Medication Management for Older Adults: 11 Pharmacist-Backed Tips for Caregivers

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Managing medications for an older adult can be an overwhelming process. Along with timing doses and storing medications, there are also interactions and side effects to track. This can seem daunting, especially as more medications are added to the list. Fortunately, there are things you can do to make it easier.

Pharmacists can be your resource for how to manage medications for older adults. We cover 11 pharmacist-backed tips for caregivers below.

1. Create a comprehensive medication list

Maintaining a medication list is a great way to stay on top of what may seem like an ever-growing number of medications To start, you'll need to find a method to stay on track. You can write the list by hand, type it, or use a medication reminder app. Do what works best and is easiest for you.

To stay organized, include clear, concise information on your list. You'll want to make sure to add the following:

• The medication name

• The medication dose or "strength"

• Route of administration (such as oral, topical, or injected)

• Directions for taking the medication (such as dose frequency, time of day, etc.)

• Date medication was started

• What the medication is treating or being used for

• The prescriber's name

Some people like organizing medications in chronological order. In this case, you would list them based on the times they're to be taken throughout the day (e.g., morning, noon, and night). Others section their list based on what health conditions the medications are treating. With so many options on how to organize the list, there's no "right" answer. You'll just want the information together in one place, so it's easy to reference.

If new medications are prescribed, or if certain medications are stopped, you should update the list right away. That way you'll always have the most updated list to take to healthcare appointments. Be sure to share these changes with the healthcare team and any others sharing caregiver duties.

Over-the-counter (OTC) medications, supplements, and vitamins are also key to track. These items have the potential for drug interactions. Healthcare professionals will want to know about them. Be sure to keep the medication list in an accessible place and that it is identifiable. This is helpful in the event of an emergency. For example, the File of Life comes in a magnet packet that's kept on the refrigerator. First responders will be able to recognize the document.

If possible, sticking with one pharmacy can help make medication organization easier. It can also lessen the burden of updating changes. But if you need to use more than one pharmacy, make sure to have all pharmacy information readily available.

2. Utilize technology for medication management

Medication regimens can be complex. Some medications need to be taken in the morning, while others are taken at night. And some should be taken with food, while others need to be taken on an empty stomach. Medications that interact may need to be separated by a certain amount of time. Keeping track of these details on your own can be difficult.

Fortunately, there are technologies that can help with this. For example, medication reminder apps are a great way to track when to give medications. They alert you on your phone when it's time to administer them.

Calendar apps on your smartphone are another way to remember when to give a dose. Weekly or monthly medications, vaccines, and healthcare appointments can all be tracked.

If you want a simpler approach, you may decide to use recurring alarms on your phone. Establishing a daily routine also always helps keep things organized.

3. Ask about dosage form options

Often, the same medication can come in multiple formulations. This is kind of like how an egg can be prepared in several ways: scrambled, poached, or sunny side up. For medications, this is known as "dosage forms." This describes the physical forms available for medications. Medications can take the form of tablets, liquids, or patches, just to name a few. Not all medications come in different dosage forms. But they can be helpful when they do.

For example, older adults often find it difficult to swallow pills. In this case, liquid forms or orally dissolving tablets may be easier to administer. If these forms aren't commercially available, a compounding pharmacy may be able to make them for you.

And, if you're looking to lower the number of pills or injections per day, there are a few options to consider.

• Topical options: Patches can provide medication through the skin. Donepezil pills (Aricept), for example, are also available in patch form called Adlarity. Each patch lasts for 1 week.

• Combination pills: Sometimes medications are combined for convenience, such as Namzaric (donepezil and memantine). Many blood pressure and diabetes medications are also available in combination pills.

• Longer-acting injections: Daily injections, such as Neupogen, may be available in longer-acting forms, such as Neulasta. This is also the case for glucagon-like peptide-1 agonist injections for Type 2 diabetes.

If you think changing the dosage form may help your older adult, talk to their prescriber or pharmacist. Although dosage form changes can provide convenience, they may result in higher costs.

4. Be mindful of medication storage

Medications are best stored in places that'll help you remember to administer them. But there are a few do's and don'ts regarding organizing medications to know about. They include:

1. DON'T store medications in the bathroom. Store medications in cool, dry places. Avoid areas that are high in humidity and moisture and fluctuate in temperature. This includes the bathroom.

2. DO keep all medications together in one place. Unless specified otherwise, try to keep medications together in one designated place. Medications that need to be refrigerated are an exception.

3. DON'T take medications out of their original packaging. Some pills need to be kept in their original containers. If you're using a pill organizer, make sure it's OK to transfer the pills before doing so.

4. DON'T mix medications together in one bottle. This may cause confusion later on when trying to remember what's stored in the bottle.

5. DO keep away from pets and children. Consider locking up medications if you have pets and children in the home. This can help prevent medication overdose and toxicity.

6. DON'T ignore specific storage instructions. You may need to store medications in specific places, such as the refrigerator. For example, liquid antibiotics may require refrigeration. And some medications need to be refrigerated before they're opened, then kept at room temperature while in use.

