Medication and Older Adults

You are a partner in your health care. This is a partnership between you, your doctor, and your pharmacist. You need to be assertive and knowledgeable about the medications you take.

The Food and Drug Administration is also working to make drugs safer for older adults, who consume a large share of the nation's medications. Adults over age 65 buy 30 percent of all prescription drugs and 40 percent of all over-the-counter drugs.

"Almost every drug that comes through FDA [for approval] has been examined for effects in the elderly," says Robert Temple, M.D., associate director for medical policy in FDA's Office of Drug Evaluation and Research. "If the manufacturer hasn't done a study in the elderly, we ask for it."

More than 15 years ago, the agency established guidelines for drug manufacturers to include more elderly patients in their studies of new drugs. Upper age limits for drugs were eliminated, and even patients who had other health problems were given the green light to participate if they were able. Also, drugs known to pass primarily through the liver and kidneys must be studied in patients with malfunctions of those organs. This has a direct benefit for older adults, who are more likely to have these conditions.

In several surveys, FDA discovered that drug manufacturers had been using older adults in their drug studies; however, they weren't examining that age group for different reactions to the drugs. Now, they do. Today, every new prescription drug has a section in the labeling about its use in the elderly.

Says Temple, "The FDA has done quite a bit and worked fully with academia and industry to change drug testing so that it does analyze the data from elderly patients. We're quite serious about wanting these analyses."

When More Isn't Necessarily Better

Of all the problems older adults face in taking medication, drug interactions are probably the most dangerous. When two or more drugs are mixed in the body, they may interact with each other and produce uncomfortable or even dangerous side effects. This is especially a problem for older adults because they are much more likely to take more than one drug. Two-thirds of adults over age 65 use one or more drugs each day, and a quarter of them take three drugs each day.

Not all drug combinations are bad. High blood pressure is often treated with several different drugs in low doses. Unless supervised by a doctor, however, taking a mixture of drugs can be dangerous.

For example, a person who takes a blood-thinning medication for high blood pressure should not combine that with aspirin, which will thin the blood even more. And antacids can interfere with certain drugs for Parkinson's disease, high blood pressure, and heart disease. Before prescribing any new drug to an older patient, a doctor should be aware of all the other drugs the patient may be taking.

"Too often, older people get more drugs without a reassessment of their previous medications," says Feinberg. "That can be disastrous."

There is also evidence that older adults tend to be more sensitive to drugs than younger adults are, due to their generally slower metabolisms and organ functions. As people age, they lose muscle tissue and gain fat tissue, and their digestive systems, liver, and kidney functions slow down. All this affects how a drug will be absorbed into the bloodstream, react in the organs, and how quickly it will be eliminated. The old adage "Start low and go slow" applies especially to the elderly.

Older adults who experience dizziness, constipation, upset stomach, sleep changes, diarrhea, incontinence, blurred vision, mood changes, or a rash after taking a drug should call their doctors. The following suggestions may also help:

* Don't take a drug unless absolutely necessary. Try a change in diet or exercise instead. Ask your doctor if there's anything else you can do besides drug therapy for the condition.

* Tell your doctor about all the drugs you take. If you have several doctors, make sure they all know what the others are prescribing, and ask one doctor (such as an internist or general practitioner) to coordinate your drugs.

* Ask for drugs that treat more than one condition. Blood pressure medicine might also be good for heart disease, for example.

* Keep track of side effects. New symptoms may not be from old age but from the drug you're taking. Try another medication if possible until you find one that works for you.

* Learn about your drugs. Find out as much as you can by asking questions and reading the package inserts. Both your doctor and pharmacist should alert you to possible interactions between drugs, how to take any drug properly, and whether there's a less expensive generic drug available.

* Have your doctor review your drugs. If you take a number of drugs, take them all with you on a doctor's visit.

* Ask the doctor, "When can I stop taking this drug?" and, "How do we know this drug is still working?"

* Watch your diet. Some drugs are better absorbed with certain foods, and some drugs shouldn't be taken with certain foods. Ask a pharmacist what foods to take with each drug.

* Follow directions. Read the label every time you take the medication to prevent mistakes, and be sure you understand the timing and dosage prescribed.

* Don't forget. Use a memory aid to help you--a calendar, pill box, or your own system. Whatever works for you is best.

