With over 1 in 3 adults greater than 65 years old taking more than 5 medications daily, understanding and managing medication use can be expensive, confusing and sometimes harmful. Coming up with tools to help your loved ones use their medications will better ensure they get the health benefits they desire.
Listen in as Matt Kresl, PharmD explains how to manage medications for yourself and your loved ones to get the best adherence and safety.
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Managing Your Loved One’s Medications
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Learn more about Matt Kresl, PharmD
Matt Kresl, PharmD
Matt Kresl is a pharmacist practitioner with Allina Health. He started with Allina in 2004 and has worked in various patient care and administrative positions. His current practice involves working with primary care providers on improving patient symptoms, better treating chronic diseases, and removing barriers to safety and effectively taking medications.Learn more about Matt Kresl, PharmD
Transcription:
Managing Your Loved One’s Medications
Melanie Cole (Host): With over one in three adults greater than 65 years old taking more than five medications daily, understanding and managing medication use can be expensive, confusing, and sometimes harmful. Coming up with tools to help your loved ones use their medications will better ensure they get the health benefits they desire. My guest today is Dr. Matt Kresl. He’s a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. Why is medication management so important nowadays?
Dr. Matt Kresl (Guest): Melanie, thank you for having me. Medications are obviously given with good intentions but oftentimes can cause more harm than good. In fact, prescription drugs rank fourth with stroke as a leading cause of death in the United States. You can imagine, a billboard outlining the risk of stroke, but you oftentimes don’t see things related to medicine and the risk of that. So, oftentimes, medication management is important because you’re ingesting things with known risks and as a pharmacist, we try to address that risk when we meet with patients.
Melanie: What are some for the most common mistakes or issues that you see when people are taking multiple medications?
Dr. Kresl: It’s interesting because oftentimes patients see multiple providers, especially elderly adults. Oftentimes when they’re seeing many different doctors, they simply just don’t understand what the medicine is for. They oftentimes just go along with whatever the provider tells them during an encounter like that and because they see so many different types of doctors, they can oftentimes leave the doctor’s office not understanding what it is they take. When we get involved, oftentimes they’re a little dumbfounded as to what their medicines are for. Then we go in and try to give them the information they need. But, in terms of practical examples, oftentimes, patients will not generally have the habits that are necessary to ensure that they’re taking them on a regular basis. That, again, is another thing as a pharmacist we do is, really try to develop the tools and habits that allow them to safely take medicines.
Melanie: So, there are other things that can affect medications and whether they work effectively or not. What are some of those supplements or vitamins? How do those work with medications?
Dr. Kresl: Well, vitamins and supplements occupy a very large part of America. It’s anywhere from a $12 to $37 billion dollar industry depending on what statistics you see. Vitamins and supplements can be used for lots of different reasons. They can sometimes complement the medicines you’re taking. So, for example, you take a vitamin D supplement because it helps your calcium be absorbed. Oftentimes, people are taking vitamins to mitigate or lessen a side-effect from a medicine. So, for example, CoQ10 is used for patients who don’t tolerate cholesterol medicines. Supplements are great in many different contexts but it’s very much a buy or beware market. Supplements are not regulated the same way that prescription drugs are and what I mean by that is, supplements aren’t mandated to prove their effectiveness. They’re really only mandated to prove that they’re not going to be unsafe when you take them. And so, it creates a situation where the barriers to entry for vitamins and supplements are very low. You get lots of different makers out there and when you have that situation, you don’t necessarily know what you’re taking as well. So, that’s my long-winded way of saying that supplements can be great. There are many good examples of that that I illustrated but it very much requires a diligent eye as to who makes it and is that company that you’re buying that supplement from, reputable.
Melanie: One of the most important things is knowing what medications you’re on. What are some of the best things people can do to set themselves up for success with their medications if they have to go to the emergency room or if a loved one is taking care of them? What do you tell people everyday about managing their medications?
Dr. Kresl: I think the biggest thing is having a list. And I go back to a point I made earlier where patients are seeing multiple different providers. As a pharmacist, what I do when I go into patients homes or see them in clinic is if they’ve seen multiple providers and they don’t even have an accurate list to present to a caregiver about what they’re taking. And, anytime there’s an omission or an incorrect dose or something like that, that can set somebody up for a potential error. So, just having a list with them, updating it on a regular basis. And I think really, a big point is just understanding the basics of what it’s for and what to expect. I don't expect my patients to know every side effect of every medicine they take, but just a basic, “This is for my blood pressure. This is for my cholesterol. This is for my COPD or asthma. This is for UTI prevention.” Just a very kind of, again, layman’s understanding can be really helpful so caregivers can get a sense of what’s going on with the patient.