5. Consider medication synchronization programs

Medication synchronization programs are a great way to stay on top of medications refills. They work by having your pharmacy fill medications on the same day each month.

So instead of making multiple trips to the pharmacy, the pharmacy aligns prescription pickups to one day. This works best when using one pharmacy. And using only one pharmacy can help avoid duplication and interactions, too. Most pharmacies can provide this service without any additional cost.

Healthcare professionals like synchronization programs because they make sure your older adult is taking their medications regularly. One thing to note is that "as needed" medications are usually not included in these programs. They are refilled once you notify the pharmacy that you're out of the medication.

The American Pharmacists Association Foundation is a good resource to learn more about these programs.

6. Utilize medication therapy management services

Something every caregiver could benefit from is a comprehensive medication therapy evaluation. This service is known as medication therapy management (MTM). It provides a professional personalized review and guidance on managing medications.

In other words, a pharmacist evaluates your care recipient's medical issues and medications (prescription, non-prescription, and herbals), and makes suggestions to improve their care.

Below you'll find some of the information provided during an MTM session:

1. Optimal medication dosing

2. Lessening the number of medications if needed (de-prescribing)

3. How to avoid or lessen side effects

4. Potential drug interactions

5. Directions on correct medication administration and timing

6. Medication specific monitoring (e.g., blood glucose goals for diabetes medications)

7. Cost-lowering considerations

Some people may qualify for these services for free from their insurance providers, like Medicare Part D and state-provided Medicaid. But if MTM isn't covered, there's always an option to pay out of pocket. Ask your local pharmacy if MTM services are available.

7. Be aware of interactions with foods, herbal supplements, and OTC medications

You may already know that prescription drugs can interact. But did you know that food and herbal supplements are a big culprit for interactions too? Healthcare professionals screen for drug interactions when prescribing medications. But they may not always be aware of all the foods, herbals, and OTC medications that your older adult is taking.

Caffeine, leafy greens, and aged cheese, are just a few of the foods that can cause problems. It's a common misconception that food and herbal supplements are "natural" and therefore safe to take with all medications. That isn't always the case.

That's why it's important to let the pharmacist know of any herbal or OTC medications that are not listed in the prescription medication profile. They'll be a helpful resource if any interaction information is available.

8. Familiarize yourself with potential side effects

It may seem like potential side effects are endless on prescription medication guides. But your pharmacist can help narrow down the most common side effects to monitor. Consult with a pharmacist to get key information on possible side effects.

Keeping track of changes you notice in your older adult can also help in monitoring for side effects. You can do this by recording the time of day, description, and duration of side effects in a diary. Your notes can help their prescriber narrow down which medications may be contributing to these effects.

It's also a good idea to learn about OTC medications that can cause risky side effects in older adults and should typically beavoided. Common examples include certain allergy medications, motion sickness pills, and sleep aids. Your pharmacist can help you find safer options to manage symptoms.

9. Plan for emergencies

Since you can't predict when you'll have an emergency, planning for one in advance is always a good idea. Cases of unexpected travel, contamination, or lost medications, may leave you without medications. This is why you should have a back-up plan in place.

Although laws may differ based on the state you live in, pharmacists may be able to provide emergency refills. This allows them to dispense a certain amount of a medication without a prescriber's OK first.

Otherwise, try to order medications once you're down to a one-week supply. Most medications can be refilled within a week of the refill due date. (Controlled medications, though, are usually an exception). If your insurance allows, you can try to get a 90-day supply. This way you're more likely to have extra medication on hand in case of an emergency.

Be sure to always have emergency medications on hand. Some examples include rescue inhalers, nitroglycerin, and injectable epinephrine (such as an EpiPen). These medications are life-saving, so it's also important to have them available. Make sure that you're familiar with how to use or administer them.

10. Dispose of expired or unused medications

Have any old cold medicine, vitamins, or prescription medications still hanging around? Over the years, it's easy to accumulate a mountain of unused medications. While it may seem useful to keep them around "just in case" - it may do more harm than good. Check expiration dates often to make sure your medications are still safe and effective to take.

If you'd like to dispose of your medications, there are several drug disposal or "take back" programs that you can find in your area. Never flush medications down the toilet or throw them directly into the trash. Flushing them down the toilet can cause environmental harm. And throwing them in the trash means they may end up in the wrong hands.

11. Join caregiver support groups

The caregiver role is vital and it's often rewarding, but it can also be tiring and stressful. Caregiver stress can cause loneliness, irritation, or feelings of overall sadness. There are many resources available to help.

Caregiver support groups are one way to connect with others dealing with similar situations. In addition to providing support, you can hear from others about what works (and hasn't worked) for them when it comes to medication management. For example, you may learn some useful tips for how to get your older adult to take their medication.

Caregiver training opportunities and free guide books may also be useful for managing stress. And don't forget to take care of your own health. Regular check-ins with your healthcare team is another way to monitor for and treat caregiver stress. And if you're feeling overwhelmed with caregiver duties, consider hiring an advocate for support.

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