April 2012 – Managing Chronic Diseases

In this issue, we will talk about issues of managing chronic disease.  Having multiple diseases can cause a challenge in coordinating medications, performing activities of daily living and managing doctor visits and instructions.  Hopefully, you will find this information helpful.

Multiple Chronic Diseases Present a Challenge

Chronic Disease is defined as a condition that lasts more than a year and affects Activities of Daily Living and/or requires on-going medical monitoring. Two thirds (2/3) of older adults have 2 or more conditions that impact their lives.

What are older adults dealing with when they have multiple conditions? They are experiencing fatigue which may impact their ability to handle day to day tasks of living. They often express emotional distress because of the constant attention that must be paid to medications, doctor visits and other requirements of managing some diseases. Their activities may be limited by the condition.

Many older adults are living alone and they may not have children living close to them. They have more medications than younger adults and may not see as well as they did so reading the medicine bottle becomes a challenge. Remembering to take the medications and to follow up with the doctor’s instructions becomes a challenge. With multiple specialists, often there may not be the communication to ensure that medications are not duplicated or contraindicated. Today’s older adults grew up during a time when they trusted their doctors and did not question them. Consequently, they are less likely to challenge something they don’t understand or feel may be inappropriate for them.

Healthcare was designed to take care of one disease at a time; hence…the reason for different specialists to take care of specific diagnoses. This does cause confusion if doctors do not know who else the patient is seeing and what medications they may have prescribed. There can be a lot of confusion when an older adult enters the hospital and has different medications upon discharge. They may have many older prescriptions in the home that are no longer needed. Many times they arrive home mentally confused from anesthesia and need someone to organize the information and medications for them. That is where having a care manager or family member to oversee care can be helpful.

Some of the best practices recommended for ensuring better care management include:

  1. Early identification of individuals at risk;
  2. Medication management oversight;
  3. Someone managing continuity of care over transitions such as from the hospital to home or nursing home or hospital to rehab to residence;
  4. Patient Education and Self-Management of conditions with follow-up by care manager or nurse;
  5. Implementing a Care Plan with periodic evaluation and adjustments.

Managing Medications is Key

Medication compliance is one of the most frequent challenges with seniors.  Many times their medications are in a big shoebox or basket or scattered around the house.  This does not make it easy to see if the meds were taken on time or in the quantity that was prescribed.

It is important to find a method that meets the needs and limitations of the older adult.  Sometimes a sectored box will work.  Other times it might require a more sophisticated system that will only dispense at the time the medication is to be taken.  This system even gives a verbal message telling them to take the medications.  Another system available involves hooking up to a computer system that will record when the medications are being taken.  It will give a clear picture of the person’s history of taking medication.

Older adults should not take medications at the same level as a younger person.  When a medication is introduced, it should be given at a lower dose first and then increased as needed.  If your doctor does not treat older adults on a regular basis, he/she may not be aware that they are over-medicating the older adult.  When receiving a new medication, write down what you are taking and how often you need to take it before leaving the doctor’s office.  Many times after the patient leaves, they are unclear about how and when to take the medication.  Writing it down will ensure clarity.

If you feel that your medications should be reviewed, there are several geriatric pharmacists in St. Louis who will review and consult doctors on your behalf.

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