Medicine and Special Needs

Arthritis, poor eyesight, and memory lapses can make it difficult for some older adults to take their medications correctly. Studies have shown that between 40 and 75 percent of older adults don't take their medications at the right time or in the right amount. About a quarter of all nursing home admissions are due at least in part to the inability to take medication correctly.

A number of strategies can make taking medication easier. Patients with arthritis can ask the pharmacist for an oversized, easy-to-open bottle. For easier reading, ask for large-type labels. If those are not available, use a magnifying glass and read the label under bright light.

Invent a system to remember medication. Even younger adults have trouble remembering several medications two or three times a day, with and without food. Devise a plan that fits your daily schedule. Some people use meals or bedtime as cues for remembering drugs. Others use charts, calendars, and special weekly pill boxes.

Mary Sloane, 78, keeps track of five medications a day by sorting her pills each evening into separate dishes. One is for morning pills, the other for the next evening. Then she turns each medicine bottle upside down after taking the pill so she can tell at a glance if she has taken it that day.

"You have to have a system," Sloane says. "Because just as soon as I get started taking my pills, the phone rings, and when I come back to it, I think, 'Now have I taken that?'"

Drug-taking routines should take into account whether the pill works best on an empty or full stomach and whether the doses are spaced properly. To simplify drug-taking, always ask for the easiest dosing schedule possible--just once or twice a day, for example.

Serious memory impairments require assistance from family members or professionals. Adult day-care, supervised living facilities, and home health nurses can provide assistance with drugs.


Active Lives

Not all older adults are in danger of drug interactions and adverse effects. In fact, as more and more people live active lives well into their 80s or beyond, many take few medications at all. Among healthy older adults, medications may have the same physical effects as they do in younger adults. It is primarily when disease interferes that the problems begin.

To guard against potential problems with drugs, however, older adults must be knowledgeable about what they take and how it makes them feel. And they should not hesitate to talk to their doctors or pharmacists about questions and problems they have with a medication.

Says the University of Maryland's Feinberg: "We need to have educated patients to tell us how the drugs are working."

Rebecca D. Williams is a writer in Oak Ridge, Tenn.


Cutting Costs

The cost of medications is a serious concern for older adults, most of whom must pay for drugs out of pocket. Even those who have insurance to supplement Medicare must often pay a percentage of the cost of their medicines.

For a new prescription, don't buy a whole bottle but ask for just a few pills. You may have side effects to the medication and have to switch. If you buy just a few, you won't be stuck with a costly bottle of medicine you can't take.

For ongoing conditions, medications are often less expensive in quantities of 100. Only buy large quantities of drugs if you know your body tolerates them well. But be sure you can use all of the medication before it passes its expiration date.

Call around for the lowest price. Pharmacy prices can vary greatly. If you find a drug cheaper elsewhere, ask your regular pharmacist if he or she can match the price.

Other ways to make your prescription dollars go further include:

* Ask for a senior citizens discount.

* Ask for a generic equivalent.

* Get drug samples free. Pharmaceutical companies often give samples of drugs to physicians. Tell your doctor you'd be happy to have them. This is especially convenient for trying out a new prescription.

* Buy store-brand or discount brand over-the-counter products. Ask the pharmacist for recommendations.

* Call your local chapter of the American Association for Retired Persons (AARP) and your local disease-related organizations (for diabetes, arthritis, etc.) They may have drugs available at discount prices.

* Try mail order. Mail-order pharmacies can provide bulk medications at discount prices. Use this service only for long-term drug therapy because it takes a few weeks to be delivered. Compare prices before ordering anything.

Choosing the Right Wheelchair For You

Most people are familiar with prescriptions from a doctor for medications, but not for mobility aids such as wheelchairs or even crutches. The process of choosing the right wheelchair can be especially difficult, because the types of options available are as varied as the types of people in the world and their various lifestyles.

Depending on what you do on a daily basis, you may need a chair with a pressure-relieving cushion, brake extensions, or other special options in order to make it effective. Since a wheelchair is designed to either fully provide or significantly add to your mobility, it’s vital that you get the right chair for you.

