Today’s seniors have more choices than ever when it comes to deciding on where they should live as they get older. Traditional nursing homes have expanded to include a greater range of assisted living homes and senior apartment communities that are styled to function just like a regular personal home – but with greatly needed assistance and additional opportunities to socialize.
Many older adults find it necessary to move from the home that they currently live in. Some of the reasons for moving can include:
• The neighborhood has deteriorated and safety is a concern
• To be near children (more than half of those 65+ live within 1 hour of a child)
• Size and layout of a home (including multi-levels or staircases)
• Maintenance costs and requirements
• Proximity to necessary services and shopping, especially if they are no longer driving
• Need for daily assistance with medications and household tasks
Some assisted living communities are built like small, self-contained ‘neighborhoods’, with housing units styled to include private bedrooms and bathrooms, with a common living area and kitchen. 24-hour basic care is provided, along with meals, laundry services and transportation.
Apartment style living is also popular, with small apartments that also have the benefits of common dining and living, along with a dedicated staff and plenty of social activities and group transportation to shopping, as well as private transport for personal appointments.
Another lifestyle choice includes senior high-rise centers that offer different levels of care depending on the changing needs of the residents. These senior centers often include a ‘buy-in’ plan, much like purchasing a home, along with monthly care and maintenance fees. For seniors and families who have the financial means, this option can offer a lifetime of extended care. Housing ranges from stylized apartment living for independent seniors to moderate care and assistance to full time nursing care. As the seniors continue to age, they stay in the same high-rise building, but move from floor to floor as their needs change.
While many older adults choose to ‘age in place’ at home, often with constant or live-in help, many relocating seniors find satisfaction in group settings which can help them maintain social interaction and friendships, along with the benefits of having helpful, friendly staff and medical professionals around them.
Wednesday, January 25, 2012
Wednesday, January 18, 2012
Healthy Lifestyles for Older Adults – The Importance of Exercise
All of us have come to realize the importance of exercise in our lifestyles – regular, planned exercise routines help lower cholesterol, keep our hearts healthier, and of course strengthen our muscles and improve our stamina. Exercise is also very important to the overall wellness of older adults.
Staying fit with exercise and physical activity benefits people of all ages and physical conditions. Developing a consistent exercise program of walking, stretching and range of motion exercises can help prevent or delay a number of infirmities that face seniors as they continue to age, including dementia and decreased memory functions.
The National Institutes of Health (NIH) report that even moderate exercise and physical activity can improve the health of seniors who are frail, or who have diseases that accompany aging.
Some older adults are reluctant to get up and get out. They may be fearful that they will fall or that strenuous exercise can hurt them. The NIH actually tells us that exercise is safe and beneficial for people of all age groups, and that older adults will hurt their health more with inactivity.
The first and most important step is to visit with your loved one’s doctor to determine what types of exercise will be safe and beneficial. Your may want to consider talking with a fitness instructor or physical therapist that specializes in working with older people. They can recommend the amount and length of activity to start with. As for anyone, a good physical fitness plan starts off slowly and builds up over time as the person becomes more fit and active.
Some of the areas that are especially important for seniors include strength, balance, flexibility and endurance. A trained professional can help you determine what areas need the most work and a good action plan to get started with.
It’s also important to recognize that it is never to late to get started with some type of exercise. Over time, exercise can both improve a senior’s overall health as well as prevent further deterioration in certain areas. Even if your loved one has never exercised or is confined to a wheelchair, therapeutic exercise can help their mental and physical state.
Getting older doesn't mean you have to lose all your strength or your ability to do everyday tasks. Exercise can help older adults feel better and enjoy life more, even those who think they are too old or too out of shape. It’s great to get moving at any age!
Staying fit with exercise and physical activity benefits people of all ages and physical conditions. Developing a consistent exercise program of walking, stretching and range of motion exercises can help prevent or delay a number of infirmities that face seniors as they continue to age, including dementia and decreased memory functions.
