In This Chapter

• Guarding against medication mistakes

• Taking medications is a cooperative effort: teaming up with doctors and pharmacists

• Watch out for drug switching!

• Tips on taking medications

• Buying medicines over the Internet

• How to save money on prescriptions

The right pill in the right amount for the right reason can do wonders for your parents. That little tiny capsule can keep them alive, keep them out of a nursing home, help them get to sleep or make them feel like a million dollars. Or it can land them smack-dab into the emergency room—or even the grave.

With the average older adult getting 18 prescriptions filled every year and spending thousands of dollars out of their own pockets—staying on top of drug safety and costs can be a full-time job. It's my hope that by reading this chapter, you'll save time, money, and a trip to the hospital.

Seniors on Drugs

No, I'm not talking about seniors in high school or college. America's "other drug problem" is among seniors 65 years-plus. These seniors are swallowing one-third of all the prescriptions out there yet they make up only 13 percent of the population. And this doesn't include the over-the-counter (OTC) drugs that the senior crowd takes like aspirin, cold medicines, antacids, vitamins, and laxatives. On that front, they buy 40 percent of all the OTC drugs in the country.

Drugs That Don't Get Along

The most dangerous problem that older adults face when taking drugs is how multiple drugs interact with each other. One quarter of the elderly take at least three drugs a day. The older they are, the more drugs they take. The more drugs they take, the greater the risk in having the combination of drugs kick off a significant health problem.

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Geri-Fact - A recent study in the Journal of the American Medical Association reported that drug reactions kill an estimated 100,000 people a year in U.S. hospitals. The researchers also claim that another 2.1 million are injured by adverse reactions. The elderly are especially vulnerable because of the number of drugs they take.

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Chances are your mom and dad have more than one chronic condition, so they get to meet a number of specialists. As they visit one doctor after the next, they might walk away from each visit with a prescription in hand. If they forgot to tell either doctor about what they're taking, they've placed themselves in danger of an adverse drug reaction. Besides taking drugs that may negatively interact with each other, your parents might also be taking the same drug twice—and not know it.

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Senior Alert - One of the more common side effects of multiple medications is dizziness and confusion. Before anyone decides Dad now has Alzheimer's, make sure his physician rules out medications as a factor. Some doctors put their patients on a "drug holiday" slowly taking them off all drugs to determine exactly what's going on.

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One doctor might give a drug in the generic name and another in the brand name. Our parents might think that they are taking two separate drugs because the names are very different and the pills don't look alike. If the doctors are unaware of what Mom or Dad is taking, or your pharmacist doesn't pick up the double whammy, your parents could be in for some serious trouble.

Not all drugs or combinations of drugs are bad. For instance, a physician might prescribe an anti-ulcer medication with an anti-inflammatory medication. The doctor is doing this because the anti-inflammatory drug can cause severe irritation to the lining of the stomach. So as a precautionary measure, he or she will prescribe the anti-ulcer drug.

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Geri-Fact - A generic drug is labeled by its chemical name, while a brand name drug carries a name given by its manufacturer. For example, the brand name of the sleeping medication Restoril has a generic equivalent known as temazepam. Generics are spinoffs of brand name drugs, but they must have the same active ingredients, strength, and dosage form as brand name drugs. They must also be the same chemically and have the same medical effect. Generics cost much less than the brand name drug, sometimes half the price.

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Not Following Directions

Medication mishaps don't always come from seeing too many doctors and a lack of communication. Older pill takers have a reputation for not following directions. Studies show that three out of four older adults don't take their medications properly. A quarter of all nursing home admissions are linked to an inability to correctly take medications. They are labeled in the medical community as being "noncompliant." It's not like they mean to be this way. If Dad has arthritis and finds it a pain to open the pill bottle, is forgetful, or has poor eyesight and can't read the small print, he'll have problems keeping up with his drug regimen. When it comes to taking three or four pills a day—each one at a different time and a different number of times throughout the day—it's no wonder. Always check with your parent's doctor if you have any questions or concerns about their medications.

Over-the-Counter Drugs

To add to the pharmaceutical pot, your parents are also buying over-the-counter drugs that can negatively interact with prescribed drugs. All too often, your parents won't think of telling the doctor that they're taking aspirin, antacids, cold medicines, and laxatives. If Dad is taking a blood-thinning medication and aspirins, he's going overboard on the thinners and can risk hemorrhaging. Those Tums for Mom's calcium can cause real havoc with her medicine for Parkinson's disease. Though most of these OTC drugs are safe, they are not risk free. More than 600 of these drugs contain ingredients and dosages that 20 years ago you couldn't even buy without a doctor's prescription. Just because Mom and Dad can buy pills over the counter, doesn't mean they're not drugs.