Unlike prescriptions for medications, which are very specific, a doctor’s prescription for a wheelchair often reads “a wheelchair”. This is partly because most General Practitioners are not experts in physical medicine and so they are not really qualified to make a suggestion as to exactly what type of chair you’ll require.

When possible, it is a very good idea to go through the selection process with a qualified physiotherapist or occupational therapist who knows what your daily routine and lifestyle look like so that they can help you get the chair that properly suits your needs.

Depending on what your requirements are, you may need to have your doctor write a somewhat specific prescription for insurance purposes. If you’ll be spending a significant amount of time in your chair, or if you have particular needs in terms of posture or support, these options can represent a considerable expense above a basic wheelchair system – for many insurers to provide payment, they require that these options be outlined by a physician, which means that you may need to have the prescription re-written by your doctor after an evaluation with a rehabilitation professional.

Although evaluations are not yet required by all insurers, most rehabilitation personnel consider them an absolute requirement – people always test-drive a car before buying it, and in the same way you should get to test-drive your wheelchair and have a professional opinion to ensure that it will do what you need it to.

Getting a professional evaluation before purchasing your wheelchair is the best way to ensure that you get a chair that will support you in doing what you need to do on a daily basis so that you can live comfortably and do the things that you want and need to do, so even if your insurer doesn’t demand one – insist on it!

Caring for Elderly Parents: 5 Tips for Avoiding Caregiver Burnout

Joanne’s mother, Betty, had rheumatoid arthritis for years.  Suddenly and unexpectedly, Betty was disabled by the pain, fatigue and limited mobility that she had feared since her diagnosis.

Joanne convinced her fiercely independent mother that living alone was no longer an option.  And Joanne, the eldest of four children, knew that caring for her sick mother fell on her shoulders.  Joanne was a legend in the circles of her family, friends and colleagues for her ability to act with grace under pressure.

Joanne took two weeks of vacation from her job and cooked and froze meals for her husband and three children.  As she flew to her hometown, she wondered how she would coordinate her mother’s care from a distance. Supporting her husband as he built his new business, nurturing her kids and directing a major project at work already made her feel that she was running on empty.

You may relate to Joanne’s story.  One out of four Americans cares for a friend or relative who is sick, disabled or frail. That’s 46 million Americans who offer unpaid help to a loved one.  If they were paid caregivers’ compensation would exceed last year’s Medicare budget! And if you become a caregiver, you, like Joanne, may try to do it alone, shrouded in secrecy.

Solo caregiving compromises your ability to nurture yourself and others. Let’s take caregiving out from behind closed doors.  For your sake and the sake of those who count on you, please get some help. Caregivers are competent people who feel that they should be able to do this job.  Yet, many soon find themselves unprepared and ill-equipped to manage the sometimes daunting tasks, such as managing a complex medical regimen or remodeling a house so it’s wheel-chair accessible or even finding someone to stay with their loved ones so they can go out to a movie without worrying their relatives will fall on the way to the fridge.

If you are a caregiver, you know that this act of love has its costs.  You stand to forfeit up to $650,000 in lost wages, pension and social security.  Add to that is the personal cost to your well being, as your new demands leave you less time for your family and friends.  You may give up vacations, hobbies and social activities.  Finally, caregiving places a burden on your health.  Caregivers are at increased risk for depression, anxiety, depressed immune function and even hospitalization.

Instead of reaching out, caregivers become isolated.  Many who assume the caregiving burden fit the profile of the giving family member, like Joanne, who does not want to trouble others with their problems.  Some fear the consequences of disclosing their new demands to coworkers or employers. Caregivers are further challenged by the cultural conspiracy of silence.  Our youth-centered society turns a blind eye to the unpleasant and inevitable reality that all of us age and die.  This leaves both caregivers and care recipients unprepared.  Look no further than the path of Hurricane Katrina to witness the consequences of a lack of planning.

What can you do?   Start talking about the "what ifs" and make a plan.

1. Start with yourself.  What will happen to you and your family if you become disabled or die unexpectedly?  Do you have disability insurance? Do you have a will?  Do you have a living will, and have you identified the person who will make the medical choices you would make if you are not in the position to do so?

2. Approach healthy family members.  Say, "I hope that you live many happy years in which you enjoy all of the pleasures you worked so hard to create."  Have you thought about what would happen to you in the event that you cannot live independently any more?  If some medical event befalls you, who would make your medical choices?