The National Institutes of Health (NIH) report that even moderate exercise and physical activity can improve the health of seniors who are frail, or who have diseases that accompany aging.
Some older adults are reluctant to get up and get out. They may be fearful that they will fall or that strenuous exercise can hurt them. The NIH actually tells us that exercise is safe and beneficial for people of all age groups, and that older adults will hurt their health more with inactivity.
The first and most important step is to visit with your loved one’s doctor to determine what types of exercise will be safe and beneficial. Your may want to consider talking with a fitness instructor or physical therapist that specializes in working with older people. They can recommend the amount and length of activity to start with. As for anyone, a good physical fitness plan starts off slowly and builds up over time as the person becomes more fit and active.
Some of the areas that are especially important for seniors include strength, balance, flexibility and endurance. A trained professional can help you determine what areas need the most work and a good action plan to get started with.
It’s also important to recognize that it is never to late to get started with some type of exercise. Over time, exercise can both improve a senior’s overall health as well as prevent further deterioration in certain areas. Even if your loved one has never exercised or is confined to a wheelchair, therapeutic exercise can help their mental and physical state.
Getting older doesn't mean you have to lose all your strength or your ability to do everyday tasks. Exercise can help older adults feel better and enjoy life more, even those who think they are too old or too out of shape. It’s great to get moving at any age!
Thursday, January 5, 2012
Getting Help for Mom and Dad – How to Get Started with In-Home Assistance
As we get older, we find it more and more difficult to keep doing many of the ordinary tasks required to keep up a home – laundry, meal preparation, and housekeeping can become harder to keep up with. If you have older adults in your family, you may see gradual changes in their ability to maintain their home – or you may see a sudden decline in their ability or interests to keep up.
How do you know when it's time to consider in-home assistance for your aging parents?
Try watching for these possible warning signs:
• Personal hygiene changes like a lack of interest in bathing or brushing their teeth or an inclination to wear the same clothes day after day
• Passive responses and a lack of interest in social engagement
• Clutter in a house that was formerly very neat or the house not being cleaned on a regular basis
• Lack of food in the refrigerator or placing to-go orders instead of regular meals
• Tiredness and constant complaints that can indicate depression or isolation
• Forgetfulness - like leaving food cooking on the stove, leaving the faucet on, not taking mediations as prescribed, the phone left off the hook or bills left unpaid
• Missing appointments to see their doctor, dentist, hairdresser and others
It may be time to bring a caregiver into the home that can help your loved ones maintain order in their lives and stay focused on personal health and well-being. Start looking for a caregiver by talking to friends or co-workers – they may be able to recommend a good service or individual. Check references, check the BBB and also contact state agencies who monitor senior care. You may need to interview several people or services before finding the right fit.
It’s often most helpful to include the seniors in the discussion and decision regarding in-home care. Your loved ones may feel insulted or fearful at the beginning, so treat the topic with patience and compassion for their feelings. You may meet with some (or a great deal of) resistance at first. It may be good to ease into the situation by bringing in a helper for just a few hours a day to help with light housekeeping or errands and let the seniors get used to the idea gradually. In some instances, the caregiver can simply be a companion to drive older adults to the movies or church.
Once you have brought someone in, you also have to manage the relationship. List the duties you and your loved one expect the caregiver to perform and clearly communicate the duties and the timing with the caregiver. Clearly explain your expectations and set boundaries for the caregiver’s personal phone calls, breaks, etc.
Make sure all family members and the caregiver understand that the paid worker is not a family member. The caregiver should NOT have access to credit or ATM cards, checks or any of the family finances. Also, monitor the relationship the caregiver has with your loved ones. If your or your parents feel uncomfortable or incompatible with the caregiver, take action immediately.
In-home assistance is an active step to prolong older adults’ ability to live in their home for as long as possible. Hiring an in-home caregiver is a proactive step that can help seniors continue to lead healthy, active and happy lives.
How do you know when it's time to consider in-home assistance for your aging parents?
