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Home Safety for Older Adults Health Article

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Prevent poisoning and medication errors

Harry, a 74-year-old retired salesman in Florida, counted out his medications every night before going to bed, so they would be ready for him to take the next morning. He stored them in an old pill bottle so they would all be in the same place and he wouldn't forget any. One morning he got up and took every pill in the bottle, as he always did. Except something was wrong. He felt dizzy, lightheaded, and nauseous. Puzzled, he went to the bathroom medicine cabinet to make sure he'd taken all his pills — and that is when he discovered that the wrong bottle was empty. He'd taken all his heart pills by mistake. His wife rushed him to the emergency room. His heart rhythm was dangerously abnormal and he was admitted to the intensive care unit. Fortunately, he survived the mishap.

A poison is any type of substance that impairs normal functioning in the body. Common poisons stored in the home include household cleaners, paints, motor fluids, and lawn and garden products. But even products such as over-the-counter and prescription drugs, rubbing alcohol, and herbal remedies can become poisons if taken in larger-than-recommended doses or used inappropriately. Mixing medications or mixing drugs and herbal remedies can also create problems.

Although children younger than five are most at risk for being poisoned in the home, largely from accidentally ingesting a chemical product such as a cleaner, adults are also at risk, but for a different reason. To put it simply: With children, you worry about what's stored under the sink; with adults, you worry about what's stored in the medicine cabinet.

Medication overdoses and interactions

Medication overdoses and interactions kill at least 44,000 hospitalized Americans each year — about equal to the number of people who die in motor vehicle accidents. Although people tend to assume that medication errors occur only in hospitals or nursing homes, a significant number occur at home. There is no way to know exactly how often such errors occur at home, as many go unreported.

Poison Control Center Hotline

800-222-1222

The most obvious medication errors are those where people take the wrong drug, or take too much of it. Less obvious, but sometimes even more harmful, are interactions between medications and other substances such as alcohol, herbal and dietary supplements, other drugs, or even food and beverages. Drugs may affect you differently as you grow older, and if you have certain medical conditions such as high blood pressure.

Physiological factors

Your chance of experiencing a medication error increases with age both because of normal physiological changes and because of the likelihood that you need to take one or more medications to treat a health condition. As you age, changes in your digestive system may affect how quickly drugs enter your bloodstream. Weight loss or weight gain may affect the amount of medicine you need to take and how long it remains in your body. With age, your circulation, liver, and kidneys may slow down; these changes affect how long a drug remains in your system, how quickly it is broken down, and how well it is removed from your body. Impaired vision is another factor: It becomes harder to read the labels on those tiny pill bottles.

Medical conditions that become more common as you get older can also affect your response to a particular drug. If you have high blood pressure, for instance, talk with your doctor before using a nasal decongestant to treat a cold. If you have a chronic breathing disorder such as emphysema or chronic bronchitis, ask whether you can take a particular sleeping pill or antihistamine.

Poisoning facts

Poisoning is the second leading cause of accidental deaths in the home, accounting for one in four such deaths in people of all ages.
More than 700,000 poisoning incidents occur each year in the United States.
About 4,800 Americans — most of them adults — die each year from poisoning.
Of those poisonings where the source can be determined, more than half occur in the home.
These statistics do not include food poisoning, which is categorized by federal officials as a foodborne illness rather than an accident.

Extrinsic factors

Even if you were eternally young, you'd need to be aware of the extrinsic factors that can lead to a drug error or overdose.

Alcohol. As you grow older, you may feel drowsy or tipsy sooner when you drink. Mixing alcohol and medications can only worsen the situation, by slowing your reactions, impairing coordination, and causing irritability. And alcohol should not be taken with pain relievers such as aspirin, acetaminophen (Tylenol), and ibuprofen (Advil, Motrin, others), because it will increase the risk of stomach bleeding or liver damage.

Medication interactions. Many medications boost or impair the biological systems that break down or remove drugs from the body. As a result, taking one medication can have a significant effect on the concentration of other medications. If the blood level of the medication is too low, the drug may not be effective; if it is too high, toxicity may result.

