Managing an illness or injury is tricky in the best of circumstances. There are complicated medication routines and new terminology. You have to make treatment decisions, which can sometimes involve difficult choices. You have to coordinate your care among multiple doctors. All of these tasks must be accomplished while you are feeling ill or in pain; and likely emotionally overwhelmed by the change in your health. When you combine these demands with the difficulties associated with getting older, it is easy to see why it can be hard for those over 65 to effectively manage their own healthcare. Do you have an aging parent you worry about? How can you help seniors manage their healthcare?
Why help seniors manage their healthcare?
It’s tough to get old. It’s hard to manage complex tasks, and it’s hard to remember things. And as we age, we inevitably develop health issues that require time and attention. All of this makes it difficult for seniors to manage their healthcare. Read below for some of the reasons we should help seniors manage their healthcare.
Research shows many seniors struggle to manage their healthcare.
Based on a survey of over 2,000 US patients who were 65+ years old, researchers concluded that almost 40% of the respondents could not manage the complexities of navigating the healthcare system.
Specifically, the research found:
- It was “sometimes” or “often” hard for these patients and their families to manage healthcare activities.
- Older patients sometimes delayed, or even skipped, recommended healthcare activities.
- Dealing with everything involved in managing healthcare was too much for many.
Older patients often struggle to understand medical information.
Health literacy is the ability to obtain, process, and understand basic health information needed to make appropriate health decisions. In other words, low health literacy can affect a patient’s ability to self-manage a medical condition.
Unsurprisingly, researchers found that older adults with poorer cognitive functioning and stronger cognitive decline are at risk for low health literacy. But it’s not just people with cognitive decline that struggle with health literacy. The National Assessment of Adult Literacy found only 3% of those 65+ years old were proficient with health literacy skills.
Clearly, the ability to process and use health-related information declines as we age, potentially making it harder to effectively manage any kind of serious medical condition.
Medications pose health risks for older patients.
There are two categories of concern relating to medications for older patients: the medications themselves, and the difficulty following prescribed regimens. In order to help seniors manage their healthcare, you must consider both of the following aspects of medication:
Our aging bodies make medications riskier.
All medications have the potential to cause harm to patients, particularly to seniors. As we age, our bodies change the way we respond to medications. Generally, older age is associated with increased blood concentrations of drugs and altered metabolism, reduced effectiveness, and an increased risk of adverse reactions for many medications. A medication regimen that was safe when you were 40 might pose risks when you are 70.
Additionally, many seniors take medications that increase their risk of falling, which can lead to serious health consequences and even death. Researchers found that in 2017, about 94% of adults 65+ years old received a prescription for a drug that increased their risk of falling. Surprisingly, that number was only 57% in 1999. Moreover, the study found that rate of death caused by falls in older adults more than doubled from 1999 to 2017.
Older patients struggle to take medication as prescribed.
Failing to take medications as prescribed can lead to a substantial worsening of the disease with increased disability, or even death. Although following medication regimens is hard for many patients, the task is even harder for older patients. Why? Several factors, including:
Seniors take a lot of drugs.
Polypharmacy, the use of multiple drugs or the use of more drugs than are medically necessary, is a growing concern for seniors. Seniors take a lot of drugs. The American Society of Consultant Pharmacists states that people 65-69 years old take an average of 15 prescriptions a year. Moreover, those aged 80 to 84 take 18 prescriptions a year. Importantly, one study found that the risk of an adverse drug interaction is 82% for patients who are taking 7 or more medications.
Surprisingly, research shows that almost 50% of older adults take at least one medication that isn’t medically necessary. Unsurprisingly, polypharmacy increases the risk of drug interactions and adverse drug reactions. Furthermore, there is a strong established relationship between polypharmacy and negative health consequences.
Drugs are expensive.
Even with insurance, seniors must pay out of pocket for at least a portion of their medications. Clearly, when you’re taking 10-15 medications, these costs add up quickly. And this can lead to seniors skipping medications, which obviously can impact health.