Different Bodies, Different Doses

The aging body has something to say about all this pill popping. That vintage body can't take the same dosage as a young body. The kidney and liver—big players in processing drugs in the body—slow down with age. Less muscle tissue and more fat tissue in the geriatric body means that drug absorption rates get skewed. How long the drug stays in the body, how fast it gets through the system, and how quickly it's eliminated all play a part in how well Mom or Dad tolerates a drug. Be aware that most drugs have been tested on young people (although this practice is beginning to change). As a result, doctors and drug companies have to guesstimate what's an appropriate dose for older people. Dad's physician may start his dosage low and slowly work up to an amount that meets your Dad's unique needs. It's a smart move.

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Silver Lining - Soon you'll see clearly marked and understandable labels on all over-the-counter drugs. Thanks to the Food and Drug Administration (FDA), drug companies must use simple language to explain the risks of the drug, print the risks in large type, and present the information in a standardized, easy-to-follow format on the outside of the package. It will be similar to the food labels we now have on all food products. So read the labels!

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Working with Doctors

Taking medications must be a cooperative effort between your parents and their doctors. Passively taking pills as they go from one doctor to another isn't smart or safe. Mom and Dad have to ask questions and give information. They should do this at every visit.

When a physician gives your parents new medication, here's what they should be asking:

• What is the name of the medication (brand name and generic name)?

• What is the medication supposed to do?

• Why are you recommending that I take this?

• How often should I take the drug?

• How long should I take the drug?

• When should I take it? (Whenever I need to? Before, during, or after meals? At bedtime?)

• Should I avoid certain foods or alcohol when taking this drug? Should I stay out of the sun?

• Should this medicine be refrigerated?

• If I forget to take it, what should I do?

• What side effects might I expect? Under what circumstances should I call you?

• Is there any written material on this drug?

• Is there something else I could try first, such as a change in diet, exercise, or therapy?

• How much does this drug cost? (Let the doctor know if you cannot afford it. Ask if there is a generic substitute, which costs less.)

And here's what your parents should be telling their physician:

• The name of all prescription drugs they are taking, including how long and how frequently they're taken.

• Any over-the-counter drugs they're taking, including vitamins.

• All allergies to medications and food.

• Any serious side effect they've had to a particular medication.

• If Mom or Dad has stopped taking a medication, your parent can't keep it a secret. The doctor needs to know since some medications work in combination with other drugs.

• Any concern about not being able to afford the medication.

If your parents take quite a few medications, make a copy of the following Pill Tracking Chart and have your parents or you bring it to every physician visit. The doc will really appreciate it because it will save time and provide the information he or she needs to assess what's going on.

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Sage Source - Want to know the skinny on the drugs you or your parents take? Check out the National Library of Medicine's Web site at http://www.nlm.nih.gov/medlineplus/. It offers a guide to 9,000 prescription and over-the-counter medications.

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Working with Pharmacists

Most pharmacists are eager to give you information, if you just ask. You and your parents will find it helpful to ask the pharmacist the same list of questions that you asked the doctor. Hearing it twice and double-checking doesn't hurt. The pharmacist is also a great resource to ask about over-the-counter drugs. Many pharmacies have additional consumer-friendly information on the drugs that they dispense, so ask for a copy. Thanks to the computer age, almost all pharmacies keep a profile on what drugs you take and all of your allergies. When you're given a new medication be sure to ask the pharmacist to run a scan on your profile to make sure that you won't have a problem with the new drug. The pharmacist is also the most up-to-date person on whether or not there is a generic available for the drug you've been prescribed. (You usually don't have to check with your doctor to substitute a generic.)

Pill Tracking Chart (click here for a printable version)

"I'd Rather Fight Than Switch"

Pharmacy benefit managers (PBMs) are companies hired by insurance companies, employers, and HMOs to oversee their drug benefit plans. PBMs make sure that insured individuals don't use too many or too expensive drugs. Drug companies that give price breaks or rebates get on a list, called a formulary, with the PBMs. In return, the PBMs steer pharmacists toward those drugs on which the PBMs received a better price. It's possible a PBM will tell the pharmacist to switch your prescription to the drug on its formulary.

