Patient non-compliance is the major obstacle to a dementia prevention program in the primary care setting. Polypharmacy, adverse drug reactions, and patient non-compliance are common problems in patients over the age of 65 that contribute to many hospital admissions. Studies show that between 10-20% of medications consumed by elders are used in error, producing 10% of hospitalizations. Duplicate therapy, incorrect prescriptions, inaccurate dosing, and drug-drug interactions are common problems. Psychotropic medications are often misprescribed, especially benzodiazepines or narcotics such as Darvon. Many older persons intentionally use excessive medications or those prescribed for others; especially psychotropic or analgesic drugs. The adverse health effects of inappropriate medications are significant. Inappropriate consumption of psychotropic medications can produce delirium that results in disability or nursing home admission.
Therapeutic non-compliance produces serious medical complications in elders. Depressed elders, elders treated by multiple doctors or those who use multiple medications have greater risk for non-compliance. Elders with unrecognized dementia may forget symptoms, instructions, or dosage changes. Elders may fail to comply with diet, medication, and lifestyle changes for many reasons. About 1/3 of elders admit to medication non-compliance and 3/4 are non-compliant during direct monitoring. Many elders fail to use written instructions for medications and rely on their memory for compliance. Physicians must communicate directly with the older patient to enhance their sense of self-determination and responsibility for their health (Click here for references – 2514.13).
Recommendation
Elders should be encouraged to bring all consumed medications to every office visit and seek consultations from their local pharmacist. Discuss compliance and prevention in explicit concrete terms with the older patient. Provide written instructions and frequent reminders about medication. Include family caregiver in the discussion about medication. Advise elders to cross-check all medications with their pharmacist, including over-the-counter medications. For more information, click here – 2514.11, 2514.15.
ã Richard E. Powers, MD (2006) – Bureau of Geriatric Psychiatry
DEMENTIA EDUCATION & TRAINING PROGRAM – 1-800-457-5679