Try watching for these possible warning signs:
• Personal hygiene changes like a lack of interest in bathing or brushing their teeth or an inclination to wear the same clothes day after day
• Passive responses and a lack of interest in social engagement
• Clutter in a house that was formerly very neat or the house not being cleaned on a regular basis
• Lack of food in the refrigerator or placing to-go orders instead of regular meals
• Tiredness and constant complaints that can indicate depression or isolation
• Forgetfulness - like leaving food cooking on the stove, leaving the faucet on, not taking mediations as prescribed, the phone left off the hook or bills left unpaid
• Missing appointments to see their doctor, dentist, hairdresser and others
It may be time to bring a caregiver into the home that can help your loved ones maintain order in their lives and stay focused on personal health and well-being. Start looking for a caregiver by talking to friends or co-workers – they may be able to recommend a good service or individual. Check references, check the BBB and also contact state agencies who monitor senior care. You may need to interview several people or services before finding the right fit.
It’s often most helpful to include the seniors in the discussion and decision regarding in-home care. Your loved ones may feel insulted or fearful at the beginning, so treat the topic with patience and compassion for their feelings. You may meet with some (or a great deal of) resistance at first. It may be good to ease into the situation by bringing in a helper for just a few hours a day to help with light housekeeping or errands and let the seniors get used to the idea gradually. In some instances, the caregiver can simply be a companion to drive older adults to the movies or church.
Once you have brought someone in, you also have to manage the relationship. List the duties you and your loved one expect the caregiver to perform and clearly communicate the duties and the timing with the caregiver. Clearly explain your expectations and set boundaries for the caregiver’s personal phone calls, breaks, etc.
Make sure all family members and the caregiver understand that the paid worker is not a family member. The caregiver should NOT have access to credit or ATM cards, checks or any of the family finances. Also, monitor the relationship the caregiver has with your loved ones. If your or your parents feel uncomfortable or incompatible with the caregiver, take action immediately.
In-home assistance is an active step to prolong older adults’ ability to live in their home for as long as possible. Hiring an in-home caregiver is a proactive step that can help seniors continue to lead healthy, active and happy lives.
Wednesday, November 30, 2011
Medicare Open Enrollment – Make Your Choices By December 7th
It’s that time of year again - Medicare’s open enrollment period started earlier this year (October 15th) and ends on December 7th. If you or a family member is 65 or older, you have less than a month to make any changes, so be sure to review your options and make selections before the deadline hits.
Even if you are satisfied with your coverage plan, I highly recommend that you still review all the options available to you. While you choices may look the same as previous years, you’ll want to note the rate changes for 2012 and make sure that the options still fit your needs and your budget.
Open enrollment is the only time of the year that you can make changes (unless you experience a qualifying ‘event’ that would allow you to update your plan).
Like many private insurance programs, basic Medicare does not pay for all of your health care costs. You are responsible for paying premiums, covering deductibles, and handling coinsurance or copayments. Basic Medicare services – both Parts A and B – do not pay for long-term care or extended stays in skilled nursing or assisted living facilities. Basic Medicare also only pays for about 20% of your doctor’s charges, so if you are under the standard Medicare plan, you probably want to buy supplemental health insurance to give you adequate coverage and help out with deductibles.
While Medicare can seem a little confusing – especially if you are new to the program, there are really just two main options involved, plus the coverage for prescription drugs. Medicare programs work like an HMO, run by private companies.
Your main choices are whether or not to go with basic (also called ‘original’) Medicare or with a Medicare Advantage Plan. The Medicare Advantage Plan gives you additional services, including a standard prescription drug plan. You can also enroll in a Medicare Part D prescription plan as an alternative.
If you need assistance, you can contact Medicare directly to ask questions. You can also visit the Medicare open enrollment Web site at http://medicare.gov/open-enrollment/index. You’ll find that the Web site does a good job of explaining options and answering frequently asked questions.
Don’t wait too long! Just as the holidays are almost upon us, don’t let December 7th come and go with reviewing all of your health care coverage options.
