Older People and Heart Disease

Always Manage Your Medicines

Medications are often a big challenge for older patients, especially in terms of finding the right doses. It’s good to start with a low dose of a medication and increase based on need and how well it’s tolerated because most side effects are related to dosing.

Age changes the makeup of your body and how it processes medicine, so some medications stay around longer in older adults. This difference also increases the risks of side effects at doses used in younger patients. If you have new symptoms after starting a medication, tell your doctor.

Health Tip: Bring your medicine bottles to your health visits.

The containers often give information not included in electronic lists from the pharmacy. Reviewing the medicine you take at every health visit can help identify repeated medications and clear up confusion.

About 4 out of 10 older patients may be taking five or more medications. It is common for them to be on many more. “Polypharmacy” refers to the use of multiple medications, including those you can get over the counter without a prescription. You should be active in your care, especially if you are on many medications from different providers.

Discuss medications you are taking with your health care team, including nurses, pharmacists and physicians. Ask for ways to simplify them. Stopping therapy, or “de-prescribing,” should be considered to reduce the medication burden if possible.

Here are some questions to ask about each medication you take:

  • Is it likely to treat my symptoms and make me feel better?
  • Is it likely to reduce the risk of future illness?
  • Is it likely to cause side effects?

Getting Help

Although many of us would prefer to care for ourselves until the day we die, the reality is that most of us will need support to maintain our safety and quality of life in later years.

A support network is very important in later years when declines in function, movement and thought make daily life difficult. You may find it hard to drive or get medications refilled. If you are able to live alone, a call button to summon people in your care circle is very important for those times when you can’t reach a phone.

Often, the shift to needing help is unexpected and sudden. That makes it very important to plan early on for help with appointments, medications, diet, and transportation.

Other changes are gradual and may go unnoticed by family and friends. Denial by loved ones in regard to someone’s need for help or concern by the older adult about being a burden often compounds the situation. Some signs that more help is needed include:

  • Decreased judgment related to simple daily tasks (leaving stove turned on or doors unlocked).
  • Mishandling finances or not paying bills.
  • Making mistakes with medication or using the wrong dose.
  • Becoming more easily moody, angry, suspicious or paranoid.
  • Changes in grooming, such as stains on clothes and infrequent bathing.
  • Reluctant to spend time with others or not wanting to do so.
  • Sadness that lasts and results in loss of interest in normal activities.
  • Increased confusion, such as missed doctor appointments or skipping family events.
  • Changes in eating habits and less interest in nutritious meals.
  • Difficulty walking, unsteadiness or frequent falls.

All transitions are challenging, so understanding the changes and preparing for them can make the difference between a smooth or a rocky course. Key conversations with family and neighbors about how you want future help should be as normal as talking about other life events like getting married, having children, or retiring. These talks need to begin when memory is failing, mobility is limited, or vision is impaired, but ideally they should happen well before that.

Caregiving may be provided by an informal network of family or neighbors, hired professionals, or both. Caregiving is hard work. Support, particularly for informal caregivers, is part of caring for the older adult. Often informal caregivers are also older, which poses concerns for the health and well-being of both caregiver and recipient.

People who take part in caregiving can turn to many resources for support. The CARE Act (Caregiver Advise, Record, Enable Act) has been passed in many states. This important legislation requires hospitals to identify and record the name of the caregiver and include that individual in discharge planning. This helps the caregiver during the key transition from hospital to home.

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