Medication Reconciliation for Seniors and Fall Risk

Dear reader,

 Medication reconciliation for seniors is a plain process: get every medicine written on one list, have a pharmacist go over it, and ask each prescriber direct questions about dizziness, drowsiness and balance. It takes an afternoon to start. It can matter a great deal for staying on your feet. If you take several medicines, or help someone who does, this post is for you.

My post on the role of medications in fall risk covers which kinds of medicines are linked to falls. This one covers what to do about it, step by step.

What Medication Reconciliation Means, in Plain Words

Medication reconciliation means comparing what you actually take with what your doctors and pharmacy think you take, then fixing any differences. That is the whole idea.

The word “reconciliation” sounds formal. In practice it is three jobs:

• Write down everything you take, in one place.
• Have a pharmacist look at the whole list together.
• Ask your prescribers specific questions about side effects that affect balance.

You do not need medical training for any of this. You need your bottles, a pen, and a little time. The decisions about changing a medicine belong to your doctor, and I will come back to that.

Why a Messy Pill List Can Lead to a Fall

Most older adults do not get all their medicines from one person. A heart doctor prescribes one thing, a family doctor another, a specialist a third. A hospital stay adds more. Each prescriber sees their own part of the picture, and nobody sees all of it unless you bring it.

The mess builds up in ordinary ways:

• Two pharmacies each hold part of the record.
• An old bottle stays in the cabinet after a dose changed.
• Someone takes a store-bought sleep aid or allergy tablet and never mentions it.
• A supplement goes unlisted because it “isn’t a medicine.”
• Two prescribers each start something without knowing about the other.

Dizziness, drowsiness and unsteadiness are listed side effects of many medicines. Whether they apply to you, and whether your combination of medicines makes them more likely, is a question for your doctor or pharmacist. They can only answer it if they can see everything you take.

I will be blunt about one thing. I would rather you feel a little silly carrying a bag of bottles into a pharmacy than leave one off the list. The odd-looking item is often the one worth asking about.

Build Your Master List: Pills, Patches, Creams, Drops and Supplements

The master list is one page that holds every product you put in or on your body. Build it from the actual containers, not from memory. Memory skips things.

Gather everything from the kitchen, the bathroom, the bedside table, the purse, the coat pocket and the refrigerator. Then include all of these:

• Prescription pills and capsules
• Patches
• Creams and ointments
• Eye drops, ear drops and nasal sprays
• Inhalers
• Injections
• Over-the-counter pain relievers, sleep aids, cold and allergy products
• Vitamins, herbal products and other supplements

For each item, write down:

1. The name on the label (brand and generic name, if both are shown)
2. The dose, such as the strength printed on the bottle
3. How often and at what time of day it is taken
4. What it is for, if you know
5. Who prescribed it
6. The pharmacy that fills it
7. The date it started, if you know it

Mark the “as needed” medicines clearly and note how often you really use them. Also write your allergies and any past bad reactions at the top.

If you are a caregiver, sit down with your parent or spouse to do this together. Ask them how they actually take each item, because that can differ from the label. Write down what they tell you, not what you assume.

Keep the list on paper where it can be found, such as the refrigerator door or a wallet card. Take a photo of it on your phone as well. If an ambulance crew ever needs it, nobody should be guessing.

The Brown Bag Review: Bringing Everything to Your Pharmacist

A brown bag review is exactly what it sounds like. You put every bottle, box, tube, patch and supplement into one bag and take the bag to a pharmacist.

Call the pharmacy first. Ask whether they offer a medication review, how long it takes, and whether you need an appointment. Services differ from place to place. Book a time when the pharmacy is not rushed, not the Friday afternoon rush.

Bring:

• The bag with every product in it, including the pill organizer
• Your master list
• A list of any other pharmacies you use
• Your questions, written down

Pharmacists are trained in how medicines work and how they combine. Ask yours to go through the bag and compare it with the list and with their own records. Ask what looks unclear, duplicated, out of date or worth raising with a prescriber.

Write down what the pharmacist says. Then update the master list the same day, while it is fresh. If the pharmacist suggests something to discuss with a doctor, put it on a question list for the next appointment.

Questions to Ask About Dizziness, Drowsiness and Balance

Generic questions get generic answers. Specific questions get useful ones. Take these to each prescriber, and to the pharmacist as well:

• Can any medicine on my list cause dizziness, drowsiness or unsteadiness?
• Could two of my medicines together make those effects stronger?
• Does the time of day I take this matter? Would a different time be safer?
• Do I still need every one of these, and is the dose still right for me?
• Is there another option that is less likely to affect my balance?
• Should I do anything differently when I stand up, such as wait before walking?
• What should I watch for in the first days after a new medicine or a dose change?
• Who should I call if I feel dizzy or fall?

Before the appointment, keep a short symptom note for a week. Write the date and time, what you took and when, and what you felt: dizzy on standing, foggy in the morning, wobbly in the afternoon. A note like that gives the doctor facts to work with. “I feel off sometimes” does not.

If dizziness is a regular problem, my post on managing dizziness at home as a senior has practical steps for the house. Those steps sit alongside the medicine conversation, not in place of it.

Never Stop a Pill on Your Own: How to Ask for Changes Safely

Do not stop, skip, halve or change the timing of any medicine without talking to your doctor or pharmacist first. This applies even when you are sure a pill is causing the dizziness.

Stopping some medicines suddenly can cause problems of its own. Your doctor or pharmacist can tell you which ones, and what to do instead. You cannot tell that from the bottle.

If you suspect a medicine is making you unsteady, say so directly. Here are sentences you can use word for word:

• “I have felt dizzy since I started this. Could it be the medicine?”
• “I am worried about falling. Can we review everything I take?”
• “Is there a lower dose, a different time of day, or another option?”
• “What should I do in the meantime?”

Ask the prescriber to put any change in writing, and ask the pharmacy to update their record. If the prescriber says to keep taking it, ask what they want you to watch for, and write that down too.

Caregivers carry a heavy part of this. You may be the one who notices the unsteadiness first. Report what you see to the doctor or pharmacist, and let them decide. Hiding a pill or changing the dose quietly can leave the next prescriber working from wrong information.

Tell your doctor about every fall, even a small one with no injury. A fall is information about the whole picture, medicines included.

Keep the List Current After Every Appointment and Hospital Stay

A master list that is three months old is a risk of its own. It gives false confidence. Update it on the day anything changes.

Make these moments automatic triggers:

• After every doctor visit, including specialists
• Whenever a new prescription is started, changed or stopped
• After any hospital stay or emergency visit
• When you buy a new supplement or over-the-counter product
• When a pharmacy changes the brand of a medicine you take

After a hospital stay, ask for the discharge medication list. Compare it line by line with your master list. Ask what was started, what was stopped and what was changed, and ask who is in charge of each from here on. Hospital stays are where lists most often go out of date.

When a medicine is stopped, remove the old bottles from the house so they are not taken by mistake. Ask your pharmacy how to dispose of them safely.

Pick a regular date to check the whole list again, and put it on the calendar. Show the updated list at every appointment, and hand a copy to a family member or caregiver who could be called in an emergency.

Your Next Step

Print or write out your master medication list today, then book a medication review with your pharmacist or doctor this week. Bring the bag, bring the list, and ask the questions above.

Yours in staying steady, Your fall prevention guide.

Thank you for reading.

Drop a comment about when you plan to have a medication review in the box below.

Your friend,

Maxine 🙂

royalpalmprotection.com