Even if you are satisfied with your coverage plan, I highly recommend that you still review all the options available to you. While you choices may look the same as previous years, you’ll want to note the rate changes for 2012 and make sure that the options still fit your needs and your budget.
Open enrollment is the only time of the year that you can make changes (unless you experience a qualifying ‘event’ that would allow you to update your plan).
Like many private insurance programs, basic Medicare does not pay for all of your health care costs. You are responsible for paying premiums, covering deductibles, and handling coinsurance or copayments. Basic Medicare services – both Parts A and B – do not pay for long-term care or extended stays in skilled nursing or assisted living facilities. Basic Medicare also only pays for about 20% of your doctor’s charges, so if you are under the standard Medicare plan, you probably want to buy supplemental health insurance to give you adequate coverage and help out with deductibles.
While Medicare can seem a little confusing – especially if you are new to the program, there are really just two main options involved, plus the coverage for prescription drugs. Medicare programs work like an HMO, run by private companies.
Your main choices are whether or not to go with basic (also called ‘original’) Medicare or with a Medicare Advantage Plan. The Medicare Advantage Plan gives you additional services, including a standard prescription drug plan. You can also enroll in a Medicare Part D prescription plan as an alternative.
If you need assistance, you can contact Medicare directly to ask questions. You can also visit the Medicare open enrollment Web site at http://medicare.gov/open-enrollment/index. You’ll find that the Web site does a good job of explaining options and answering frequently asked questions.
Don’t wait too long! Just as the holidays are almost upon us, don’t let December 7th come and go with reviewing all of your health care coverage options.
Tuesday, November 8, 2011
Medication Management for Seniors – The Impact on Society of Med Noncompliance
According to PhRMA (Pharmaceutical Research and Manufacturers of America), more than 75% of adult Americans who take three or more medicines daily are non-compliant with taking their medications properly. More than half of our seniors who take multiple medications (and one in four of them take 10-19 mediations each day) either forget to take the correct dose or fail in some other manner to take the right medication. While we can see for ourselves the impact this can have on our loved ones, did you know that the economic impact to our society is in excess of $100 billion each year?
Medication non-compliance puts even more stress on an already over-burdened healthcare system, adding to the costs of healthcare and contributing to steadily rising insurance costs. It stretches our Medicare and Medicaid resources, and the demand causes even more shortages of healthcare professionals.
Wow. And it’s not just the dollars and cents – medication non-compliance kills more of our seniors every year than accidents, flu and pneumonia combined – it’s the leading cause of death of senior citizens in America.
Reasons from forgetfulness to fear of drugs and the high cost of prescriptions all lend to seniors not taking medications correctly.
What can we do? First, if we have an elderly family member, we should take extra precautions to make sure that they fill the right prescriptions and take both over-the-counter and prescription meds as directed. We may need to accompany them to doctor’s visits, engage a caregiver, or purchase medical alert systems that help with reminders and dosages.
We should also get involved with our neighbors – a simple welfare check every now and then on an elderly neighbor could mean a world of difference in making sure their loved ones or physicians are aware of any problems they are having with medications.
With such a systemic problem, we all have a certain responsibility to make sure that family members, friends and neighbors are educated in where to find help for taking medications properly. Many studies show that people who live alone are more likely to have problems with taking their medications as they should. We should all take more notice of our elderly neighbors who are by themselves.
Medication non-compliance is so widespread that it will take all of us to help solve the issues involved – not just the medical or care-giving communities. A study by PhRMA found that patients who regularly took their medications as prescribed significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days a patient spent in the hospital.
If you have concerns about an older adult’s willingness or ability to take the right medications, speak up and let the people who care for them know. If your own family member is having a hard time taking their medications, take steps through technology or the family doctor to create a routine that will help your loved ones stay compliant with the doctor’s orders. It helps each and every one of us!
Medication non-compliance puts even more stress on an already over-burdened healthcare system, adding to the costs of healthcare and contributing to steadily rising insurance costs. It stretches our Medicare and Medicaid resources, and the demand causes even more shortages of healthcare professionals.
