The Aging Parent-Multiple Medication Conundrum

pillsThe intersection of elderly parents and multiple medications continues to be a conundrum for many adult children. It certainly is for my family! Two recent Washington Post articles about medication issues may be useful for the children or aging adults to read and then share with one another.

In Older Patients Sometimes Need to Get Off of Their Meds, but It Can Be a Struggle, physician Ravi Parikh writes about evaluating medications with the aim of de-prescribing some of the medicines that people take. He describes the struggles that can arise when patients hesitate to go off medications that they have been taking for years, because their sense is that their medications are working. People are reluctant to associate physical problems with medications that they already take, so when new symptoms arise, many people seek a prescription for that problem and are less inclined to examine whether or not the new problem might be caused by medications they already take.

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Aging Parents: Chronic Disease Complications on Vacation

A family picture at Upstate Medical University in Syracuse, NY, looking at the special “treehouse” architecture that is a part of the Golisano Children’s Hospital.

What to do when an aging parent becomes ill on a family vacation? With little knowledge about the quality of care in an away-from-home location, even in a place visited for years, double anxiety is the name of the game if a loved-one is taken to the hospital.

We faced this issue last weekend when, just after breakfast as we were leaving for home, my dad had difficulty standing. Although he recovered fairly quickly, a trip to a hospital emergency room was in order. In this case we asked ourselves, how can we judge the knowledge of the caregivers and be certain he receives the best care? That’s a tall order.

After receiving a day of assiduous and personalized attention at the small, local hospital, The River Hospital (click to see the amazing St. Lawrence River view from the emergency waiting room below), an ambulance transported Dad 90 miles south to Upstate Medical University Hospital, a teaching hospital in Syracuse, New York. River Hospital staff made all of the arrangements, ensuring an easy and smooth transfer, so when he reached Syracuse, the ambulance crew carried him right up to an assigned hospital room on the 8th floor — an extraordinary convenience in itself.

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Many Seniors Don’t Know About Medicare Extra Help Subsidy

According to a January 4, 2011 Kaiser Health News (KHN) article, many American seniors who qualify for a Medicare Part D subsidy that reduces prescription costs have not signed up. The article, 2 Million Medicare Beneficiaries Missing Out On Discounted Drug Coverage, explains that the program, called Extra Help, lowers medication costs and reduces money spent in Part D doughnut hole.

This is a significant program that the children of senior parents should learn about, especially if their parents’ incomes are limited. A Kaiser Family Foundation research study estimates that nearly 2.3 million people qualify but have not signed up for the program, despite a huge amount of publicity, direct mail and even ads and video broadcasts (see video below) with Chubby Checker — the rock musician who popularized the twist in 1960. Checker, now age 69 is eligible for Medicare benefits. The KHN article provides more detailed information.

The article describes who is can sign up for the Extra Help benefits: Continue reading

Too Many Medications? More Aging Parent Health Problems?

Check out this site about polypharmacy.

Polypharmacy is a serious problem for many seniors. Here on AsOurParentsAge I’ve written multiple posts (links to a few at the bottom of this page) about the medications that our aging parents take for various chronic conditions. I’ve wondered, after considerable experience with my husband’s and my parents, why they have so many, and more importantly, why their physicians do not coordinate the medications. It seems like it would be prudent for primary care physicians to review a patient’s medications, perhaps once a year, comparing and contrasting the drugs with patient experiences and outcomes.

My musings led me to a terrific blog posting by Joanne Kenen, “Pill Popping–Or Pill Stopping? Polypharmacy’s Impact on Older Patients.” Kenen, a health policy writer, posted her December 11, 2010, piece on the Altarum Institute blog — Altarum focuses on improving health care delivery. She writes about a study, Feasibility Study of a Systematic Approach for Discontinuation of Multiple Medications (abstract), published in the October 11, 2010 Archives of Internal Medicine. The journal article is not free, but Kenen’s blog post provides a comprehensive, almost perfect and easy-to-understand summary of the research, and she has even communicated with the researcher. If you have aging parents who are on multiple medications, I strongly recommend that you read these two articles, though you may need to read the journal article at a hospital library.

The study, undertaken by Doran Garfinkel, MD, set out to discover what might happen if seniors’ medications were re-evaluated and where possible, discontinued. Continue reading

Aging Parents: After a Stroke – Taking Prescribed Medications

If you find this post interesting you may want to read  Aging Parents and Medications and Thoughts on Medications and Seniors, Part I.

Anyone with a stroke survivor in the family knows how many details caregivers attend to immediately after the event. Coordinating many medications and rehabilitation services, as well as trying to surmise the extent to which independence will be restored or limited, can become a primary focus for several months. We certainly experienced this when my husband’s mother suffered a stroke, and we found that medications were the hardest to coordinate.

Monitoring Medications Post Stroke

So it was with some interest that I read an article about stroke survivors and medications in the Los Angeles Times Booster Shots blog. The post describes research that investigated the medication experiences of more than 2,500 patients  treated at 106 hospitals during the first three months of post-stroke recovery. The goal of the research was to measure whether individuals were continuing to take prescribed medicines at the end of three months and also to identify factors that might support on inhibit medication compliance.

On August 9, 2010 the Archives of Neurology published an article about the longitudinal medication research study (abstract). Researchers discovered that 25 percent of the patients had stopped taking at least one prescribed medication. According to the journal article (available at a medical library), “The assessment of and reasons for nonpersistence at 3 months poststroke are important because the risk of recurrent stroke is greatest during this period.”

Some of the Factors Associated with Higher Medication Compliance (You may want to read my post Association vs. Causation: the Differences?)

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Medicare Doughnut (Donut) Hole: $250 Sent Automatically

According to an August 10, 2010 press announcement from the Department of Health and Human Services, more than 750,000 rebate checks for $250 have already been mailed to Medicare beneficiaries who have already entered the doughnut hole this year because of prescription costs. Adult children need to be sure that a parent reaching the doughnut understands the following:

Medicare.gov is a user-friendly site for seniors and adult children.

  • By the end of the year about 4 million people will receive the $250 check.
  • The rebate is automatically mailed to a beneficiary when the doughnut hole is reached.
  • There is no requirement to sign up or give out personal information in order to receive the rebate. Listen to this recording about protecting your personal medicare information.
  • If anyone unfamiliar solicits personal health or financial information, it should be reported to www.stopmedicarefraud.gov

For other important information go to Medicare.gov to read a PDF document, Closing the Prescription Drug Coverage Gap.