Olivia Carriola was frightened. The 67-year-old was dizzy and disoriented. "I didn't know what was happening to me. I was bouncing off the walls," she says. "In the hospital, the doctor told me I had low sodium, but they didn't tell me where it was coming from."
Carriola eventually got the answers she needed when she received a comprehensive medication review at the DeForest Area Community and Senior Center. "Now I know that the Tegretaol XR I'm prescribed to relieve seizures is what's lowering my sodium, and I have to be very careful about how much water I drink," she says.
When she was low in sodium, Carriola got confused and started taking her medications the wrong way. "Things were just getting worse," she says.
The pharmacist who did the medication review wrote a letter to Carriola's doctors, who made changes in her blood pressure medication. She also learned some of her meds had expired. "I didn't realize I shouldn't take those," she says.
Now that her medications are under control, Carriola is much more likely to maintain her independence. That's good news for her and her community. There are more than 50,000 seniors in Dane County, and that number is projected to reach 112,000 by 2030, the year the last baby boomer turns 65.
"We have been asking health professionals what are the tipping points that move seniors to high levels of care," says Hooyung Young, director of Community Impact at United Way and manager of the Safe and Healthy Aging Initiative. "The common theme from those interviews is adverse drug events [ADE]."
Data collected from Group Health Cooperative of South Central Wisconsin, Unity Health Insurance and UW Health Systems, which cover about 8,000 local seniors, show that older adults have an average of 6.4 prescriptions. When over-the-counter and mail-order drugs are included, the number can go up to 15 to 17 medications. All these medications can add up to trouble. In 2009, 1,630 seniors ended up in emergency rooms and hospital rooms because of adverse drug reactions. In addition, falls, many of which were probably related to drug reactions, brought another 1,493 into care.
Seniors are dealing with a triple threat. Older adults often have complex drug regimens to treat their multiple health conditions, and that puts them at risk of taking the wrong dosages. And taking so many medications increases the chance of negative interactions. In addition, many medications that work well for younger people have an adverse effect on the elderly.
"Medication management is a huge issue," says Young. "Pharmacists say that if seniors take five to eight medications, they are exposed to an increased chance of ADE, and if they take more than eight medications, then they are definitely experiencing some kind of adverse effect."
But there is some good news, says Young: Up to 65% of falls and 90% of adverse drug events are preventable.
To help seniors manage their medications more safely, United Way developed a partnership with the Pharmacy Society of Wisconsin and the Wisconsin Pharmacy Quality Cooperative. The Wisconsin Pharmacy Quality Cooperative has trained a network of local pharmacists who can now offer comprehensive medication reviews for older patients to identify any adverse drug reactions. If a risk is found, pharmacists communicate with the physicians to establish an updated and safer medication regime.
Alan Lukazewski, director of pharmacy services at Oakwood Village Continuing Care Retirement Communities, learned about adverse drug reactions in older adults about 10 years ago when he suggested a resident take a statin like Zocor or Lipitor to lower cholesterol. The patient told him that Zocor made him loopy and affected his memory. Switching to a different statin had a similar effect.
"After he told me that, I searched the literature," says Lukazewski. "I learned that statins do cause memory loss in a very small but significant number of people. People can actually be falsely diagnosed with Alzheimer's disease because of memory loss from medication." The Food and Drug Administration has revised safety labeling for statins to include memory loss, he adds.
Lukazewski warns that older adults are vulnerable to what he calls a "prescribing cascade." "What if my statin prescription is causing memory loss," he says. "So I start a drug for memory health like Aricept or Excelon, and a couple of weeks later I start to experience urinary incontinence, which can be caused by these medications. That results in a prescription for a medication like Detrol or Ditropan for incontinence. And to make matters even worse, the incontinence drug can block the beneficial effects of Aricept and compound the memory loss caused by the statin in the first place."
Prescription drugs aren't the only culprit. Over-the-counter medications (OTCs) like Motrin, Nuprin, Aleve and Tylenol PM are popular with people who suffer from pain or insomnia, but these non-steroidal pain medications are a leading cause of hospitalization for intestinal bleeding in older adults, according to Lukazewski.
"People need to understand that OTCs can be as dangerous as the wrong prescription drugs," he says. "OTC drugs for insomnia can cause sedation, cognitive impairment and increased falls and should not be used by older adults."
A comprehensive medication review often provides valuable insights, but can cost from $100 to $180 per patient, says Young. "Group Health Cooperative and Unity Health Insurance are covering the cost for their members, and we are waiting to hear back from Medicaid and United Health Care."
For those who can't afford the service, United Way can cover the costs for as many as 750 seniors. A free screening program was launched this February at Northwest Dane Senior Services in Black Earth, where director Angela Velasquez has noticed an uptick over the past year in the number of seniors falling.
Velasquez says the screenings are critical, and she would like to get the message about adverse drug reactions out to the families of seniors. "How many of us have been to our parents' homes and seen a lazy Susan in the middle of the table filled with pills?" she asks. "That concerns me. A medication review could reassure adult children that the medications and over-the-counter drugs and supplements their parents are taking are helpful and not harmful."
Velasquez is glad that pharmacy students assist the pharmacists doing the screenings. "I think it's great that we are training the next generation of pharmacists to do this work."
Older adults or their caregivers can call 211 to be connected with a confidential resource service for information about a comprehensive medication review, a balance class and other services.
Lukazewski has high hopes that the medicine screening program will have far-reaching effects.
"We have 30 pharmacists in Dane County who have been trained to understand the nuances of medication use in older adults," he says. " It's like planting seeds. We are reaching people and making an impact, and we are educating prescribers."
