Consumer guidelines for using medications wisely. (Pharmacology and Older People)

The wise use of medications requires compliance, understanding, communication, and resources available to assure acquisition of medications and proper counseling concerning their use. In order to gain the full therapeutic benefit of any medication, compliance with directions is essential. Poor compliance with drug therapy is a problem that exists in young and old; however, given the number and severity of chronic diseases that often plague them, the consequences of noncompliance may have a greater magnitude in the elderly. As quoted by Simonson (1984), a British physician once stated: "The failure of an elderly person to respond to an effective drug is nearly always due to failure of the patient to take the drug rather than to absorb it." Given, also, the fact that elders are two to seven times more likely to experience an adverse drug reaction to administered drug(s) than are younger adults, the proper use of medications, the possible benefit gained, and potential side effects must all be understood in order to intelligently comply with medication instructions and gain the desired therapeutic effect.

WHAT CONSTITUTES UNWISE USE OF MEDICATIONS?

There are a variety of aspects to unwise or noncompliant use of medications. The most obvious is the omission of doses of medication. This may be the result of forgetting a scheduled dose, simply avoiding taking it, or even deciding not to purchase a prescribed medication. The last usually involves an active decision not to take the medication because of possible side effects, misunderstanding the proper need for the medication, or the lack of agreement between patient and prescriber as to the need or benefit of taking the particular medication. There may be instances in which noncompliance may seem appropriate, for example, when adverse effects are being experienced; however, in most cases, omitting doses of prescribed medication can be considered unwise.

Other forms of unwise use of medications include intentionally increasing or decreasing the recommended dose of the medication, taking the medication for an unintended purpose, making errors in frequency of administration, administering the medication incorrectly, and using combinations of prescription and nonprescription (over the counter) medications without proper advice (Tolliver, 1985). Another type of unwise use consists in taking old medications left over from previous illnesses or in sharing someone else's medications for what is perceived to be the proper reason for use in an undiagnosed disease process (Simonson, 1984). Another unwise practice is the continued use of medications prescribed a long time in the past, irrespective of current prescribed therapy. All these examples of unwise use of medications may have undesired and potentially dangerous consequences.

POTENTIAL CONSEQUENCES OF MEDICATION MISUSE

Failing to use medications wisely may have adverse consequences, some obvious and others not so obvious. Failure to adhere to prescribed treatment regimens can lead to treatment failure or relapse of disease. Infections, for example, may fail to be resolved and may relapse if antibiotic therapy is prematurely discontinued once the symptoms of the infection abate. Other consequences may be more subtle or overlooked. For example, patients whose physicians, or other healthcare providers, observe treatment failure and do not consider …