that any new symptom in an older person should be considered a drug side effect until proven otherwise."  Not only do medications have side effects but they also interact with other medications causing contraindications, enhancing side effects, etc.  It is important to always keep a current list of medications, including prescriptions, over-the-counter medications, herbal medications and supplements.  All medications, not just prescriptions, can interact with each other, as well as, food/beverages and other substances i.e. tobacco.
There are several ways caregivers can assist in medication management.  If you feel that your parent is being overmedicated, talk with your primary care physician or geriatrician, and pharmacist.  There are also several online tools you can use to check your medications for interactions.  Here are two online tools:  PDRhealth.com and drugdigest.org.  Educating yourself on what medications cause potential problems for seniors is a good way to become an advocate for your parent.  As well as knowing the suggested lists of medications to avoid if a senior has a specific diagnosis.  My Health Care Manager also reviews seniors' health history and medications and can consolidate that information into one locale to assist families in managing their parent's health care.

I've had a few questions lately about technical help in dealing with memory loss.  There are some good tools to assist seniors and caregivers with things like medication management, appointments, self monitoring reminders, falling concerns, and even mobility. 

Saying this, I should quickly add that these are all fairly new and nothing has yet emerged standard practice.  This may be due to the reality that memory loss and related conditions of dementia are typically progressive diseases.  Meaning, a technology that works this month likely will not work in six months.  For example, one caregiver we were working with purchased an electronic pill dispenser.  Each time a medication was to be taken an ever more persistent alarm would sound to remind their loved one to take their medicine.  Some of these devices can even use a phone connection to dial a central database and report the activity of the unit.  This worked well for time, but one day their parent decided that this device was annoying, unplugged it, and put it under the bed.  Any attempts to reset the unit resulted in some similar behavior.  A new approach had to be found.

So for caregivers caring for parents with dementia, simply be prepared to monitor and make adjustments with any solution you might consider.  Technology can be a temporary suppport tool.  The news is better if your parent is not dealing with significant cognitive problems.  In this case, technology can be a real and lasting support tool.

In past blogs I've talked about the 17 dimensions My Health Care Manager uses to build the Personal Health Record.

We've spent a lot of time on some of the most used data like the medication list, provider list, and other "current state" information.  By "current state" I'm referring to information which is primarily valuable for it's current data values.  For example, when you are caring for aging parents it may be of some very slight interest which doctors your parents went to 3 years ago, but the current doctors are far more important.  The same would be true in medication management.  It's the current prescriptions and treatment plans that are most relevant.

However, 10 of the 17 dimensions deal with "longitudinal data".  That is, data that should be measured over time.  If you are primary caregiver it is very easy to miss major changes because they happen incrementally. 

It's just like watching children grow up.  Parents, who see their kids every day, know they're growing, but its the Aunt from across the country who's stunned by how much they've grown each Thanksgiving.  Parents can get a sense of this themselves by looking at pictures.  So it is with eldercare.  The people closest to the situation need to take an actual "snapshot" of the key data items and periodically look at those for problem areas.

My Health Care Manager does this through the use of a formal assessment.  At least annually and at every major health event key areas like Activities of Daily Living, Socialization, and Cognitive Skills should be assessed, scored, and tracked. 

Let's return to the question of the impact of technology.  In particular, to the impact on a key issue facing seniors and caregivers, medication management.  We've touched on the fundamentals - preparing and communicating the medication list with simple computer tools.  What we haven't spent much time on is the day to day management of medications.

Technology can help.  For example, one of the tools My Health Care Manager makes available to seniors and their families is a weekly medication schedule.  This schedule provides a map of the all medications with the day and time and dosages they are to be taken over the course of the week.  This schedule can also provide a variety of additional information such as sliding insulin scales or even life style guidance for exercise or other activities.  In many cases our clients will actually record daily health monitoring results on the form (like blood sugars, blood pressures, and so on).  This is a great way to help aging parents and their care givers stay on top of the weekly regimen.  

There are some limits.  We have found that people dealing with Dementia (Alzheimer's disease or other forms) need the assistance of a caregiver to use a tool like this.  Often they will also need reminders through the course of the day to prompt taking their medications.  Technology can help here, as well.  There are a number of medication reminder systems emerging in the market.

 

Don't procrastinate any longer.  Create your medication list or, if you are a caregiver, create one for your aging parents.  If you want help and advice get a geriatric care manager. 

This first job is easy to start.  Even if you are going to enlist help from a geriatric care manager or other in home services, having this list will only speed up their ability to help you or your loved one.  The medication list is the first step in any program of medication management.

Click on this link for a FREE quick spread sheet from one of my previous posts - Medication List Spreadsheet.

Make copies of the list and let your doctors know, it's critical.

There are several innovations available to help seniors organize and remember to take their medicines.  Although not necessary for many older adults managing multiple medications, some can benefit by having their medicines pre-sorted and dispensed in pouches that are organized by time of day and day of week.  We’re moving to a system like this as Mother’s filling a 28 compartment pill tray with 14 prescribed medicines and OTC pills each week becomes even more challenging with her aging.  This pre-loaded dispensing solution has been used in nursing homes and some hospitals for several years, but some companies are now offering the program to individuals in their residences.  But before making any change of this type, be sure to check the Medicare Part D prescription medicine plan to be sure the vendor is recognized in the insurance company’s plan. 