A Kaiser Family Foundation survey found that seniors have concerns about the cost of prescriptions that could lead to health issues:
- 23% of older adults who take prescription medications say it is “difficult” to afford their prescription medications. And 8% say it is “very difficult” to afford their prescription medications.
- 21% say they didn’t take their medications as prescribed because of the cost.
- Due to cost:
- 12% did not fill a prescription.
- 11% took an over-the-counter medication instead.
- 8% cut pills in half or skipped a dose.
Aging impacts our thinking.
As we age, our brain changes in ways that can impact our memory and thinking skills. Clearly, those with dementia are impacted more significantly. On top of this, many medications can make it harder to concentrate and think clearly. These cognitive changes can easily lead to forgetting to take a medication, taking the wrong dosage, taking a medication at the wrong time, and other medication management mistakes.
Hospital stays pose health concerns for older patients.
Unfortunately, seniors’ health is at risk both during and after hospital stays. There are many factors that can cause a rapid decline in health for hospitalized seniors, including:
- Seniors are susceptible to adverse drug reactions.
- Hospitalizations can lead to an increase in the number of medications taken.
- Falls among seniors are common and dangerous.
- Limited physical activity leads to deterioration.
- Hospitalizations increase the risk of dangerous blood clots.
- Seniors are more susceptible to pressure sores.
- Seniors are particularly impacted by sleep loss.
- Dementia patients face more complications and worse outcomes.
Additionally, when seniors leave a hospital, they are more susceptible to “post-hospital syndrome”. After hospital stays, all patients, especially older patients, face a short-term period of increased susceptibility to disease and adverse events, which can lead to hospital readmissions and even death.
Surgery poses risk for older patients.
Older patients are more vulnerable during and after surgery, as compared to younger patients. Unfortunately, common health problems related to aging, such as high blood pressure, clogged arteries, as well as heart and lung disease, increase the risk of side effects or complications during or after surgery. Furthermore, research shows that increasing age itself can increase the risk of complications and deaths following surgery.
Additionally, residents of nursing homes have substantially higher rates of death and of invasive interventions (such as mechanical ventilators and feeding tubes) after major surgery, as “compared with adults of similar age who had the same number of chronic illnesses“. So, if your loved one resides in a nursing home, talk to the doctor specifically about this issue and carefully consider risks before deciding on surgery.
The risks of anesthesia in older patients.
Unfortunately, the aging brain is more vulnerable to anesthesia. Therefore, seniors are more at risk for two common anesthesia-related surgery risks – postoperative delirium and postoperative cognitive dysfunction.
Invasive interventions bring risk.
Invasive interventions after surgery, such as ventilators, central lines and feeding tubes, make it even harder for seniors to recover since these interventions increase the risk of infection and often keep patients in bed – both of which can lead to deteriorating health.
What can you do to help seniors manage their healthcare?
Consider the following recommendations to help seniors manage their healthcare:
Find the right doctor and hospital.
- If possible, find a gerontologist – they receive special training in the medical needs of older people.
- Look for a doctor’s practice that provides “patient-centered” or “person-centered” care.
- Try to use a hospital that is designated as an “Age-Friendly Health System”. These hospitals are committed to providing appropriate, evidence-based care for seniors, and causing no harm. Additionally, these hospitals have committed to considering the desires of seniors and their families. Visit the IHI website to see the list of the thousands of hospital systems deemed friendly to seniors. Additionally, you can search online with the term “acute care for elders” and the name of your city or hospital to learn about programs and policies regarding senior care.
Get the most out of medical appointments.
- In an ideal world, you would attend appointments with your loved one, providing a second set of ears, asking questions, and supporting your loved one. However, this is often impossible due to job and family responsibilities, and geographic distance.
- If your loved one must attend an appointment by his/herself, you can attend via phone or video. Ask your loved one to call you at the beginning of the appointment, letting you listen in and ask questions as needed. Note that it’s a good idea to let the doctor know about these plans.