Melanie: What about different pharmacies? If they use more than one pharmacy, how do they combine all of these different medications? Can they tell one pharmacy all of the things? Do you recommend that they just stick with just one?
Dr. Kresl: In general, yes. I think, anytime you can provide a consistent process for yourself, not only the pharmacy you go to but that pharmacist who is there consistently, having that relationship, I always advocate for. Unfortunately, there are times when patients need to use multiple pharmacies. For example, if they need to get a novelty drug that isn’t available at every pharmacy. Again, one place for consistency is best to help, again, with the record keeping. And then, from there, if there are multiple locations, updating that list or helping your loved one update that list can be vital.
Melanie: If someone’s taking care of an aging parent, what are some of the signs they should look for that the parent might need assistance with their medication?
Dr. Kresl: It’s a great question. When I go into patient homes or see them in clinic, the first thing I ask the patient to do is to just get all your medicines in one spot. So, if you’re a loved one and trying to figure out, is my loved one doing it right or not, gathering all the medicines is a good idea. And, if they’re in multiple places in the home, that’s a warning sign that they’re not managing it well because having them in one spot just ensures that they’re more likely to do it on a regular basis. Many patients use pill boxes and so, oftentimes, when I meet with patients, I’ll just take a peek in the box. If there are lots of slots that are still full of medicine, it gives you some confidence that they’re not taking them as they should. The other thing is just simple things like looking for medicines on the floor. I have patients who sometimes have shaky hands due to an essential tremor or Parkinson’s disease, and the medicines won't actually physically get into their mouth. So, if you see a pill on the floor, that’s another sign that things may not be as they should. If your loved one doesn’t have regular patterns, meaning eating time, sleeping time, running errands, etc., oftentimes it can be harder for them to remember to take their medicine and so that can be another sign that you could look at or a clue. It can feel little bit like you’re a detective putting a story together. And then, the last thing is just looking at the bottle, and if the dates are old and the number of pills times the number of times a day they’re taking it, don’t add up, that’s another sign they’re not taking their medicines.
Melanie: Now, with so many people on pain medications and possible opioids, do you advise children of aging parents to count these number of pills because there is an OD problem in this country with elderly and taking these pain medications at the wrong times or too close together. What do you tell them?
Dr. Kresl: Oftentimes, I tell them, these can be habit forming. I think the media nowadays is doing a much better job of outlining the risks. I hear my patients talking a lot more about the risk and they’re worried about dependency but as it relates to small children, keeping them in a locked cabinet or facility that is under lock and key. I have patients who store controlled substances literally in a safe just because of their concern about other people in the home potentially getting access to them and abusing them or misusing them. Beyond that, I think really articulating appropriate use and inappropriate use, and then just being aware of what their risks actually are. For example, with opioid medicines or benzodiazepines--those are things like Ativan or Diazepam or Oxycodone or Hydrocodone--the big risks, the life-altering risk, is respiratory depression meaning they literally stop breathing from overuse of the medicine. And just kind of making it very clear again in layman’s terms what the risk is for overuse can, I think, make a big difference as to how they go forth and use them.
Melanie: Where’s the best place to store your medications?
Dr. Kresl: Wherever you’re going to remember them the most to take them. So, when I talk to patients about adherence, I give them very frank statistics about adherence rates. So, when you go into the peer review literature and look at adherence, oftentimes patients taking their medicines half the time is what you see. And so, just being very forthright with, most people don’t remember them about half the time. So, I always tell them a central location in the house is a good place, and a lot of it is around ritual and habit formation. So, for many people, the first place they stop in the morning is the kitchen, so I tend to prefer the kitchen as a place because most medicines are taken in the morning, that’s where the day begins, and that’s where you can, again, develop the habit of taking your medicines by having them in close physical proximity. The other benefit is that they’re going to be stored under room temperature. You don’t have to worry about them overheating in the bathroom where heat and humidity can become more of an issue.
Melanie: And just wrap it up for us, Dr. Kresl, if you would. What’s your best advice when it comes to managing your own or someone else’s medication? Give the best advice and tell people what you tell them every day about remembering to take these important medications?