Wow. And it’s not just the dollars and cents – medication non-compliance kills more of our seniors every year than accidents, flu and pneumonia combined – it’s the leading cause of death of senior citizens in America.
Reasons from forgetfulness to fear of drugs and the high cost of prescriptions all lend to seniors not taking medications correctly.
What can we do? First, if we have an elderly family member, we should take extra precautions to make sure that they fill the right prescriptions and take both over-the-counter and prescription meds as directed. We may need to accompany them to doctor’s visits, engage a caregiver, or purchase medical alert systems that help with reminders and dosages.
We should also get involved with our neighbors – a simple welfare check every now and then on an elderly neighbor could mean a world of difference in making sure their loved ones or physicians are aware of any problems they are having with medications.
With such a systemic problem, we all have a certain responsibility to make sure that family members, friends and neighbors are educated in where to find help for taking medications properly. Many studies show that people who live alone are more likely to have problems with taking their medications as they should. We should all take more notice of our elderly neighbors who are by themselves.
Medication non-compliance is so widespread that it will take all of us to help solve the issues involved – not just the medical or care-giving communities. A study by PhRMA found that patients who regularly took their medications as prescribed significantly reduced their total health care spending and lowered the number of emergency room visits and the number of days a patient spent in the hospital.
If you have concerns about an older adult’s willingness or ability to take the right medications, speak up and let the people who care for them know. If your own family member is having a hard time taking their medications, take steps through technology or the family doctor to create a routine that will help your loved ones stay compliant with the doctor’s orders. It helps each and every one of us!
Monday, October 24, 2011
Medication Management for Seniors – The Risks of Med Noncompliance
Did you know that nearly one-third of older adults take eight or more medications every day? There’s no way I could keep up with what to take and when if I had that responsibility. Medication management can pose a challenge for adults of any age, but as we get older, we also face physical challenges and memory limitations that can make taking medication correctly a real issue.
First, of all, we have to remember that all medications – both over- the-counter and prescription should only be taken according to a doctor’s instructions. All drugs interact not only with our individual system and metabolism, but with each other. The wrong dosage or combination can make us sick or lead to serious side effects.
Sometimes older adults will simply stop taking their medications as prescribed – either because the side effects are troubling, certain symptoms start improving or because they have just forgotten the correct routine. Memory problems and depression may also contribute to forgetfulness. Self-medicating or stopping a prescribed medication can have serious consequences for our older family members – and any issues with med noncompliance should be discussed immediately with their doctor.
Older adults in particular should work with the nursing staff at the doctor’s office and perhaps take advantage of pharmacy services that offer additional information and consultations about medications and side effects. Pharmacies also have programs to help with auto refills of prescriptions and consultations about manufacturer changes to certain drugs. Many seniors may need the help of a family member or caregiver to help keep their prescriptions straight.
Forgetting to take medications or taking the incorrect dose can delay recovery, worsen a person’s overall health and even be fatal in the worst case. So what steps can you take to protect your older family members?
1. Document all medications and dosages on a detailed plan that is easy for the patient, caregiver and other family members to read and understand.
2. Keep all medications in a central place, preferably in an organization box with visible and/or audible reminders.
3. Take advantage of technology and use special machines that dispense proper dosages at the correct times – and send alerts to both the patient and the primary caregiver if something is missed.
If you have any concerns about an older adult’s ability to take medications as prescribed, step in and help them create an action plan or get the outside assistance they need. Complete compliance with medical prescriptions is the only way to keep your older family members safe and healthy as the doctor ordered!
First, of all, we have to remember that all medications – both over- the-counter and prescription should only be taken according to a doctor’s instructions. All drugs interact not only with our individual system and metabolism, but with each other. The wrong dosage or combination can make us sick or lead to serious side effects.
Sometimes older adults will simply stop taking their medications as prescribed – either because the side effects are troubling, certain symptoms start improving or because they have just forgotten the correct routine. Memory problems and depression may also contribute to forgetfulness. Self-medicating or stopping a prescribed medication can have serious consequences for our older family members – and any issues with med noncompliance should be discussed immediately with their doctor.
