Falls in Older Adults: An Untold Toll of Medication Nonadherence

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Older adults take prescribed medications more than any other age group in the United States. Researchers estimate that 25% of people ages 65 to 69 take at least five prescriptions to treat chronic conditions. That figure jumps to nearly 46% for those between 70 and 79.

The importance of taking these medicines correctly cannot be overstated, as a staggering 50% of medications for chronic disease are not taken as prescribed.  This lack of adherence contributes to over $500 billion in avoidable healthcare costs and more than 125,000 potentially preventable deaths each year.

But there’s another concerning impact of medication nonadherence among older adults – one that is often overlooked and underestimated in terms of impact. Research shows that when older adults do not take their prescriptions as directed, they also increase their chances of falling.

A Common and Costly Challenge

Every second of every day, an older adult (age 65+) suffers a fall in the U.S. – making falls the leading cause of injury and injury death in this age group. Falls can also lead to head injuries, broken bones, and other serious issues. About 3 million older adults visit emergency departments for a fall injury each year.

Health conditions like Parkinson’s disease, Alzheimer’s disease, and arthritis that affect balance, physical strength, joint integrity, and/or cognitive function contribute to falls among older adults. But additional leading causes are medication errors and side effects. Recent research has shown that fall risk increases by 21 percent in older adults taking five or more medications; this increases to 50 percent in patients taking 10 or more medications. Medication errors and certain types of medications contribute to these high fall rates. For example, certain drugs (e.g., sedatives and anti-depressants) reduce mental alertness, affect balance and gait, and cause drops in systolic blood pressure while standing.

‘An Ounce of Prevention…’

While falls are common, they can be prevented. Providing enhanced medication management support and regular medication reviews are crucial to decrease the likelihood of older adults experiencing falls and reduce the risk of medication-related hospitalizations. With most seniors taking multiple medications throughout the day, it can be easy for mix-ups to happen. Older adults with chronic conditions often see numerous physicians and go to different pharmacies to fill their prescriptions. They also tend to keep their pills in bottles placed in various locations around the home, significantly increasing the chance for medication nonadherence and adverse health outcomes.

The problem is even more acute during care transitions – when seniors transfer from one setting to another. All too often, errors while transitioning a patient from one care setting (e.g., a hospital, nursing facility, primary care physician, long-term care, home health care, specialist care) to another often lead to confusion about treatment plans, missed follow-up appointments, patient dissatisfaction, medication nonadherence, and, most importantly, unnecessary readmissions.

Transitions of care have become a primary focus for improving health care quality and patient experience and reducing hospital readmissions. This year, CMS has introduced a new Star Ratings measure, Transitions of Care (TRC), to promote better care coordination across the field. This requires Medicare Advantage plans to take a more significant role in preventing readmissions. With billions of dollars in quality bonuses at stake, high-performing health plans simply cannot afford to ignore medication adherence in the upcoming year, particularly for senior polypharmacy patients who are at the most significant risk of falling.

Boosting Plan Performance

This year, the path to Star Ratings success looks a little different than it has in the past. Medicare Advantage plans must contend with an ongoing pandemic (without the relaxed rules of the prior performance year) and simultaneously meet ambitious new goals around medication adherence and member satisfaction. The Star Ratings are heavily skewed toward these areas. Thanks to triple-weighted adherence measures, more than half of a health plan’s Star Ratings score depends on high performance in the realm of medication management. The Consumer Assessment of Healthcare Providers and Systems® (CAHPS®) survey also plays an outsized role in health plan results: member experiences, as gauged by the survey, comprising nearly a third of the overall Star Ratings score.

Medicare Advantage plans can start by embracing technologies to identify high-risk individuals at the beginning of the measurement period. Once health plans have developed a high-priority outreach list, they must efficiently and effectively connect with their at-risk members. These activities must be rooted in the pharmacy, where qualified clinical professionals can deliver education, answer questions about specific medications, and coach members toward improved adherence rates.

A Holistic, Ongoing Approach

High-risk patients with medication adherence issues need multiple touchpoints throughout the year to ensure that they continue taking their medications as prescribed. Plans should establish a regular cadence of outreach with higher-risk individuals based on their specific situation and support needs.

However, most health plans do not have the in-house pharmacy teams to make this happen at the necessary scope and scale, so establishing strong partnerships with digital telepharmacy experts can significantly boost capacity. Outsourcing the effort ensures that plans have access to highly trained pharmacy professionals with the technology and experience to enact measurable, sustainable change among target populations.

AdhereHealth’s digital telepharmacy team leverages various strategies to identify and address complex challenges that lead to medication nonadherence or potential drug safety problems, such as medication synchronization (med sync), which enables patients to refill medications at a single pharmacy on the same day each month.

By investing in pharmacy-led outreach and member engagement, Medicare Advantage plans can hit more of their Star Ratings goals with less effort. Focusing on medication adherence can lead to better clinical outcomes, improved self-management for members, and higher scores for health plans on the measures that count the most. The result is satisfaction on both sides of the member-health plan relationship – and the opportunity for health plans to continue providing exceptional benefits to their members.