3. Look into community resources that support caregiving.  A day program, for example, helps your loved one by providing social connections with peers.  Your community may even offer transportation to and from the program.  Getting out of the house offers the additional benefit of getting bodies moving.  Socializing and exercise are the two most powerful interventions that help your loved ones stay at their best.

4. Make specific suggestions to friends, family members and neighbors who want to help. You may even want to keep a "help list." When they say, "Let me know what I can do," you have a response:  "Could you take Mom to her physical therapy appointment this week?"  "When you’re at the store, could you pick up some oranges and blueberries?"  "Could you watch the kids for an hour so I can get to the gym?" Your giving friends will appreciate specific ideas about how they can help.

5. Take care of your health.  Get good nutrition, plenty of sleep, and regular exercise to stay in top health.  Wash your hands regularly to prevent colds and flu.  Manage your stress with laughter, a prayer or even a deep breath.  Nourish your soul with a taste of activities that recharge your batteries such as writing in your journal or gardening.  Finally, talk to your doctor if you feel depressed or anxious.  

The best strategies for effective caregiving include preparation, acts of self-care and reaching out for help. That begins with the courage to start talking openly about caregiving.

Massage Therapy for Senior Citizens

Massage therapy can offer senior citizens a number of benefits that will greatly improve their sense of health and wellbeing.  As the population continues to age, it is important to consider ways that we can work to improve the lives of those affected by the passing of time.  A number of studies have shown that massage therapy can have a direct impact in managing the effects of aging.  It has also shown promise in bringing comfort to those suffering from arthritis and other physical ailments.

As people age, they naturally become less active.  This lack of physical activity can lead to the onset of other conditions which, if not dealt with, can greatly reduce their quality of life.  The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) has been promoting the use of massage therapy for some time now.  According to a recent study, there is a general awareness of massage therapy but a lack of understanding of its direct benefits.

In the case of senior citizens, there are a number of benefits that be derived from therapeutic massage.  According to the Touch Research Institute, it is extremely useful in the treatment of Alzheimer's patients, as it can facilitate relaxation and communication.  In the case of arthritis sufferers, it can greatly assist in pain management and help increase range of motion.  It also triggers natural joint lubrication, which is extremely important for those suffering from arthritis.

Massage therapy has also shown promise by helping to increase strength and muscle coordination.  It can also greatly improve one's posture by reducing muscle tension, which has the added benefit of assisting seniors with a higher quality of rest.  Massage has also been known to boost one's natural energy levels, along with their mental awareness.  Study after study has shown that there is a place for massage therapy within the health care community.

More and more people are becoming aware of the benefits of massage therapy.  In an age where the common approach to pain management has been dominated by the interests of the pharmaceutical industry, massage therapy has shown to be an effective and natural solution to the ailments associated with process of aging.  If you or a loved one are interested in learning more about the benefits of therapeutic massage, please visit the website mentioned below.

Why Swimming is the Perfect Exercise for Seniors

There are a many reasons why swimming and water-based exercise may be the best choice for seniors. Water based exercises are second only to walking in lowest rates for injuries. They are commonly used for physical therapy modes for those recovering from major surgery.

Water also provides more options for those who are lacking in general fitness or have a prior injury that makes land based activity difficult. Finally, water based activities work the entire body, serving as a form of both strength training even as aerobic training takes place.

Swimming utilizes nearly all major muscle groups simultaneously, imparting a total body work out. Because of the inherent resistance of the water, swimming develops both muscle strength and endurance, as well as helps flexibility.

Because of its horde of effects, swimming provides almost all of the aerobic benefits of running even as it yields many of the benefits of resistance training thrown in. Because swimming does not put the strain on connective tissues that running, aerobics and some weight-training regimens do, swimming is the kind of low-impact work out that is perfect for seniors seeking to regain or maintain their fitness.

This is a sport especially gentle to those who are physically challenged. The buoyancy factor of water makes swimming the most injury-free exercise available. So it is specifically interesting to seniors, especially those with any type of joint issues. In water, a person’s body weight is reduced by 90% as compared to its weight on land. For example, a 220 pound man will weigh about 22 pounds if he is standing in chin deep water.

