| Taking Medications
When it comes to following a complicated medication regimen, there
are several things you need to be able to do. First, you have to understand
the instructions: when to take the medicines and what kinds of restrictions
there are on each one, such as taking it with food or avoiding alcohol.
You need to be able to plan a schedule, which can be complicated when
several medicines are involved, and to understand and remember that
schedule. Finally, you need to be able to remember to take each dose.
All of these steps are affected in the aging mind.
But just because your memory is slowing down doesn’t necessarily mean
you’ll have trouble taking your medicine. “Older adults do suffer declines
in cognitive function,” Dr. Park says, “but they have plenty remaining
to remember to take a pill in the morning with breakfast.” Aging isn’t
always the best predictor of whether or not someone is going to take
their medicines properly, Dr. Park says. She has found that, indeed,
people over 78 years old were the least adherent in taking medicines.
But those between 60 and 77 followed their medication regimes the best.
The big surprise was that middle-aged people did much worse than 60-77
year olds.
The first step in understanding how to help people take their medicines
properly is to figure out why these groups have different adherence
patterns. Dr. Park believes that the 60-77 year old people feel vulnerable
enough about their health to take their medications very seriously,
and can still follow complicated regimens. Many people over 78 may have
trouble understanding and remembering their regimens, accounting for
this group’s poor adherence. As for the middle-aged people, they were
perfectly capable of following their regimens. But, Dr. Park explains,
“We found that people who reported being very busy and having a lot
of things going on in their lives were the least adherent, and these
were middle-aged people. Their working memory was full of tasks and
information, and they often were too distracted to remember to take
their medicines.”
Dr. Park concludes that people with more stable, less hectic lives
follow their medication regimens the best. And older people tend to
have more stable, less hectic lives than middle-aged people.
Medication Aids
 There
are many things you can do to help you follow a medication regimen.
Dr. Park has experimented with bottle tops that beep when you need to
take your medicine and found them very effective. But until such things
are widely available, a programmable wristwatch can be a good reminder.
A phone service or computer scheduling program might be a good substitute
if you are usually at home when you need your medications. However,
for people taking medicines on different schedules, Dr. Park is reluctant
to recommend these simple time reminders without something else to tell
them which medicine they’re supposed to take each time. Pill organizers
with a different compartment for various times of the day can help people
stick to a schedule.
But often the most difficult part of taking several medicines for
an elderly person is simply figuring out what the regimen is supposed
to be in the first place. “I think it would be really useful for a health
professional to sit down and ask the person to write out a medication
plan,” Dr. Park says. It’s best for the patient to produce the plan,
drawing out a day by day, hour by hour schedule of when they have to
take all their medications. It could be a grid with dates and times
detailing when to take each medicine, along with any restrictions on
them. A plan can be in the form of a poster, a booklet, or just a sheet
of paper. Checking off each medicine as it is taken can help you make
sure you are following the regimen properly.
“Understand as much about why you’re taking these things as you can,”
Dr. Park advises. “That helps adherence.” On drugs that are crucial
for a person’s health, she says, people are generally very adherent,
particularly older people. “One of the reasons is that people’s lives
depend on this, people’s health depends on this, and they know it.”
The last advice Dr. Park has is to build a consistent, structured
schedule for taking your medications into your daily life. “Behaviors
become automatic and almost unconsciously performed over time,” she
says. “For example, you get to your office and realize you have no memory
of how you got there. Taking medications can similarly become just as
automatic.... Having daily routines that are highly structured leads
to greater adherence.” For example, you might decide to take one medication
after you brush your teeth every morning. Dr. Park thinks that people
who have a sudden-onset medical condition like a heart attack tend to
have a harder time following a complicated regimen than those whose
regimens gradually build in complexity. The latter have had time to
slowly build these things into their lifestyles and incorporate them
into their daily schedules.
A Complicated Problem
There’s no simple solution to helping people follow their medication
regimens. Dr. Park says that a number of inventors have investigated
designing devices to dispense medications. But the task is extremely
difficult because of all the different pill sizes and complicated schedules.
“It would need a lot of programming,” she says. There are also instructions
that might be lost with such a device — to take the medicine with
food or drink, for example — as well as warnings, like not using
alcohol while taking the drug.
Dr. Park believes that in order to help people follow their medication
regimens it’s critical to understand how changes in the aging mind affect
reasoning, learning and memory. People will be healthier if they understand
their own health problems and how to manage them. A spoonful of sugar
may help the medicine go down, but if you can’t remember which of your
medicines to take and when to take them, the sugar’s not much help.
— a report from The NIH Word on Health, April 2001
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