Other higher-tech aids are in development that include pill trays that automatically open at the right time and track results (although it is impossible to remotely know if the pills were actually taken).  We’ll be seeing more use of technology in assisting with eldercare- something I imagine caregivers will welcome wholeheartedly.  Many developments are underway by inventors and large health technology companies, and I’ll use a future blog to describe some of the more promising ones.

Even though Mother was safe and secure in Independent Living (IL) in a Continuing Care Retirement Community (CCRC), we quickly realized that managing her prescription and over-the-counter (OTC) medicines was a challenge of its own.  With 10 prescription medicines and 4 OTCs, the variables of continuing supply with many expirations and prescription renewals combined with generic vs. brand names, dosages and time-of-day preferences were an overwhelming task for her … and her caregivers!  Fortunately, we devised a Weekly Schedule and medicine reconciliation program that allowed her to manage her own meds (with our assistance) that has now become a My Health Care Manager computer-based decision aid.  However, loading her pill tray every week and managing the time for her diabetes blood sugar tests and consumption of the pills became (and remains) an ongoing challenge.  Until becoming exposed to the issues of polypharmacy and older adults, I didn’t understand that normally-prescribed medicines and dosages affect many seniors differently – sometimes even causing symptoms such as confusion and loss of balance.  Even multiple medication regimes that were tolerated in the past can at any moment cause problems or unwanted symptoms.

When trying to get my hands around the multiple medications challenge, it became clear that no single health care provider had information on everything that was being taken by Mother.  Each knew what he or she had prescribed, but the rest of their knowledge was based on answers given to the common question, “What medicines are your taking?” at office visits.  Often confused over generic vs. brand names, dosages, and omitting OTC products, older adults often can’t be counted on to correctly answer this important question.  In developing My Health Care Manager’s suite of decision aids, we added a letter that the senior can choose to send to all of their health care providers (or only to the ones they designate). The letter lists the providers, their prescribed medicines, and any other OTC products being taken by the senior.  Several doctors have remarked that this simple summary of information is not available from any single source in our health care system.  You might try this important task on your own if you are immersed in eldercare.  We’ll have more on managing medicines in my next blog.

We recently had some experience with the "set it and forget it" approach to the medication list.  It's too easy to make a medication list during a flurry of activity to get organized and then consider it done... for good.  Of course medications, dosages, and frequencies change over time and the list needs to be kept current.

For anyone dealing with multiple medications, keeping it current isn't enough.  It also needs to be communicated.  When you first build a medication list for yourself, your parents, or other loved one you should send it to every provider involved.  Yes EVERY provider and caregiver.  If you expect the health care community to make the best choices, they need to know all the medications in play.

At My Health Care Manager our best practice is to write a cover letter to all the health care providers and attach the full medication list.  For members under our Medication Management Program we extend this same notification every time there is a change to the prescription list.  This lets the provider know who else is involved in the care and what medications may be impacting their treatment recommendations.

As a caregiver or active senior, you can certainly do this yourself without the help of geriatric care manager.  Remembering to communicate is the key.  Don't forget to tell the other caregivers involved.  This is critical to making certain the proper amounts are taken and that potentially serious mistakes are avoided.

Today is the last day of National "Talk About Prescriptions" month - so hopefully you have spoken with your aging loved one- especially if they are taking multiple medications. However, I would also like to encourage everyone to talk about another kind of prescription- not for a medication, but for glasses or contacts.  Our vision deteriorates as we age and this can affect our mobility.  Home safety is incredibly important for preventing falls- and one key to preventing falls is recognizing a change in vision.

A recent study proves that worse vision or 'visual field deficit' is associated with falls- especially peripheral vision deficits.  The study also provides information about the occurrence of falls among older adults and the association of falls with a greater likelihood of hospitalization, nursing home admission, and death.  The bottom line: making sure your loved one has regular exams by a health care professional- including vision exams- is a smart move!  You may also speak with your geriatrician or health care professional for more information on preventing falls.  To read the study abstract issued by the  Institutes of Ophthamology at Johns Hopkins School of Medicine and the University College in London, please click here.

October is the national “Talk About Prescriptions” month, sponsored by the National Council on Patient Information and Education (NCPIE). It’s the perfect time to talk to your loved one about the medication they are taking.  Studies have revealed that 40% of seniors cannot read a prescription label, and 76% of seniors cannot understand the medication information given to them.  Caregivers can help!  Considering that our loved ones often take multiple medications as they age (increasing the chance of interactions) and may have medications prescribed to them by multiple physicians, polypharmacy issues must be addressed.  Communication is key- not only within the family, but also (and especially) with your loved one’s geriatrician and other health care providers.  So take a few minutes this month to talk your parents, grandparents, and other loved ones about their prescriptions.  Encourage them to talk to their doctors, and make sure that all of their physicians have a current list of their prescriptions and medications.  For more information, please visit the NCPIE website here or their sister website MUST (Medication Use Safety Training) for Seniors here.

