Medication Mishaps in Elderly

I regularly see a range of common issues affecting my elderly patients in their daily lives. These challenges can significantly impact their quality of life and can even pose a difficult challenge in their treatment. I felt it was important to share these stories to raise awareness and highlight common issues and how addressing them can lead to remarkable improvements.

Story 1. Managing Medication Errors

I received a call at around midnight from one of my patients. She said she thought she had administered insulin twice but couldn’t completely remember. In this scenario, if you are sure or even unsure you did insulin twice by mistake, you need to monitor your sugar levels every 1-2 hours and take white sugar dissolved in some water. Do not hesitate to take sugar, as hypoglycemia (low blood sugar) is far more dangerous than a temporary increase in blood sugar. If you feel your blood sugar is not increasing despite taking sugar, seek medical attention immediately.

Learnings:

1. Besides diabetes medicines, seniors should keep glucose tablets or even glucose powder handy.
2. Use of insulin pens with dose counters can help track the number of doses administered, reducing the risk of double dosing.
3. Implement medication management systems such as pill organizers that clearly separate doses by time and day.
4. Utilize mobile apps designed to remind and track medication administration.
5. Keep a written log or diary to record the time and amount of insulin administered and other medicines taken.
6. Involve family members or caregivers in medication management to provide additional oversight and reminders.
7. Regularly educate and train patients on the correct administration of insulin and the importance of tracking their doses.
8. Schedule regular check-ins with your doctor to review and manage their medication regimen.
9. Use visual aids such as charts or calendars placed in a visible location to remind patients of their medication schedule.
10. Whenever possible, simplify medication regimens to reduce the number of doses and complexity.
11. Develop an emergency plan that includes steps to take if a dosing mistake occurs, including emergency contacts and procedures.

Outcome: The patient was provided teleconsultation throughout the night and advised a sugary diet intermittently and monitoring of sugar until the morning. This helped in stabilizing the patient at home.

Story 2. Unexpected increase in blood sugar

Just yesterday, my patient called me in a state of anxiety, reporting that he had checked his wife’s blood sugar, and it was around 400 in the evening and she had no symptoms of hyperglycemia. I immediately went for a home visit. Upon arrival, I discovered that despite taking all prescribed medicines, her sugar levels were increasing. We intervened and stabilized the patient. This is not a rare phenomenon in seniors; sometimes, despite taking all medicines and insulin, blood sugar levels can still rise.

Some common reasons:

Medication: Some medications, like steroids and decongestants, can raise blood sugar. Some medicines not related to diabetes can also contribute to hyperglycemia.

Missed doses: Skipping doses or not taking enough medication can lead to hyperglycemia.

Incorrect doses: Taking the wrong dose of medication can cause hyperglycemia.

Injection issues: If you use insulin, issues with the injection site or technique can cause high blood sugar. Insulin that is out of date or too warm won’t be effective and can also cause high blood sugar.

Other factors that can contribute to hyperglycemia include:

Stress

• Caffeine
• Eating too much
• Lack of exercise
• Dehydration
• Illness/Infection
• Changes in diet or environment

Symptoms of hyperglycemia:

Watch for symptoms like excessive thirst, frequent urination, fatigue, or blurred vision. Seek medical help if symptoms are severe or worsening. In seniors hyperglycemia may not be associated with typical symptoms.

Learning

The most important learning from this story is that while dealing with such cases, individuals should be careful and seek medical help promptly. However, it’s crucial not to panic, as panic and anxiety can worsen hyperglycemia and complicate the situation.

Outcome: Patient was stablised at home through home based care. Also there are many health related issues that can be taken care of through Home Based Care for seniors.

Story 3. Painkillers Replace BP Medication

Few days ago, my patient came to OPD before her scheduled follow-up appointment because her blood pressure remained high despite taking her medications. She was feeling anxious, weak, and had a constant headache, along with stomach problems, nausea, and acidity. It was before noon, and when I checked her blood pressure, it was 180/110. She mentioned she had taken her BP medication just 2 hours earlier. I was surprised, as this should have reduced her blood pressure.

By chance, I always instruct my patients to bring their medications physically to ensure they are taking the correct ones. I asked her to show me her medicines, and to my astonishment, the medication she had been taking for her blood pressure was actually a painkiller used for certain types of headaches. She had been using this medication for the past 20 days, believing it was for her blood pressure.

Upon further investigation, her husband revealed that during his last visit to the chemist to buy her monthly medicines, he had taken an empty blister pack. One blister’s name was not visible, and he mistakenly thought the color matched, so he continued giving her the wrong medication every morning, assuming it was for BP. As a result, she had been taking incorrect medications for about 20 days, and the painkiller had also caused stomach issues, contributing to her anxiety.

Learnings

Patient Education: Educate patients and their caregivers about their medications, including their names, purposes, and potential side effects.

Medication Reconciliation: Perform medication reconciliation at each visit with your doctor to verify that you are using the correct medications as prescribed.

Visual Identification: Encourage patients to use pill organizers with clear labeling or visual aids to distinguish different medications.

Family and Caregiver Involvement: Involve family members or caregivers in managing medications, especially for elderly patients who may have difficulty keeping track of their prescriptions.

At Pharmacy: Always take prescription to the chemist and look for expiry date.

Outcome: Patient was told to take appropriate medicine, and while I am writing this, I called her to know about her health status and Alhamdulillah, she is fine now with her BP of 137/85.