Medication Management in Older Individuals: Nicole Brandt, Pharmd, CGP, BCPP, Fascp

Medication Management in
Older Individuals
Nicole Brandt, PharmD, CGP, BCPP, FASCP
Director of Clinical and Educational Programs at the Peter Lamy Center on Drug
Therapy and Aging
Associate Professor, Geriatric Pharmacotherapy, University of Maryland
School of Pharmacy
Contact at: nbrandt@rx.umaryland.edu
University of Maryland Baltimore
School of Pharmacy
“As older patients move through time, often
from physician to physician, they are at
increasing risk of accumulating layer upon
layer of drug therapy, as a reef accumulates
layer upon layer of coral.”
Jerry Avorn, MD, 2004
Why are we here today?
After attending this program, participants will be able to discuss:
– The general risks and benefits of medications
– Differences between prescription medications and over-

the-counter medications
– Common medication use problems
– Ways to improve medication use safety :

 Quality communication with health care professionals
 Having a Medication List
 Understanding the Drug Facts Label
Prevalence of Medication Use
Individuals 65 and older leading

consumers of medications
 Account for 34% of prescription medications and
50% of over the counter medications
 >80% take at least 1 medication daily
 Community Dwelling Individuals on average take 4

medications daily
 Nursing Home Residents on average take 9
medications daily
Mueller C, Schur C, O'Connell J. Prescription drug spending: the impact of age and chronic disease status. Am J Public Health
1997;87(10):1626-9.
Avorn J. The elderly and drug policy: coming of age. Health Aff (Millwood) 1990;9(3):6-19.
Medications - Benefits
What is a medication?
– A medication or drug changes how your body works OR
– Treats or prevents a disease or symptom
When used correctly medications can lead to:
- Better life quality
- Healthier life
- Longer life
Types of Medications
 Prescription medications
– Examples: blood pressure medications, blood thinners,
antibiotics
 Over-the-Counter (OTC) or non-prescription medications

– Examples: aspirin, acetaminophen, vitamins, cough medicine
 Dietary Supplements and Herbal remedies

– Examples: calcium, vitamins, iron, glucosamine, saw palmetto
 Vaccines and immunizations
For all medicines, you must read and follow the directions!
Types of Medications:
Prescription
– Must be prescribed by a health care provider
– Usually Purchased from a pharmacy
– Samples sometimes given from doctor
– To be taken only by patient it is prescribed

for
Nonprescription or Over-the-
Counter (OTC)
 Self-prescribed- you decide what you need.
 Purchased from any number of places

(grocery store, pharmacy, convenience stores)
 You are responsible for choosing the correct

medicine.
 Just because a medicine is available over-the-

counter does not mean that it can’t hurt you.
Not sure which OTC may be right for you? –Ask your pharmacist !
Dietary Supplements & Herbal
Remedies
 Self prescribed, available from many sources
 You are responsible for choosing the correct medicine, dose,

and watching for side effects
 Herbal remedies do not have to follow the same strict rules

that prescription drugs do.
 For herbal remedies, manufacturers do not have to prove

that the product is safe, effective, or that it contains the
ingredients on the label.
Medications - Risks
 It is important to know that ALL
medications, both prescription and OTC,
have risks as well as benefits.
– The risks of medicines are the chances that
something unwanted or unexpected could
happen to you when you use them.
– Risks could be less serious things such as an
upset stomach, or more serious things, such as
liver damage.
Medications - Risks
 Medications can cause problems, even if used

correctly:
Allergic reaction: when your body’s defense system
reacts in a bad way to a drug.
– Hives/itching/rash
– Narrowing of throat, difficulty breathing, shortness of
breath
It is important that you inform all healthcare

providers of your medication allergies!
Medication Use Problems
 What are Medication Use Problems?
– Medication use problems are any “bad” things that happen

to you as a result of taking a medication or several
medications.
- Medication use problems can result in you not getting the

best result from your medicine
 Medication Use Problems can:

– Prevent you from getting well as fast as you would like to
– Make you sicker
– Lower your quality of life
– Cause disabilities, accidents, or injuries
Potential Medication Use
Problems
 Over use – taking more than prescribed or
recommended by the healthcare provider or label.
Taking unnecessary medications
 Under use–taking less than prescribed or

recommended, or by missing or skipping doses
 Not following instructions for use carefully
 Drug interactions
 Side effects
Drug Interactions
Drug interactions occur when a drug interacts with another
drug, food, or alcohol and changes the way the drugs act
in the body
• May cause unexpected side effects
• The drugs involved can be prescription medications,
over-the-counter medicines or vitamins and herbal
products.
• Examples:
• Warfarin and levofloxacin
• Warfarin and green leafy vegetables
• Alcohol and pain medications
• Antidepressants and St. Johns Wort
Side Effects
 Side effect = undesired effect of a medication

– Some side effects are common (headache, upset stomach)
– Others are very rare (liver failure)
– Side effects can occur even though the medicine is being
taken correctly at the normal dose.
 Often, there are simple steps that can be taken to

manage minor side effects.
– Taking with food
– Timing of the medication
When Can Medicine Use
Problems Happen?
– When a new Medicine is added to the regimen
– When a Medicine is stopped
– When a Dose of a medication is changed
– When alcohol is consumed while taking medicines
– When OTC and herbal products are taken without the doctor or
pharmacist knowing they are part of the medicine regimen.
– Can really happen any time

Ways to Avoid Medication
Use Problems
 Communication
– Asking questions to increase knowledge
– Talking to your health care providers
– Keeping a medication list
 Using one pharmacy
 Medication Review
– Check your prescription prior to taking
– Have all medications reviewed at least annually
Know Your Medications!
 What is this medication used for?