Older adults in particular should work with the nursing staff at the doctor’s office and perhaps take advantage of pharmacy services that offer additional information and consultations about medications and side effects. Pharmacies also have programs to help with auto refills of prescriptions and consultations about manufacturer changes to certain drugs. Many seniors may need the help of a family member or caregiver to help keep their prescriptions straight.
Forgetting to take medications or taking the incorrect dose can delay recovery, worsen a person’s overall health and even be fatal in the worst case. So what steps can you take to protect your older family members?
1. Document all medications and dosages on a detailed plan that is easy for the patient, caregiver and other family members to read and understand.
2. Keep all medications in a central place, preferably in an organization box with visible and/or audible reminders.
3. Take advantage of technology and use special machines that dispense proper dosages at the correct times – and send alerts to both the patient and the primary caregiver if something is missed.
If you have any concerns about an older adult’s ability to take medications as prescribed, step in and help them create an action plan or get the outside assistance they need. Complete compliance with medical prescriptions is the only way to keep your older family members safe and healthy as the doctor ordered!
Tuesday, October 11, 2011
Want More Money for Education? Take Your Medicine!
Laura Landro with the Wall Street Journal wrote a great article on medication adherence and I felt compelled to share. The most interesting figure to me is the $290 Billion wasted on patients who don't take their medications as prescribed. If you don't read anything else please read paragraph 5 of the article.
If you or someone you know struggles with medication management I encourage you to reach out to Alert Response or any other number of qualified companies and learn more about how technology can help save everyone a lot of time, energy and money.
When it comes to medicine, as many as half of Americans don't stick to their regimens. They fail to fill about 20% to 30% of prescriptions written by doctors, don't take drugs as directed, and don't refill medications when they run out.
Now, health-care providers have new strategies to increase medication adherence, as concerns rise about health risks and the high costs of treating noncompliant patients who have chronic illnesses.
Prescriptions that don't get picked up or refilled can be tracked using electronic medical records and prescribing technology. Clinical pharmacy specialists, case managers and other team members follow up with reminders, phone calls and counseling to get patients back on the wagon.
Consequences of non-adherence can be dire. Studies of heart-attack patients show those who don't fill prescriptions to help prevent another heart attack have a higher rate of death one year later. Meanwhile, patients who adhere to their medications have better health outcomes, and require less care, than those with similar conditions and poor adherence, research shows.
Research by the New England Healthcare Institute shows that patients who don't take their medications as prescribed cost the U.S. health care system an estimated $290 billion in avoidable medical spending each year. A study published last January in Health Affairs showed that while improved medication adherence for four chronic diseases leads to higher spending on drugs, it also produces substantial savings because of less hospitalization and emergency-department use.
Out-of-pocket costs are a major reason some patients don't take medicine, but even fully insured patients often drop or fail to start a prescribed drug, studies show. Patients sometimes aren't convinced the medicine is important, or they are concerned a drug may do more harm than good. Often, they worry about side effects. Some 32 million Americans are prescribed three or more medications, which can lead to drug interactions and confusion over schedule and dosages.
Medication Nation
• 32 million Americans take three or more medications daily.
• Nearly 75% of Americans report not always taking their medications as prescribed.
• Almost 30% of Americans stop taking their medicine before it runs out.
• Only about half of patients with high blood pressure take their prescribed doses of drugs
Source: PhRMA; National Council on Patient Information and Education; WSJ reporting
Barbara Forman, 65 years old, takes five different medications after undergoing a cardiac bypass surgery seven years ago. She has worked with several doctors to develop a regimen she can tolerate. As a small business specialist for the post office, she used to drive long distances, but a beta blocker she took to reduce blood pressure made her so drowsy she caught herself drifting off the road more than once.
She tried changing the time of day she took the medication; sometimes she didn't take it at all. She had muscle aches from her cholesterol-lowering statin, and a cough as a side effect of another medication. A new cardiologist has helped her better manage her medications, and they are still fine tuning her regimen, she says.