Exercises in water can also be done more often because of the low incidence of injuries and it is more effective for exercising the entire body as any movement in water  12 times greater resistance than movement in air.

For the elderly, water fitness is safe, fills the need for exercise, increases a body's range of motion and is a low-impact exercise.

Keep Seniors Independent and Involved -Practical Acts of Kindness

Sometimes elderly people can be fierce about maintaining their independence - some would say downright stubborn. But it is hard to give up taking care of oneself and give the reins over to someone else. It can diminish their spirits to depend on others to do tasks they used to do so easily.
How can you help without taking away their independence?
Following are five ideas from the e-book, "101 Ways to Change the World".


Use them to stir up your own ideas. Let's keep our seniors involved in life - they are a valuable commodity!
1. If you have an old computer that still works, take it to an elderly person.

Teach how to operate it to send and receive email. Give them a connection to the world.

What a great way to keep them connected to their family and friends who are probably online too.

Their kids and grandkids will think they are so cool, and be so impressed that they mastered the computer!

Become an E-mail Pen Pal with them yourself!

2. Help someone around the house who is elderly or sick. You could:

Paint

Garden

Mow the lawn

Shovel snow

Take out trash

Just look around. You'll be able to discover what needs to be done. If there is an extensive list of things to do, enlist the help of a couple other people - take a lunch along and make it a party! The senior will appreciate the help and the company. 3. Take daily walks with an elderly neighbor who doesn't feel comfortable or safe going out on their own. Exercise will help keep them mobile and keep their spirits up, too. And you may just learn tidbits of history and wisdom from their perspective.
4. Birds are always a delight to watch for those who are homebound.

Take over a bird feeder and keep it filled with birdseed.

Hummingbirds are fun to watch. Keep their feeder filled with fresh hummingbird nectar for hours of entertainment!

5. Help the elderly or homebound decorate for the holidays. They often miss out on the fun of holidays because they aren't able to handle the traditions and decorations. Yet they usually have boxes of items that made their holidays special over the years. Make sure you return to put them all away!
There you have it - five simple ways to make a difference in an elderly person's life. All you have to do is make the decision to help and then do it. It's just that simple!
For more suggestions, visit http://www.101WaysSeries.com and download the e-book, "101 Ways to Change the World". Use these tips to change your world, one kindness at a time.

Tips For Seniors

Since January, millions of seniors have enrolled in the new Medicare Part D prescription drug benefit plan. However, the task of choosing a plan may seem daunting and can often be confusing for seniors even after they have enrolled.

The decision to participate is important, and careful consideration is vital to ensure a plan is chosen that best meets a customer's needs. To get help in finding the right plan, seniors and caregivers may want to consult their local pharmacists, who are the most accessible members of the health care delivery system. Many pharmacists are specifically trained on how to explain the Medicare Part D drug benefit to their customers and can help guide seniors through the process.

"Over the last several months, we have assisted many customers to help them better understand their choices under the Medicare Part D drug benefit. We will continue our efforts to help customers work their way through the large number of choices available to them," said Matt Leonard, Senior Vice President of Pharmacy at CVS/pharmacy. "One of the most important steps when choosing a plan is to ensure current prescription drugs are covered, and your local pharmacist is a great resource for that."

Because health needs can change quickly, a Medicare Part D plan may be appropriate even if a customer's costs and number of prescriptions are currently low. Once a decision has been made to enroll in a particular plan, the following facts should be taken into consideration to ensure a smooth process:

-Customers who enroll in a plan after the May 15, 2006, deadline will pay higher premiums, and their next opportunity to enroll will not be until November 15, 2006.

-Submit your enrollment application to the insurance plan of your choice as early in the month as possible. That way, there is enough time to mail out your new Medicare Prescription Drug Card and enter you into the system before your coverage begins on the first day of the following month.

- When first utilizing your new Medicare Prescription Drug Card, order your prescription refill while you still have a few days' supply remaining. This will ensure that you do not run out of your medication if your pharmacist needs time to research and resolve any issues pertaining to your new Medicare coverage.

Medicare Part D can greatly benefit seniors who take the time to make an informed decision. In addition to personalized assistance from a pharmacist, Medicare Information Centers are available in all CVS/pharmacy stores. The Centers explain how Medicare drug plans will work and assist customers in selecting a plan that best meets their needs.