 Is this a BRAND or GENERIC?
 How to take it?
 How much
 How often/what time of day
 With or without food, other medications,
 What should you expect?
 How to tell if the medication is working
 Possible side effects and what to do about them
 Tests or monitoring needed
Your Medication List
When visiting any health care professional:

– Take your Medication List, which
contains information on:
 all prescription medications, including eye drops,
topicals, samples
 non-prescription medications, herbals, vaccines
 what are medications used for
 how you take them
Your Medication List
Make copies of your list
 Give one to your doctor, one to your pharmacist,

and one to a loved one.
 Carry one with you and keep a copy at home.
Make sure to keep it updated!
.
Talking with Your Health
Care Provider
 Prior to your visit, make a list of questions.
 Ask about:
– Questions you may have about a disease,
symptom(s), or medications.
– The need to continue current medications
– Non-drug treatments
– Over the counter preparations
– Need for follow up appointments, lab work
You are an important part of your health care

team!
Ways to avoid medication use
problems: The OTC Drug Fact
Label
 All over-the-counter medicines in the United States have a Drug Facts Label that looks like this:
 Learning to read the Drug Facts Label will give you the knowledge to make better decisions ,and use OTC medications safely.
Ways to avoid medication use
problems: Drug Fact Label
 Taking an OTC medicine safely is too important for
guesswork.
 If you have questions, ask your pharmacist or doctor.
 Don’t combine prescription medicines and OTC drugs

without talking to your pharmacist or doctor first.
 Reading the Drug Facts Label will give you the

knowledge to make better decisions ,and use OTC
medications safely.
Ways to Avoid Medication Use
Problems: Written Information
 The information sheet you get with your prescription
medicine contains useful information to help you get the
best results and avoid problems. Read it carefully.
 The information sheet tells you:

– What the medicine is used for
– How to take your medicine correctly
– What side effects to watch for and what to do if they
occur
– Warnings and Precautions
– Storage.
In Review: Remember the 3 R’s
1. Risk - all medicines (prescription &

nonprescription) have risks as well as benefits; and
you need to weigh these risks and benefits
carefully for every medicine you take.
2. Respect - respect the power of your medicine

and the value of medicines properly used.
3. Responsibility - take responsibility for learning

about how to take your medication safely.
“It is time to move beyond the illusion
of medication safety to face the
difficult reality of acknowledging the
significant risk that medications pose
to patients and implementing
strategies to reduce it.”
Classen D. Medication safety: moving from illusion to reality. JAMA 2003;289:1154-6.

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Medication Management in

– The general risks and benefits of medications

– Differences between prescription medications and over-

– Common medication use problems

– Ways to improve medication use safety :

Individuals 65 and older leading

 Community Dwelling Individuals on average take 4

– A medication or drug changes how your body works OR

– Treats or prevents a disease or symptom

When used correctly medications can lead to:

- Better life quality

 Over-the-Counter (OTC) or non-prescription medications

 Dietary Supplements and Herbal remedies

 Vaccines and immunizations

– Usually Purchased from a pharmacy

– Samples sometimes given from doctor

– To be taken only by patient it is prescribed

 Purchased from any number of places

 You are responsible for choosing the correct

 Just because a medicine is available over-the-

 You are responsible for choosing the correct medicine, dose,

 Herbal remedies do not have to follow the same strict rules

 For herbal remedies, manufacturers do not have to prove

 Medications can cause problems, even if used

It is important that you inform all healthcare

– Medication use problems are any “bad” things that happen

- Medication use problems can result in you not getting the

 Medication Use Problems can:

 Under use–taking less than prescribed or

 Not following instructions for use carefully

 Side effect = undesired effect of a medication

 Often, there are simple steps that can be taken to

– When a Medicine is stopped

– When a Dose of a medication is changed

– When alcohol is consumed while taking medicines

– Can really happen any time

 What is this medication used for?

When visiting any health care professional:

 Give one to your doctor, one to your pharmacist,

 Carry one with you and keep a copy at home.

Make sure to keep it updated!

You are an important part of your health care

 If you have questions, ask your pharmacist or doctor.

 Don’t combine prescription medicines and OTC drugs

 Reading the Drug Facts Label will give you the

 The information sheet tells you:

1. Risk - all medicines (prescription &

2. Respect - respect the power of your medicine

3. Responsibility - take responsibility for learning

Classen D. Medication safety: moving from illusion to reality. JAMA 2003;289:1154-6.

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