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Older adults are often responsible for managing their prescription and non-prescription medications at home. This practice is called medication self-management. Failing to correctly manage a prescribed medication regimen can have severe consequences including longer stays in hospitals, use of more hospital services, and an increase in the cost of health care (Peterson & Dragon, 1998). Nurses play an important role in teaching older adults about medication self-management. The purpose of this article is to provide nurses, frontline providers of health care, with information needed to teach older adults in a variety of settings how to self-medicate safely.
Individuals 65 and older consume four times more health care products and services than other age groups (Bottomley, 2001). Older adults are responsible for 30% of the 1.5 billion prescriptions written annually, averaging 13 to 15 per older adult, and 40% to 50% of the over-the-counter (OTC) medications purchased each year (Beizer, 1994; Stuck et al., 1994). Those residing at home take fewer medications than those living in nursing facilities, but average two prescriptions and one or two non-prescription medications (Simonson, 1994). These are important statistics because positive correlations have been found between the number of prescribed medications and the number of inappropriate medications, wrong doses, and potential drug interactions (Beers, Baran, & Frenia,2001; Gallagher, 2001;Willcox, Himmelstein, & Woolhandler, 1994).
MEDICATION MISMANAGEMENT
The concept of medication mismanagement refers to errors older adults make in planning for and taking their own prescription medications. Medication mismanagement is correlated with increased adverse effects, drug interactions, emergency department visits, and hospital admissions (Prince, Goetz, Rìhn, & Olsky, 1992). Older adults are two to seven times more likely to experience an adverse drug reaction (ADR) than younger adults (Higbee, 1994). Approximately one-third of older adult hospital admissions and almost one-half of nursing home admissions are associated with prescription medication-related problems (Cooper, 1994). For example, ADRs are a major risk factor for falls in older adults (Miller, 2002). Ninety percent of all hip fractures are caused by falls (Nelson, 2000; Smith, 2001). Hip fractures are often a life-threatening event (Curry & Hogstel, 2002), especially if the older person has other medical problems, such as pulmonary or cardiovascular disease.
Nature of Medication Mismanagement
When self-medication practices of older adults are monitored within the home, many...