Cholesterol Treatment in the Elderly

By Jude Roberts

 

The risks associated with high cholesterol have been well-documented, yet compliance with treatment schedules is still low. In fact, more than 50 percent of Americans have high cholesterol, yet only one in five people are actively treating it through diet, exercise or even medication. Among the elderly, treatment compliance is low, even though the benefits of these methods are widely known.

High cholesterol is one of the main contributors to cardiovascular disease. Strokes and heart attacks are common outcomes of this disease, although lowered heart function can also result. The World Health Organization approximates that 20 percent of strokes and 50 percent of heart attacks are attributed to high cholesterol. There are three types of cholesterol or fat in the bloodstream, some of it benefiting the body while others can be dangerous if they are too high.

  • LDL – also known as “bad” cholesterol since it clogs arteries. Levels about 70 mg/dl should be avoided and if the level is higher, it should be actively treated.

  • HDL – also known as “good” cholesterol and can help the body by attaching to the bad cholesterol, pushing it to the liver where it can be filtered out of the body. Levels of HDL cholesterol should be 60 mg/dl or higher.

  • Triglycerides – While it is not a form of cholesterol, it is also a form of fat that should be kept to levels below 150 mg/dl. It can also clog arteries and cause significant damage to the cardiovascular system.

The goal is to lower bad cholesterol, but also to maintain high enough levels of good cholesterol at the same time. For many people, a combination of a healthy diet, increased exercise, and weight loss can lower cholesterol. For those who are not able to achieve a healthy good/bad cholesterol ratio through these methods, medication can be warranted.

Coronary Heart Disease: Another Reason to Focus on Cholesterol Levels

Coronary Heart Disease (CHD) is the leading cause of death among individuals age 65 and older, contributing to death in more than 84 percent of cases (American Family Physicians, 2005). Even though a healthy diet and exercise are helpful, many patients with a diagnosis of CHD will need medication to help lower bad cholesterol and increase the level of good cholesterol.
One of the concerns among physicians, however, is the low compliance rate in the elderly population who are taking cholesterol medication. It is important that not only should the patient understand his or her treatment plan, but caregivers who assist the patient should understand the plan as well.

Caregivers Can Help with Medication Compliance

Despite the type of medications prescribed, it is important to take them as directed by the physician. Some studies note that medications that are prescribed to treat symptom-less conditions, like high cholesterol, are less likely to be taken as directed. Patients, and some caregivers, mistakenly think that because there are no symptoms to a condition, the effect of taking the medications is somehow diminished. In fact, ignoring or treating these conditions irregularly can prove devastating in the long run.

Some of the reasons why medication is not taken as it is prescribed include:

  • Financial difficulties, filling the medications or trying to  save money for other reasons

  • Lack of understanding about how the medication works

  • Side effects of the medication, actual or perceived, and  fear of side effects

  • Being overwhelmed by the number of medications  currently prescribed

  • Symptoms disappeared

  • Difficulty taking (swallowing, etc.) or opening the medication

  • Not remembering to take the medication

If the problem appears to be memory-related, try simple solutions like establishing daily routines around taking medication, using medication reminders, or subscribing to a reminder alert system. For instance, some alerts are available now by email or through companies that work through contracts to call patients when it is time to take their medication. Pharmacies can also help package medications in easy-to-remember single doses so that it is easier to remember which ones to take.

If the medication is difficult to swallow, caregivers can talk to the doctor to find out if the medication can be prescribed in liquid form or if the tablets can be cut or crushed. Some medications cannot be crushed or cut, so it is important to ask before trying this method. If the medication cannot be made available in a liquid form, cut or crushed, perhaps the doctor can prescribe an alternative medication that provides the same benefit.

Financial issues can often be overcome through several methods. For Medicare beneficiaries, double-check the types of plans offered during open enrollment (November 15 – December 31st). Some medications may be covered through one plan and not another. A benefits counselor, usually available through the local Area Agency on Aging, can help decide which plans may provide more coverage. Due to high demand, it helps to schedule an appointment with the benefits counselor before open enrollment begins. For those who are not eligible for Medicare, pharmaceutical companies offer prescription assistance programs with purchasing some medications. A few programs that can provide assistance locating the right plan or program include www.needymeds.com and the Partnership for Prescription Assistance (www.pparx.org) or by calling 1-888-477-2669.

Other issues can best be addressed through education. A two-prong approach to education may work best. The first method is to learn as much as possible about the risks of the condition and how treatment should work. For example, patients and their caregivers should be well acquainted with the risks and effects of untreated high LDL cholesterol and triglycerides. If the doctor’s office is not able to provide this education, and most can, then medical libraries are available online to provide assistance. One of the most well-known and consumer friendly sites is www.cdc.gov (Centers for Disease Control and Prevention), which provides reputable, well-researched information about high cholesterol, its risks, and how it can be treated.

The second prong in the education arena is learning about the medication that has been prescribed. A patient’s doctor should always be the first person asked about the medication. It is important to learn why it is prescribed, possible side effects, and if follow-up tests are needed to determine its effectiveness. Some cholesterol medications, for example, may need liver function tests to make sure that liver damage does not occur as a side effect of treatment.

Another good source of information about a specific medication is the pharmacist who fills the prescription. Pharmacists are usually more than happy to provide information about side effects, the length of time before a medication may begin to work, and medications (over-the-counter or prescribed) that are contraindicated while using particular prescriptions. Experts recommend that patients have all of their prescriptions filled at the same pharmacy. While some co-pays may be cheaper at other pharmacies, the health benefits may outweigh the cost savings. If the patient consolidates all prescriptions at the same pharmacy, the pharmacist can quickly catch the problem of over-prescribing or adverse affects between drugs. Some of these drug-to-drug adverse effects can be fatal or extremely dangerous if not caught immediately.

Finally, if side effects are a concern, discuss those issues up-front with the doctor. Often patients have heard horror stories from others, whether well-intentioned or not, that may color their perception of how a medication may work. It is important to realize that not everyone experiences the same reaction to a medication, and side effects may not occur in everyone. Learning the most common side effects and what to expect before starting a medication at home is extremely helpful. Some side effects are extremely dangerous and should be reported immediately to the doctor. Others are more bothersome than dangerous and may go away after taking the medication over time.

Since CHD is the leading cause of death among the elderly, it is especially important to adhere to treatment plans. These treatment plans may include cholesterol-lowering medications. If patients are uncomfortable with side effects or are unwilling to take them as prescribed, caregivers can help overcome these issues primarily through communication.

 

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