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Senior Alert - If your parent's insurance company or Medicare managed care plan has asked the pharmacist to switch the drug to something different (other than a generic) from what the physician prescribed, tell the pharmacist you want to know! Ask him or her to explain the difference between the two drugs. If your parent doesn't adjust well to the drug the insurance plan says he or she must take, let the doctor know. Ask the doctor to call the insurance plan to get your parent back on his or her proper medication.

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But here's the problem: Many of these PBMs have financial relationships with drug companies and, in fact, a significant number are owned by drug companies. The FDA is now investigating conflict of interest issues and whether these switches are causing adverse reactions for patients. Physicians and elderly advocates across the country want a full investigation. According to studies conducted by the American Medical Association, millions of Americans are at risk because of this practice and already have been hurt by adverse drug reactions. If your parent has been doing well on a medication and all of a sudden he or she is told to switch, look into it. If your parent would rather fight than switch, let the physician know what's going on and file an appeal with your insurance carrier.

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Silver Lining - Your mom or dad may be eligible to participate in a clinical trial where he or she will receive free medications and medical care. This is very helpful if your parent has a special condition for which current treatment practices aren't effective. These clinical trials are overseen by the FDA and are conducted by medical groups and universities throughout the country. To find a clinical trial that might help your parent, visit a National Institutes of Health Web site at http://www.clinicaltrials.gov that tracks trials down for you by condition and location. Be aware, though, that your parent might be chosen to get the "dummy" pill known as the placebo.

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Tips on Taking Meds

Swallowing a pill seems simple enough. But, as in most things, there's more to it than meets the eye. Here are some tips your parents need to keep in mind:

• Don't share your medications with your spouse or friends.

• Take the full dosage for the time prescribed. Don't quit as soon as you feel better.

• Don't take fewer medications per day to stretch out the prescription.

• If you're not feeling better or are reacting poorly to the drug, call your physician.

• If you're taking multiple drugs, set up a system to keep track of what you are taking and when. Check them off as you go.

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Sage Source - The National Library of Medicine's http://www.nlm.nih.gov/ medlineplus is a great Web site for up-to-date consumer information on medications, over-the-counter drugs, and new discoveries. It also offers terrific links and related information.

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• Discard expired medications. It's too easy to confuse old medicine bottles with new ones.

• If the prescription bottle is too hard to open or too small, ask your pharmacist to dispense it in a bigger bottle with large print and an easy-to-open cap.

• Ask your pharmacist about devices that can help you keep track of your medicines. (The pharmacist calls them compliance aids.) To name a few, there are check-off calendars, containers for daily doses, and bottle caps that beep when it's time to take a dose.

• Here's a shocker: Don't store your prescriptions in the medicine cabinet! Turns out, the bathroom is too warm and humid. Pills should be stored in cool and dry places.

Buying Medications on the Internet

Cyber pills. You knew it had to come. Instead of getting your pills at the friendly corner drugstore, you're a click away to online buying. There are certainly some advantages to getting your meds online:

• Easy access for homebound elderly

• Easy comparative shopping for the best price

• Access to a great variety of products

• Ability to consult with a pharmacist and order products in the privacy of your own home

The FDA, however, warns that there are a growing number of rogue sites that are downright dangerous. They'll send you pills without a prescription, which is never a good idea. Or they'll have you fill out a questionnaire, then tell you that a doctor has looked over your symptoms and recommends the following medication—when no such doctor ever looked it over!

In a famous national case, a man ordered Viagra online. He also had a history of chest pains and a family history of heart disease. All he did was fill out an online questionnaire. He died of a heart attack as soon as he started taking the drug. Though there is no direct proof that the man's death was linked to the drug, FDA officials contend that a traditional doctor-patient relationship with a good physical may have prevented the death. In the meantime, Congress is scrambling to keep up with online drug buying and come up with legislation to regulate it for the public's safety, just as they regulate pharmacies.

So, what if you want this convenience and still be assured it's safe? Here's some safe Internet buying tips from the FDA:

• Check with the National Association of Boards of Pharmacy to make sure that the site is a licensed pharmacy in good standing. Visit the Web site at http://www.nabp.net/vipps/, or call 847-698-6227.

• Stay clear of sites that offer to prescribe a prescription for a drug the first time without a physical exam.

• Don't buy from sites that sell prescription drugs without a prescription or that sell drugs not approved by the FDA.

