Boosting therapeutic compliance : Drug Therapy for Geriatric Care

• To circumvent noncompliance caused by visual impairment, provide dosage instructions in large print if necessary.
• To alter eating habits that lead to noncompliance, emphasize which drugs the patient must take with food and which he must take on an empty stomach. Explain that taking some drugs on an empty stomach may cause nausea, whereas taking some drugs on a full stomach may interfere with absorption. Also find out whether the patient eats regularly or skips meals. If he skips meals, he may be skipping doses too. As needed, help him coordinate his drug administration schedule with his eating habits.
• To correct problems related to drug form and administration, help the patient find easier ways to take medicine. For example, if he can't swallow pills or capsules, switch to a liquid or powdered form of the drug if possible. Suggest that he slide the tablet down with soft food such as applesauce. Keep in mind which tablets you can crush and which you can't. For example, enteric-coated tablets, timed-release capsules, and sublingual and buccal tablets shouldn't be crushed. Doing so may affect absorption and effectiveness. Some crushed drugs may taste bitter and may stain or irritate oral mucosa.
• If mobility or transportation deters compliance, help the patient locate a pharmacy that refills and delivers prescriptions. If appropriate, consider using a mail-order pharmacy.
• If forgetfulness interferes with compliance, devise a system for helping the patient remember to take his drugs properly. Suggest that the patient or a family member purchase or make a scheduling aid, such as a calendar, checklist, alarm wristwatch, or compartmented drug container. 
• Some patients may try to save money by not having prescriptions filled or refilled or by taking fewer doses than ordered to make the drug last longer. If financial considerations are preventing your patient's compliance, help him explore new ways of managing. Suggest that he use less-expensive generic equivalents of name-brand drugs whenever possible. Also, explore ways that family members can help, or refer the patient to the social services department and appropriate community agencies. Many states have programs to help low-income elderly patients buy needed medications.