Ms. Forman, now retired from the post office, is president of the Dayton, Ohio, chapter of Mended Hearts, a patient-support network affiliated with the American College of Cardiology. She invites a local pharmacist to meetings to emphasize the importance of taking medications after cardiac procedures. She advises patients to advocate for themselves. "Read the sheets that come with the pills, and let doctors know if you are suffering side effects," she says. "There are other alternatives to many of these drugs."
In a study in the Journal of General Internal Medicine last month, Kaiser Permanente Colorado, a big nonprofit health plan, reported that patients in systems like its own, with electronic health records linked to their pharmacies, collect new medications more often than patients outside such systems. In the study, 7% of patients with newly ordered medications for hypertension, diabetes and high cholesterol didn't pick up their prescriptions. In contrast, in other studies of non-integrated systems, as many as 22% of patients failed to pick up new prescriptions.
Kaiser is using clinical pharmacy specialists who focus on managing medication therapy, to find out why patients aren't taking drugs and help with side effects or administration.
The personal touch worked for Ralph "Mitch" Bernal, 61, a retired deputy sheriff and avid hunter in Lakewood, Colo., who suffers from a lung injury and heart disease and takes several medications to control his blood pressure and cholesterol. During a hunting trip in 2009, he felt short of breath and achy. A blockage was found in one of his arteries and was treated with the placement of a stent.
After treatment he became a patient of Kaiser's cardiac-risk program. Clinical pharmacy specialist Alicia Cymbala was assigned to monitor his lab results, blood pressure and medications, and she checked in with him at least every three months. His blood pressure remained a problem, so she changed his meds to get it under control, including a single pill combining a medication to relax blood vessels so blood can flow more easily with a diuretic that causes the body to get rid of extra salt and water.
Last year, Mr. Bernal admitted to Dr. Cymbala that for two weeks he'd stopped taking his cholesterol drug because it was giving him digestive troubles. "She jumped right on it and told me it was a side effect, but I had to take something," Mr. Bernal says. She switched him to another statin, which he was able to tolerate.
Dr. Cymbala, who typically follows 800 to 900 patients, says Kaiser's electronic system would have eventually picked up Mr. Bernal's noncompliance through elevated cholesterol levels or a failure to refill a prescription. "We try to let patients know they can trust us and call us, and we care to know when they are having a problem," she says. Sometimes she will gently point out to people who claim to be taking their meds that they haven't refilled their prescription.
John Merenich, who heads disease management and prevention programs at Kaiser Colorado, says, "You can't just tell them, 'If you don't take this medication you are going to have another heart attack.' " Patients need ongoing reinforcement about their health goals, he adds, "We have to bring the patient back into the center of the conversation."
If you or someone you know struggles with medication management I encourage you to reach out to Alert Response or any other number of qualified companies and learn more about how technology can help save everyone a lot of time, energy and money.
When it comes to medicine, as many as half of Americans don't stick to their regimens. They fail to fill about 20% to 30% of prescriptions written by doctors, don't take drugs as directed, and don't refill medications when they run out.
Now, health-care providers have new strategies to increase medication adherence, as concerns rise about health risks and the high costs of treating noncompliant patients who have chronic illnesses.
Prescriptions that don't get picked up or refilled can be tracked using electronic medical records and prescribing technology. Clinical pharmacy specialists, case managers and other team members follow up with reminders, phone calls and counseling to get patients back on the wagon.
Consequences of non-adherence can be dire. Studies of heart-attack patients show those who don't fill prescriptions to help prevent another heart attack have a higher rate of death one year later. Meanwhile, patients who adhere to their medications have better health outcomes, and require less care, than those with similar conditions and poor adherence, research shows.
Research by the New England Healthcare Institute shows that patients who don't take their medications as prescribed cost the U.S. health care system an estimated $290 billion in avoidable medical spending each year. A study published last January in Health Affairs showed that while improved medication adherence for four chronic diseases leads to higher spending on drugs, it also produces substantial savings because of less hospitalization and emergency-department use.
