Challenges and Practical Solutions
Current Research on Medication Use in Older Adults
As people age, managing medications becomes increasingly complex. Recent studies show that polypharmacy, typically defined as taking five or more medications, is very common among older adults. Large U.S. and international research estimates that between one-third and more than half of adults age 65 and older take at least five prescription medications, often to manage multiple chronic conditions.
Medication safety is also a significant concern. Research consistently finds that medication-related errors are common among older adults, though exact estimates vary. These errors can include missed doses, taking medications at the wrong time, or difficulty understanding instructions. Contributing factors often include complex regimens, multiple prescribers, and the physical or cognitive changes that accompany aging.
Together, these trends highlight the need for practical, easy-to-use systems that simplify organizing, preparing, and taking medications. Especially for individuals with physical, visual, or cognitive challenges.
Common Challenges
Older adults may struggle with medication tasks for a variety of reasons:
- Physical limitations such as arthritis or reduced hand strength
- Visual impairments that make labels difficult to read
- Cognitive changes that affect memory, sequencing, and organization
Understanding these barriers helps determine which tools and supports will be most effective.
PREPARATION: Setting Up a Safe Medication System
1. Create a Comprehensive Medication List
Preparation begins with organizing information clearly so it can be easily shared and accessed. A complete, up-to-date list is the foundation of good medication management. Include:
- Medication name
- Dose or “strength”
- Route of administration (oral, topical, injection, etc.)
- Directions (frequency, time of day)
- Start date
- Purpose of the medication
- Prescriber’s name
Update this list at every doctor visit or any time medications change. Keep a current copy somewhere easy to find, such as posted on the refrigerator, so it’s accessible to caregivers and first responders in an emergency.
Tip: With the widespread use of digital medical records, this list can often be printed directly from your patient portal. Keep a printed copy with your medications and give a copy to a trusted family member or caregiver.
2. Set Up Automatic Refills and Home Delivery
Most pharmacies offer automatic refill programs that prevent missed doses due to lapsed prescriptions. Home delivery services can reduce trips to the pharmacy and ensure timely access to medications.
3. Decide Who Will Manage Medications
Some individuals may benefit from support beyond simple reminders. A team approach often works best, especially as needs change. Consider who can reliably take on each role:
- A family member can fill a weekly or monthly pill organizer and help monitor for missed doses or changes.
- In some cases, a pharmacist-led in-home medication management service may be appropriate.
Having family members or trusted supporters involved helps create consistency, reduces errors, and ensures that any concerns are noticed and addressed early.
4. Consider Pre-Sorted Medication Packaging
Some pharmacies offer pre-sorted medication packets labeled with the exact date and time each dose should be taken. This can greatly simplify complex regimens and reduce the risk of errors, especially for individuals managing multiple prescriptions. This type of service can be an excellent option for those who benefit from clear, ready-to-use packaging.
ADMINISTRATION: Daily Strategies for Taking Medications Safely
1. Clearly Label Medication Bottles
Clear labeling helps prevent confusion and reduces the risk of errors. Consider the following strategies:
- Create large, easy-to-read labels or have the pharmacy print large-font labels for easier reading
- Write the first letter of each medication in bold marker on the lid
- Use color-coded tape or rubber bands (for example: yellow for morning, blue for bedtime)
- Use a labeled pill caddy for bottles to separate morning and evening medications
- Ensure good task lighting in the area where medications are stored and taken
- Keep a magnifying glass or a pill-vial magnifier and keep it with the medications
These simple modifications make it easier to distinguish medications, especially for individuals with low vision or memory challenges.
2. Establish a Routine
Consistency is one of the best safeguards against medication errors. Set routine times not only for taking medications but also for refilling pill organizers. Try “habit pairing;” linking medication with an existing daily activity, such as brushing your teeth, eating meals, or any other reliable habit. Connecting medications to something already done every day makes the routine easier to remember and more automatic.
You can also place medications where the routine naturally occurs. For example, keep the pill bottles you take with meals on the kitchen table, and place nighttime medications on the nightstand or where you keep your toothbrush. These location cues support consistency and reduce the likelihood of missed doses.
3. Set Reminders That Actually Work
While high-tech options exist, they’re not always ideal for older adults. This is a population that did not grow up with technology and has varying degrees of comfort with using technology.
As Speech-Language Pathologist Lisa Levine Sporer notes, simpler is often more effective.
Practical reminder ideas:
- Phone alarms with a dedicated medication tone
- A picture book that visually displays which pills to take at specific times. This can be made simply with a binder divided into morning and evening sections including photos and descriptions of each medication
- Pill organizers paired with visual guides to improve accuracy
These strategies work especially well for cognitively impaired individuals who may become overwhelmed by new technology.
Important consideration: If someone requires an automatic medication dispenser to remain safe, it may be time to evaluate whether living alone is still appropriate. This can be a difficult but important safety consideration.
See our prior blogs, Senior Living Options: In-Home Care vs. Assisted Living and Having the Talk About Assisted Living, for a deeper look at this issue.
4. Medication reminder apps
For those comfortable with technology, reminder apps can provide visual or digital cues to stay on schedule. GoodRx offers a review of currently available medication reminder apps. These apps work best for individuals who are familiar with smartphones and can follow digital notifications.
Caution: Reminder apps should not replace supervision for individuals with significant memory challenges.
5. Automated “Smart” medication delivery systems
One of the most frequently cited devices is the Hero medication dispenser. Caregivers load the dispenser with medications and set the schedule; the machine then handles the rest. At each dose time, Hero sounds an alarm, and the older adult simply presses a button to dispense the correct pills into a cup.
Hero also includes a companion app that allows family caregivers to monitor adherence. If a dose is missed, the app sends an alert so a designated caregiver can follow up promptly. These devices can be especially helpful but may involve subscription fees, so cost and long-term use should be considered.
OTHER HELPFUL DEVICES
A few simple tools can make preparing and taking medications much easier and safer:
- Easy-grip bottle openers: Help individuals with arthritis or reduced hand strength open tightly sealed prescription bottles. An example is the Jokari Easy Open Medicine Bottle Opener with built in magnifying glass.
- Blister-pack “extraction” tools: Make it easier to push pills out of bubble packs without straining fingers.
- Pill splitters: Provide a safer, more accurate way to cut tablets when a partial dose is prescribed.
- Pill crushers: Useful for those who have difficulty swallowing pills and need medications in crushed form (only when approved by a prescriber or pharmacist).
Safety reminder: Always check with a pharmacist before crushing or splitting pills, as some medications must not be altered.
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Joanne Bedwell, PT, is the Resident Blogger at Be Active Be Well. Based in San Francisco, she lives with her husband and two nearly grown daughters. With over 25 years of experience as a physical therapist, she provides in-home client care and teaches fitness classes both in person and online.
DISCLAIMER: This article contains information that is intended to help the readers be better informed regarding health care issues. It is presented as general advice on health care and is not intended to be a substitute for the medical advice of a licensed physician. The reader should consult with their doctor in any matters relating to his/her health.