• Beware of sites that advertise a new cure for a serious disorder or a quick cure-all for lots of ailments. It's cyber snake oil!

• Don't do business with sites that don't provide you access to a registered pharmacist.

• For any first-time drug—always go through your physician first.

In general, legitimate online pharmacies will ask you to open an account with them, and then submit credit and insurance information. They'll ask you to submit a valid prescription which your doctor can call in, fax, or mail. The online pharmacy can ship it to you, or you can pick it up at a local drugstore. Most sites have an online registered pharmacist to whom you can e-mail questions or can reach at a toll-free number.

Saving Money on Prescriptions

It certainly isn't a news flash that prescriptions these days cost an arm and a leg. Medicare doesn't pick up the tab on pills (unless you're in the hospital), insurance is expensive, and prices continue to skyrocket. A recent study by the nonprofit consumer advocacy group Families USA confirmed that the prices of drugs most frequently used by older Americans rose 30 percent on average over the last six years. It's not uncommon for people to shell out $2,000 to $3,000 a year on prescription drugs.

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Silver Lining - Help out the Feds! If you think you've come across an illegal pharmacy Web site, let the FDA know by e-mailing them at webcomplaints@ora.fda.gov.

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It's no wonder so many older folks are up in arms over drug prices. My mother, in order to get pain medicine for my dying stepfather, had to use her charge card to buy 10 pills for a staggering $800. He died four days later. At least she had the credit to cover the costs. As Secretary of Aging, I met hundreds of older people who had to walk away from the pharmacy because they simply couldn't afford to pay. Others paid their utility bills late, shut off the air-conditioning, or went without food in order to buy the medications. Hopefully, you're not in that situation but with no end in sight of rising drug prices, it's to your advantage to become a smart consumer. Check out my Prescription for Saving on Medications:

• Ask if there is a generic equivalent of the drug being prescribed. Generics are less expensive than the brand name drug, sometimes as little as half the price.

• If your parent is taking a new drug for the first time, ask for a trial size rather than a 30-day supply. That way if you have an adverse reaction to the drug, you won't be throwing away your money and the pills for a full 30-day supply. If the drug is working well, you'll need to ask your doctor for a refill to finish the prescription.

• Ask the doctor for drug samples. In most cases, the doctor will be able to get you started on a drug with free samples provided by the drug company.

• If your parent is taking a maintenance drug—a drug Mom or Dad has to take for a long time to maintain health—look into buying in quantity. A 90-day supply will be cheaper than a month's supply.

• Look into ordering maintenance drugs by mail or online. They are usually cheaper than they would be at a drug store because there is less overhead. If you're ordering online (see the previous section, "Buying Medications on the Internet"), make sure it's a credible group that has been approved by the National Association of Boards of Pharmacy. Visit http://www.nabp.net/vipps/ to see if they're okay.

• Shop around. Call pharmacies to find out their prices for various medications. You'd be surprised at the difference. Many will deliver for free, so you won't have to travel all over town to get the best buy. Also ask them if they offer senior citizen discounts.

• If your parent must take medications over the long term (for diabetes, blood pressure, Parkinson's, or cardiovascular problems, for example), look into an insurance plan. If the monthly premiums and deductibles are less than what they put out every month—go for it.

• Some states have prescription assistance programs for low-income elderly. Call the local area agency on aging to find out how to qualify for any programs in your state.

• Some drug companies offer free or reduced-price medications in certain cases. Visit http://www.phrma.org/patients/ to see if the manufacturer of your parent's drug participates. Only your parent's physician can apply to the drug company on your parent's behalf. It doesn't hurt for you to do the homework and share the information with your parent's physician so he or she can apply on your parent's behalf.

• If your parent receives prescriptions in a nursing home from the facility's pharmacist be sure to scan the monthly bill. Many homes inflate the prices. Instead, you can choose to buy them on your own and have your parent's medications delivered to the nursing home.

The Least You Need to Know

• It's estimated that 100,000 people die from adverse drug reactions and millions of others are injured from them every year.

• When taking medications, it's crucial that your parents work closely with their doctor and pharmacist, to ask questions and offer information.

• If your parent has been doing well on a medication and then is suddenly told to switch, check with your parent's doctor right away.

• If your parent takes multiple drugs, set up a system to keep track of what Mom or Dad is taking and at what time. Always take the full dosage for the entire time prescribed.

• Buying medications online offers many benefits, but be alert to scams.

• There's plenty you can do to save money when buying medications.