Out-of-pocket costs are a major reason some patients don't take medicine, but even fully insured patients often drop or fail to start a prescribed drug, studies show. Patients sometimes aren't convinced the medicine is important, or they are concerned a drug may do more harm than good. Often, they worry about side effects. Some 32 million Americans are prescribed three or more medications, which can lead to drug interactions and confusion over schedule and dosages.
Medication Nation
• 32 million Americans take three or more medications daily.
• Nearly 75% of Americans report not always taking their medications as prescribed.
• Almost 30% of Americans stop taking their medicine before it runs out.
• Only about half of patients with high blood pressure take their prescribed doses of drugs
Source: PhRMA; National Council on Patient Information and Education; WSJ reporting
Barbara Forman, 65 years old, takes five different medications after undergoing a cardiac bypass surgery seven years ago. She has worked with several doctors to develop a regimen she can tolerate. As a small business specialist for the post office, she used to drive long distances, but a beta blocker she took to reduce blood pressure made her so drowsy she caught herself drifting off the road more than once.
She tried changing the time of day she took the medication; sometimes she didn't take it at all. She had muscle aches from her cholesterol-lowering statin, and a cough as a side effect of another medication. A new cardiologist has helped her better manage her medications, and they are still fine tuning her regimen, she says.
Ms. Forman, now retired from the post office, is president of the Dayton, Ohio, chapter of Mended Hearts, a patient-support network affiliated with the American College of Cardiology. She invites a local pharmacist to meetings to emphasize the importance of taking medications after cardiac procedures. She advises patients to advocate for themselves. "Read the sheets that come with the pills, and let doctors know if you are suffering side effects," she says. "There are other alternatives to many of these drugs."
In a study in the Journal of General Internal Medicine last month, Kaiser Permanente Colorado, a big nonprofit health plan, reported that patients in systems like its own, with electronic health records linked to their pharmacies, collect new medications more often than patients outside such systems. In the study, 7% of patients with newly ordered medications for hypertension, diabetes and high cholesterol didn't pick up their prescriptions. In contrast, in other studies of non-integrated systems, as many as 22% of patients failed to pick up new prescriptions.
Kaiser is using clinical pharmacy specialists who focus on managing medication therapy, to find out why patients aren't taking drugs and help with side effects or administration.
The personal touch worked for Ralph "Mitch" Bernal, 61, a retired deputy sheriff and avid hunter in Lakewood, Colo., who suffers from a lung injury and heart disease and takes several medications to control his blood pressure and cholesterol. During a hunting trip in 2009, he felt short of breath and achy. A blockage was found in one of his arteries and was treated with the placement of a stent.
After treatment he became a patient of Kaiser's cardiac-risk program. Clinical pharmacy specialist Alicia Cymbala was assigned to monitor his lab results, blood pressure and medications, and she checked in with him at least every three months. His blood pressure remained a problem, so she changed his meds to get it under control, including a single pill combining a medication to relax blood vessels so blood can flow more easily with a diuretic that causes the body to get rid of extra salt and water.
Last year, Mr. Bernal admitted to Dr. Cymbala that for two weeks he'd stopped taking his cholesterol drug because it was giving him digestive troubles. "She jumped right on it and told me it was a side effect, but I had to take something," Mr. Bernal says. She switched him to another statin, which he was able to tolerate.
Dr. Cymbala, who typically follows 800 to 900 patients, says Kaiser's electronic system would have eventually picked up Mr. Bernal's noncompliance through elevated cholesterol levels or a failure to refill a prescription. "We try to let patients know they can trust us and call us, and we care to know when they are having a problem," she says. Sometimes she will gently point out to people who claim to be taking their meds that they haven't refilled their prescription.
John Merenich, who heads disease management and prevention programs at Kaiser Colorado, says, "You can't just tell them, 'If you don't take this medication you are going to have another heart attack.' " Patients need ongoing reinforcement about their health goals, he adds, "We have to bring the patient back into the center of the conversation."
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