Dr. Kresl: Really, the only advice I give them is around looking at their rituals or daily habits. Taking medicines is no different than any other habit that you develop, if it’s a good one, and understanding how you tick, understanding what you do on a daily basis, and then, fitting your medicines into that daily routine, I think, is really, when it comes down to it, the best advice I can give. And then, beyond that developing a strategy to help you remember such as a pill timer or an alarm, I think, could be a useful tool as well.
Melanie: Thank you so much for being with us. It’s really great and very important information. You’re listening to The WELLcast with Allina Health. For more information, you can go to www.allinahealth.org. That’s www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Managing Your Loved One’s Medications
Melanie Cole (Host): With over one in three adults greater than 65 years old taking more than five medications daily, understanding and managing medication use can be expensive, confusing, and sometimes harmful. Coming up with tools to help your loved ones use their medications will better ensure they get the health benefits they desire. My guest today is Dr. Matt Kresl. He’s a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. Why is medication management so important nowadays?
Dr. Matt Kresl (Guest): Melanie, thank you for having me. Medications are obviously given with good intentions but oftentimes can cause more harm than good. In fact, prescription drugs rank fourth with stroke as a leading cause of death in the United States. You can imagine, a billboard outlining the risk of stroke, but you oftentimes don’t see things related to medicine and the risk of that. So, oftentimes, medication management is important because you’re ingesting things with known risks and as a pharmacist, we try to address that risk when we meet with patients.
Melanie: What are some for the most common mistakes or issues that you see when people are taking multiple medications?
Dr. Kresl: It’s interesting because oftentimes patients see multiple providers, especially elderly adults. Oftentimes when they’re seeing many different doctors, they simply just don’t understand what the medicine is for. They oftentimes just go along with whatever the provider tells them during an encounter like that and because they see so many different types of doctors, they can oftentimes leave the doctor’s office not understanding what it is they take. When we get involved, oftentimes they’re a little dumbfounded as to what their medicines are for. Then we go in and try to give them the information they need. But, in terms of practical examples, oftentimes, patients will not generally have the habits that are necessary to ensure that they’re taking them on a regular basis. That, again, is another thing as a pharmacist we do is, really try to develop the tools and habits that allow them to safely take medicines.
Melanie: So, there are other things that can affect medications and whether they work effectively or not. What are some of those supplements or vitamins? How do those work with medications?
Dr. Kresl: Well, vitamins and supplements occupy a very large part of America. It’s anywhere from a $12 to $37 billion dollar industry depending on what statistics you see. Vitamins and supplements can be used for lots of different reasons. They can sometimes complement the medicines you’re taking. So, for example, you take a vitamin D supplement because it helps your calcium be absorbed. Oftentimes, people are taking vitamins to mitigate or lessen a side-effect from a medicine. So, for example, CoQ10 is used for patients who don’t tolerate cholesterol medicines. Supplements are great in many different contexts but it’s very much a buy or beware market. Supplements are not regulated the same way that prescription drugs are and what I mean by that is, supplements aren’t mandated to prove their effectiveness. They’re really only mandated to prove that they’re not going to be unsafe when you take them. And so, it creates a situation where the barriers to entry for vitamins and supplements are very low. You get lots of different makers out there and when you have that situation, you don’t necessarily know what you’re taking as well. So, that’s my long-winded way of saying that supplements can be great. There are many good examples of that that I illustrated but it very much requires a diligent eye as to who makes it and is that company that you’re buying that supplement from, reputable.
Melanie: One of the most important things is knowing what medications you’re on. What are some of the best things people can do to set themselves up for success with their medications if they have to go to the emergency room or if a loved one is taking care of them? What do you tell people everyday about managing their medications?
Dr. Kresl: I think the biggest thing is having a list. And I go back to a point I made earlier where patients are seeing multiple different providers. As a pharmacist, what I do when I go into patients homes or see them in clinic is if they’ve seen multiple providers and they don’t even have an accurate list to present to a caregiver about what they’re taking. And, anytime there’s an omission or an incorrect dose or something like that, that can set somebody up for a potential error. So, just having a list with them, updating it on a regular basis. And I think really, a big point is just understanding the basics of what it’s for and what to expect. I don't expect my patients to know every side effect of every medicine they take, but just a basic, “This is for my blood pressure. This is for my cholesterol. This is for my COPD or asthma. This is for UTI prevention.” Just a very kind of, again, layman’s understanding can be really helpful so caregivers can get a sense of what’s going on with the patient.
Melanie: What about different pharmacies? If they use more than one pharmacy, how do they combine all of these different medications? Can they tell one pharmacy all of the things? Do you recommend that they just stick with just one?
