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Medication Management
by Sandy Dunlap RN, LCSW
Director of Nursing
Seniors use more medications than any other age group. Multiple medical problems often mean multiple
physicians who are all prescribing medications. In addition to prescribed medication, many seniors
take over the counter pills to combat their ailments. They may even take their spouse's, neighbor's
or friend's pills because "it helped them."
Medications are prescribed in varying dosages and for different times. Some are taken with meals,
after meals, or before meals. Others are taken once or more daily, once weekly, or at bedtime. All
of this can be very confusing and stressful even for seniors with no memory loss. For those with
even mild memory loss, the task of taking medications may become overwhelming. They may forget to
take their medications completely, take multiple dosages, or take them incorrectly. There are many
reasons why taking medications can be dangerous for the older adult.
Frequently the senior forgets to tell their physician that they have been prescribed a medication by
another physician and the doctor may prescribe something that can cause a negative or harmful response.
Often the patient does not remember the name of the medication they are taking or what the medication is
for, stating "It is something for my heart". They may mistakenly believe that more medication will cure
them faster. Physical problems such as loss of eyesight or physical dexterity may hinder their ability
to take the correct medication. For example, the pill bottle will be left open because it is easier and
then the pills are spilled and perhaps replaced in the wrong bottle.
There are emotional or psychological issues related to taking medication also. Some people are in denial
of the need for medication. Others are feeling better so they stop taking their pills saying "I don't need
it any more." They do not understand that they feel better because they are taking the pills and stopping
medication without the physician's approval can lead to relapse of the original problem or other adverse
effects. Some medications must be gradually reduced in dosage prior to discontinuation to avoid a negative
problem. A major reason given by seniors for stopping medication is cost. Even when there are adequate
financial resources, the older adult may skip dosages because the pill is very expensive.
In doing a random sample of 50 of our patients, the average number of prescribed medication is 10. If half
of the pills are once daily and the others are more, there can easily be 15 or 20 pills taken. One senior
has 28 prescriptions all taken at varied times and dosages.
Often when family does not live nearby, they question their loved about health but never think to ask about
their medications. An awareness of the potential problems can alert you that additional help may be needed
to ensure the safety or well being of your loved one. For this reason, Rona Bartelstone Care Management &
Home Healthcare provides nurses who are able to review medications and fill medication box dispensers. This
enables the elder, the family and the multiple physicians to know that the person is in compliance with the
maximum medication routine for the individual's needs.
Rona Bartelstone Associates provides private health care and care management services to older adults and
individuals dealing with illness and chronic disabilities. The agency's founder, Rona Bartelstone, is a
Licensed Clinical Social Worker, Certified Care Manager and Diplomat in Clinical Social Work. She is a
sought-after speaker, university instructor, consultant and published author in the areas of aging,
caregiving and programming for chronic care needs. Bartelstone is founder and past president of the
National Association of Professional Geriatric Care Management and founder and vice president of the
National Academy of Certified Care Managers.
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