Among elderly, more medications = less compliance

FRANKLIN LAKES, N.J. —Juggling multiple obligations poses a challenge for most people, but that can be especially true when those obligations come in pill form.

Many elderly people in the United States are buckling under the weight of multiple medications, with about one-quarter of them taking between 10 and 19 pills each day, according to a report by pharmacy benefit manager Medco Health Solutions.

The Medco report, released at the end of December 2009, is the result of a national survey of more than 1,000 people ages 65 and older using medications, conducted by Kelton Research. Of those surveyed, 57% said they sometimes forgot to take medications, with missed doses increasing in tandem with the number of medications prescribed. Among those using five or more medications—which constituted 51% of respondents—63% said they forgot doses, compared with 51% of those taking fewer than five.

“It’s usually the patients who are in worse health who are taking large numbers of prescription drugs,” Medco Retiree Solutions VP and chief medical officer Woody Eisenberg said. “For those people, especially, taking their medications properly and regularly is critical. The problem is that the more medications prescribed, the harder it is for older people to manage them well and know essential information that can help prevent medication-related harm.”

Many seniors also worry about their ability to afford their medications, according to the report. Forty percent of those taking five or more medications a day cited affordability as a top concern, while side effects and drug interactions occupied the minds of 23% and 17%, respectively. Close to half of those enrolled in a Medicare Part D plan seek ways to delay or avoid falling into the “doughnut hole,” a coverage gap in which beneficiaries must cover the full cost of their medication. According to a Medco study in 2007, a large number of elderly patients using cholesterol medications stopped taking them in response to the doughnut hole.

But mail order may offer solutions to the adherence problem. According to a study by researchers from the University of California at Los Angeles and Kaiser Permanente’s Division of Research released earlier this month, patients with diabetes, high blood pressure and high cholesterol who received their medications by mail were more likely to take them as their physicians prescribed them than patients who obtained them at a local pharmacy. The 12-month study, which measured refill from between 2006 and 2007, found that 84.7% of patients who got their drugs by mail used them properly, compared with 76% of those who got them from retail pharmacies.