Dr. Kresl: In general, yes. I think, anytime you can provide a consistent process for yourself, not only the pharmacy you go to but that pharmacist who is there consistently, having that relationship, I always advocate for. Unfortunately, there are times when patients need to use multiple pharmacies. For example, if they need to get a novelty drug that isn’t available at every pharmacy. Again, one place for consistency is best to help, again, with the record keeping. And then, from there, if there are multiple locations, updating that list or helping your loved one update that list can be vital.
Melanie: If someone’s taking care of an aging parent, what are some of the signs they should look for that the parent might need assistance with their medication?
Dr. Kresl: It’s a great question. When I go into patient homes or see them in clinic, the first thing I ask the patient to do is to just get all your medicines in one spot. So, if you’re a loved one and trying to figure out, is my loved one doing it right or not, gathering all the medicines is a good idea. And, if they’re in multiple places in the home, that’s a warning sign that they’re not managing it well because having them in one spot just ensures that they’re more likely to do it on a regular basis. Many patients use pill boxes and so, oftentimes, when I meet with patients, I’ll just take a peek in the box. If there are lots of slots that are still full of medicine, it gives you some confidence that they’re not taking them as they should. The other thing is just simple things like looking for medicines on the floor. I have patients who sometimes have shaky hands due to an essential tremor or Parkinson’s disease, and the medicines won't actually physically get into their mouth. So, if you see a pill on the floor, that’s another sign that things may not be as they should. If your loved one doesn’t have regular patterns, meaning eating time, sleeping time, running errands, etc., oftentimes it can be harder for them to remember to take their medicine and so that can be another sign that you could look at or a clue. It can feel little bit like you’re a detective putting a story together. And then, the last thing is just looking at the bottle, and if the dates are old and the number of pills times the number of times a day they’re taking it, don’t add up, that’s another sign they’re not taking their medicines.
Melanie: Now, with so many people on pain medications and possible opioids, do you advise children of aging parents to count these number of pills because there is an OD problem in this country with elderly and taking these pain medications at the wrong times or too close together. What do you tell them?
Dr. Kresl: Oftentimes, I tell them, these can be habit forming. I think the media nowadays is doing a much better job of outlining the risks. I hear my patients talking a lot more about the risk and they’re worried about dependency but as it relates to small children, keeping them in a locked cabinet or facility that is under lock and key. I have patients who store controlled substances literally in a safe just because of their concern about other people in the home potentially getting access to them and abusing them or misusing them. Beyond that, I think really articulating appropriate use and inappropriate use, and then just being aware of what their risks actually are. For example, with opioid medicines or benzodiazepines--those are things like Ativan or Diazepam or Oxycodone or Hydrocodone--the big risks, the life-altering risk, is respiratory depression meaning they literally stop breathing from overuse of the medicine. And just kind of making it very clear again in layman’s terms what the risk is for overuse can, I think, make a big difference as to how they go forth and use them.
Melanie: Where’s the best place to store your medications?
Dr. Kresl: Wherever you’re going to remember them the most to take them. So, when I talk to patients about adherence, I give them very frank statistics about adherence rates. So, when you go into the peer review literature and look at adherence, oftentimes patients taking their medicines half the time is what you see. And so, just being very forthright with, most people don’t remember them about half the time. So, I always tell them a central location in the house is a good place, and a lot of it is around ritual and habit formation. So, for many people, the first place they stop in the morning is the kitchen, so I tend to prefer the kitchen as a place because most medicines are taken in the morning, that’s where the day begins, and that’s where you can, again, develop the habit of taking your medicines by having them in close physical proximity. The other benefit is that they’re going to be stored under room temperature. You don’t have to worry about them overheating in the bathroom where heat and humidity can become more of an issue.
Melanie: And just wrap it up for us, Dr. Kresl, if you would. What’s your best advice when it comes to managing your own or someone else’s medication? Give the best advice and tell people what you tell them every day about remembering to take these important medications?
Dr. Kresl: Really, the only advice I give them is around looking at their rituals or daily habits. Taking medicines is no different than any other habit that you develop, if it’s a good one, and understanding how you tick, understanding what you do on a daily basis, and then, fitting your medicines into that daily routine, I think, is really, when it comes down to it, the best advice I can give. And then, beyond that developing a strategy to help you remember such as a pill timer or an alarm, I think, could be a useful tool as well.
Melanie: Thank you so much for being with us. It’s really great and very important information. You’re listening to The WELLcast with Allina Health. For more information, you can go to www.allinahealth.org. That’s www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.