So what exactly is in a Personal Health Record (PHR)? 

You won’t be surprised to know that the answer varies depending on who you ask.  Let’s start by looking at what My Health Care Manager includes in its PHR.

 

We have identified 17 dimensions to examine as part of initializing a PHR.  These are:

1. Demographic:  General demographic information including but not limited too the senior’s current living and marital status; accessibility to bathroom, bedroom, and laundry; and work/volunteer history. 
2. Family: Family members deceased and living.  Family health history and availability.
3. Social support:  The family’s/friends’ level of support, communication techniques, and the senior’s engagement in social activities.
4. Representatives/Key Contacts: Individuals that the senior has identified to have permission to health and/or financial information, including the level of information they may access and the manner in which the information can be shared.
5. Financial:  The senior’s perception of his/her financial needs and if additional assistance is required to support health or alleviate stress.
6. Spiritual:  The senior’s perception of his/her spiritual needs and level of comfort/peace with current health status.
7. Legal: Arrangements for an individual to act on the senior’s behalf including the status and copies of the senior’s advance directives, funeral, and/or burial/cremation arrangements.
8. Insurance:  Current insurance information and identified gaps or needs for continued education.
9. Support Services:  Multiple service providers and the level of communication between the providers.
10. Caregiver Support: The stress level and needs of the caregiver.
11. Physical Health:  The senior’s past medical history, treatment plans, and current health status - capturing chronic illnesses, chronic pain, incontinence, weight loss/gain, nutritional status, and sleep habits.   
12. Functional Health Status:  The senior’s perception of and satisfaction with his/her health status while assessing the senior’s physical functional status including activities of daily living, balance, ambulation, assistive devices, and sensory status.
13. Emotional/Psychological:   The cognitive, emotional, and behavior status of the senior including screens for cognitive impairment, anxiety, depressive symptoms, and substance abuse.
14. Medication History:  Medications list, multiple providers, multiple pharmacies,   allergies, polypharmacy, and medication administrative needs. 
15. Home/Residential Environmental & Safety Assessment:  Visual assessment of the senior’s environment.  Assessing fall risk, elder abuse, disaster plans, fire/burn prevention, crime/injury, injury prevention, communication system, and support network.          
16. Preventive Health Activities:  Preventative recommendations and attending health screening activities. 
17. Wellness: The senior’s understanding of activities that promote improved health status such as wellness classes, tobacco use cessation, and/or intellectual stimulation.

This information can be gathered and assessed by an individual, a caregiver, or even a Health Care Manager.  We use a 3 ring notebook to collect and organize this information so that it can easily be updated and kept current.  The binder is easily taken along on medical provider appointments and is large enough to be difficult to misplace.

A friend here at My Health Care Manager sent me an article today with a very interesting statistic.  Science Daily reports that “Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart.”  That’s right, not even ONE of their medications.  People simply can’t remember cryptic medical names, dosages, frequencies, and instructions for the multiple medications they’re taking.

It’s not hard to imagine that in a senior population where people may be dealing with cognitive decline that this statistic would be even worse.  Add to this, the fact that People over 75 take an average of 7.9 medications per day and someone struggling with health issues may be taking many more.  Nobody could remember all this, yet it may be one of the most critical elements to a geriatrician and other health care providers in determining treatment.

If you are a caregiver, encourage your loved one to get all their medications listed with the dosage, frequency, and any special instructions on paper.  Check it and make sure it's right.  If it's too complicated get help from a geriatric care manager or health professional.  Make copies for yourself, and all of the health providers your loved one contacts.

To read the full article “Patients Can't Recall Their Medications To Tell Doctors” Click Here.

At the center of the tools to help with geriatric care management you will find the Personal Health Record (PHR).  Wikipedia has this to say about the Personal Health Record: "The PHR is an ill-defined concept that has been developing over several years."  You'll be pleased to know that it doesn't stop with that.  In fact, it goes on to describe some of the key elements.

Perhaps the most common confusion is comparing the PHR to and Electronic Medical Record (EMR).  An EMR provides a hospital, doctor, therapist, or even insurance company with useful information.  It does little, however, to directly impact the people most affected - the senior and caregiver trying to understand a care regimen.  The few interactions with these systems which do exist, such as Explanation Of Benefit (EOB) statements, are often confusing and frustrating for aging parents.  Little or no information is available from these systems on care plans, medications, multiple disease states, life style, state of mind, living circumstances, support networks, caregivers, or the other complexities faced by seniors.  They do not represent a holistic picture of the environment impacting independence and quality of life.

The Personal Health Record (PHR) has developed in response to this need.  The PHR provides a way for individuals to build and maintain a health care record independent of their health care provider and easily understood by the family.  The reliance on the individuals' understanding of their health situation and care plans to populate the PHR means that great care must be taken with the completeness and accuracy of the record.

Most caregivers can build this PHR either as collection of paper documents or using a variety of computer tools.  A geriatric care manager can help by understanding all the materials to include, off loading the time consuming tasks from a caregiver, taking advantage computer tools, and providing a knowledgeable review of the contents.