Polypharmacy, which is generally defined as taking more than 5 medications, is a growing trend as the world population ages. According to National Center for Health Statistics Data Brief No. 347, August 2019, about 1 in 5 American and Canadian adults took 5 or more prescription medications in the last 30 days with the percentage climbing to about 1 in 3 in the 60 – 79 year old age group. Polypharmacy is linked to poorer outcomes including poor medication adherence, falls, cognitive impairment and incontinence. In addition to quality-of-life issues and poorer health outcomes, the fiscal impact of polypharmacy cannot be ignored whether the cost is borne by the patient, the government or insurance carriers.
As an occupational therapist practicing in the home setting for many years, I saw firsthand the struggles patients faced when managing their medications. This was especially true after discharge from an acute care setting, when there had been a new diagnosis which changed their medication routine, or when the patient was taking a number of different medications.
As with all IADLs, occupational therapists start with a complete assessment of a patient’s impairments and functional limitations related to their ability to manage and adhere to their medication regime. This could include hand function – strength, ROM, sensation, pain and coordination; visual perceptual impairments, cognitive or psychological impairment and non-adherence.
After assessment, occupational therapists may recommend:
- Remediating underlying limitations including physical, sensory, behavioral, cognition and perception.
- Training in compensatory techniques (low vision techniques; step-by-step instructions; integrate task into existing routine).
- Training in the use of adaptive equipment, assistive devised and technology. (Automatic pill dispensers; electronic reminders; pill organizers).
- Suggesting environmental modifications (lighting; color coded bottles; large print labels).
- Instructing in activity modification (arranges for delivery; set up text or email reminders for refills).
- Exploring why the patient is non-adherent (assesses readiness for change; teach use of tools like SMART goals).
- Providing education on the information accompanying the medication.
- Providing caregiver education and training.
Since occupational therapists serve in a supportive role for medication management be sure to understand the protocols in place within your organization as you assist patients. OT never prescribes medication, recommends a medication, fills pill boxes or administers medications.
As an IADL, medication management is an area where occupational therapists can provide important supports. Working on this IADL with patients can increase their medication compliance and help them realize the full benefit of their prescriptions. Increasing their health literacy and understanding of their medications can support the patient’s discussions with their physicians, pharmacists and others on the healthcare team.