Protecting the Elderly with Medication Reconciliation

April 20, 2021

Colin Banas, M.D., M.H.A.

Protecting the Elderly with Medication Reconciliation

As we age, most people begin to have anything from mild aches and pains to serious chronic disorders. Many seniors over 65 manage multiple conditions with over-the-counter and prescription medications. The elderly population makes up just 14% of the U.S. population but use 40% of all prescription drugs. Those who are 65 to 69 fill an average of 14 prescriptions per year and adults 80 to 84 years old average 18 prescriptions per year.

The numbers are striking not only in volume but also because taking multiple medications at the same time can increase the risk of adverse drug events (ADEs). In fact, this risk jumps from 13% for someone taking two medicines to 58% for a patient taking five and 82% when taking seven or more.

The Elderly Are More Susceptible to ADEs

It can be especially difficult for seniors to remember the names and dosages of their medications, especially if they aren’t with their caretakers, don’t prepare a list, or forget to bring all their bottles with them to routine doctor visits or emergency trips to the hospital. This information is essential to patient safety and medication reconciliation. Clinicians need accurate home medication history information to avoid overdoses, medication errors, and ADEs. This process is so critical to patient safety, it is recommended every time a patient visits a doctor or is admitted, transferred, or discharged from a healthcare facility, and is a National Patient Safety Goal of The Joint Commission, the organization that accredits hospitals in the U.S.

Knowing what medications elderly patients are taking is crucial because aging changes how medications are handled by the body. This includes changes in the classic ADME processes—absorption, distribution, metabolism, and excretion (clearance)—which can prolong the half-life of drugs, increase the potential for drug toxicity, and increase the likelihood of ADEs. Age-related changes in organ mass and blood circulation also play a role. A 25% to 35% reduction in liver size and a 40% decrease in the liver’s blood flow are common in healthy aging patients, resulting in reduced drug clearance that can alter the efficacy of prescription drugs.

Preventing Drug Reactions

When providers have access to a more complete, current, and accurate picture of what medications patients are taking, there is a greater likelihood of avoiding ADEs. An electronic medication management system like MedHx by DrFirst provides the most robust and consumable medication history from local and national data sources so clinicians can make informed prescribing decisions.

Some drug interactions can be serious but not commonly seen, and so may not be readily recognized by prescribers. In these cases, an e-prescribing solution that includes medication history can deliver automatic drug-to-drug interaction and allergy alerts that support providers’ clinical decision-making.

In addition to support from software solutions, dedicated med rec staff also can help reduce the risk of ADEs. The American Society of Health-System Pharmacists (ASHP) advocates for hiring Discharge Pharmacy Technicians dedicated solely to this process when patients leave the hospital. Using this approach, MultiCare Health System saw a $2.3 million return on investment over a 31-month period by improving home medication list review rates from 65% to 100%. The staff education associated with the program also improved med rec at other points of transition, with a significant impact on patient outcomes. The rate of med rec by admitting physicians conducted within 24 hours of admission improved from 30.5% to 88%, the rate of ADEs decreased by more than 25%, and medication harm events dropped by almost 50%.

In addition to ASHP’s advocacy, other industry initiatives include the Agency for Healthcare Research and Quality’s (AHRQ) Medications at Transitions and Clinical Handoffs (MATCH) toolkit and the Society of Hospital Medicine’s MARQUIS Med Rec Collaborative.

Making the Elderly a Priority

Elderly patients are often the most at risk for poor outcomes. By improving medication reconciliation for the riskiest patients, hospitals can improve quality of care and avoid reactions that can lead to readmissions.

About Colin Banas, M.D., M.H.A.
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Colin Banas, M.D., M.H.A. is Chief Medical Officer of DrFirst, and former Internal Medicine Hospitalist and former Chief Medical Information Officer for VCU Health System in Richmond, Virginia.