Dietary supplements. Vitamins and herbs present another potential hazard when it comes to drug safety, because they may interact with digestive enzymes important for metabolism. Vitamin K, for instance, enhances blood clotting and thus may interfere with the effectiveness of blood-thinning medications such as warfarin (Coumadin). The herb St. John's wort, reputed to improve mood, impairs the metabolism of irinotecan (Camptosar), a chemotherapy agent. Dietary and herbal supplements also interact with a wide variety of drugs. Glucosamine sulfite, for instance, which is sometimes taken for arthritis, may interact with blood sugar–lowering medications taken for diabetes and diuretics taken for heart disease. Still another problem with dietary supplements is that you can never be sure what ingredients are actually in the supplement, and at what dose. Herbal products and other dietary supplements are not regulated for safety, purity, or efficacy by the FDA, and a number of studies have reported that the ingredients listed on the labels of supplements do not always match what is actually inside the bottle.

Food and beverages. Many types of food can have an impact on how your body metabolizes certain medications. Grapefruit juice, for instance, boosts the effects of many drugs because it impairs intestinal enzymes that would normally break the drugs down. This can be a particular problem if you are taking a calcium-channel blocker to lower your blood pressure or certain statin drugs to lower your cholesterol. Some cheeses and soy sauce, which contain a substance known as tyramine, can cause a potentially fatal increase in blood pressure in people taking monoamine oxidase inhibitors to treat a mood disorder.

Medications often look alike. Make sure you're taking the right pills.

Labels. Many mix-ups occur because of the pill bottles themselves: They all tend to look alike, and the labels are often printed in tiny type that becomes smudged the more you use the medication and handle the bottle. If you can no longer read the label, contact your doctor or pharmacist for advice about how to use the medicine.

Avoid medication errors at the doctor's office or hospital

Always bring a complete list of all over-the-counter and prescription medications, vitamins, and herbal remedies you are taking so that your doctor knows.
If a new medication is prescribed or recommended, ask what its name is and what it is supposed to do.
Ask how long you should take the medication, and at what time of the day.
Ask whether a medication should be taken with food or water, and what types of foods or beverages to avoid while you are taking it.
Ask what to do if you forget to take a dose, or if you take a double dose by mistake.
Find out what side effects are common with the medication, and what you can do about them.
Find out if you will have to undergo blood tests or any other type of monitoring while on the medication. If so, find out when and where such tests will take place.
Ask whom you can call if you have questions about the drug when you are at home.

First aid for overdoses and poisonings

Call your local poison control center, describe what substance has been ingested, and follow the instructions.
For alcohol or medication overdoses or interactions, bring the person to an emergency room if he or she is conscious and mobile, or dial 911 if the person is unconscious.
If you or a loved one develops headache, dizziness, or nausea and you suspect poisoning from carbon monoxide or some other inhaled substance, seek fresh air immediately.

Avoid medication errors at the pharmacy

Consider obtaining all your medications from one pharmacy, as this will increase the chances that any potentially dangerous drug combinations will be flagged by the pharmacy's computer system.
Make sure that you receive a patient information sheet along with the medication. This sheet should describe what the drug is used for, how much to take, how to take it, and what side effects to expect.
Ask the pharmacist how to store the medication.
If you have trouble reading labels or the patient information sheet, ask if these materials can be provided in larger print.
If you have trouble opening childproof caps, ask if other bottles are available. (If you have young children or grandchildren, this may not be an option for you. Or you can store the medication in a locked cabinet.)
If you refill a medication and the package or pills look different, find out why.

Avoid medication errors at home

Keep the patient information sheets provided by the pharmacy with the medication, and read these sheets before you take the drug.
Store medications in cabinets that have childproof locks or regular locks. (Children are notorious for gaining access to hard-to-reach locations.)
If you take multiple medications, purchase a pill organizer that separates pills by day so you can keep track of what you need to take and whether you have taken it. Do not combine different medications in an old pill bottle as a way of organizing them.
Another option is to keep a medication diary (write down every pill you take and when), or have a "buddy system" in which a friend helps you keep track of which medications you've taken.
Go through your medicine cabinet at least once a year. Discard drugs that have expired and those you no longer need.