- Whether you join the patient, or he/she goes alone, it’s a good idea to record medical appointments with a phone or recording device. Listening to the conversation later will help everyone remember details discussed. Additionally, the recording can be shared with anyone unable to attend the appointment. But ask for permission before recording. For more information, read Should You Record Medical Appointments?
- You and/or your loved one should prepare for medical appointments by writing down all questions before each appointment. Additionally, write down the patient’s “story” to describe anything pertinent to his/her health. For instance, if the patient feels sick after eating or dizzy in the heat, write it down and share it with the doctor.
- As appropriate, ask for written materials that explain the medical condition your loved one is dealing with.
- Stay organized. You or your loved one should take careful notes at appointments and keep all health-related documents, such as test results, organized and accessible. Share these notes and documents with providers at each appointment or hospital stay.
Pay close attention medication management.
Whether you accompany your loved one to appointments, or he/she goes alone, it’s important to discuss medications with each doctor to minimize the risk of medication-related issues.
- Ask the doctor why, how, and when to take each new medication. Write this information down and share it as needed.
- Ask each doctor if any particular medications, or a combination of medications, could increase the risk of falling. If so, ask about safer options.
- Ask each doctor if all of the medications taken are needed. This includes prescription and over-the-counter drugs.
- Don’t be afraid to tell the doctor if the cost of medication is a concern, including letting him/her know if medications are skipped due to money. The doctor may have suggestions for similar medications, generics, or discounts.
- The patient should always carry a list of their medications (and dosage), including over-the- counter medications.
- Make sure each doctor has a up-to-date list of all medications taken to reduce the risk of an adverse drug interaction.
- If possible, fill all medications at the same pharmacy so the pharmacist, and/or the pharmacy computer, can catch potential adverse interactions.
- Set up a system to keep pills organized, such as using a simple pill sorter you can buy at any pharmacy. You can also purchase pills pre-packaged according to the particular day and time needed, making it easy to organize pills (try CVS or PillPack). And set up a system to remind the patient it is time to take a medication. In some cases, you might need a pill dispenser that dispenses pills at the designated time and reminds patients it’s time to take medication (note these generally have monthly user fees).
Reduce the risk of medication errors if your loved one is in a hospital or long-term care facility.
Unfortunately, medication errors are common among in-patient facilities. In fact, a 2006 landmark report by the Institute of Medicine estimates at least one medication error per patient every day in hospitals and long-term care facilities! To reduce the risk of medication errors, consider the following:
- Make sure all your nurses and doctors know about past medication-related allergies and/or side effects.
- Keep a complete list, with the patient, of all medications taken.
- You or the patient should speak up if a medication doesn’t look familiar.
- Ask the nurse if any medications are considered “high-alert”. These medications, such as insulin and blood thinners, must be given the right way at the right time. If any of your loved one’s medications are high-alert, ask what steps staff take to make sure they provide these high-alert medications in the proper manner and time.
Reduce the risk of hospital-related issues.
As noted above, older patients are more at risk for harm during and after a hospital stay. If your loved one is in the hospital, or has a planned hospital visit, read Risks for Seniors in the Hospital for more information and helpful tips.
Reduce the risk of harm due to a surgical procedure.
Clearly, it’s important to learn about potential risks, and steps that can reduce the risk of harm, before scheduling a surgical procedure. For more information on this topic, plus a full list of questions to ask doctors, read Questions Seniors Should Ask Before Surgery.
It’s important that you stay engaged in the process to help your loved one get the best care and outcome possible. For more information on how to help seniors manage their healthcare, read these blog posts:
- Understanding Medical Information Is Harder Than Most Realize.
- 10 Tips for a Better Medical Appointment.
- Why Take Detailed Notes at Doctor Appointments?
- 10 Tips to Communicate Better with Doctors.
- What is the Best Time of Day for Medical Care?