By
Sandra Ray, Staff Writer
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
Editorial guidelines
