Undermedication occurs when an elderly patient is denied access to necessary medications or is given dosages that are inadequate to treat conditions. Undermedication can be severely detrimental to elderly patients, causing physical and psychological complications. Like any type of medication error, undermedication can be a sign of abuse or neglect, and can occur in institutional or residential care settings.
Reasons for Undermedication
Overmedication of elderly patients has been a growing concern over the past few years, and many organizations are holding prescribing physicians and nursing homes responsible for incidents of overmedication. Due to this scrutiny, physicians and other medical workers may be hesitant to prescribe medications unless absolutely necessary, for fear of being accused of overmedicating patients. Undermedication may also occur when patients are not given recommended doses of prescribed medications.
In either home or institutional setting, patients may be intentionally undermedicated by caregivers. Caregivers or family members with drug abuse issues may steal patients’ medications, either not giving the patient medication at all or giving a lower dosage than what is required to avoid scrutiny surrounding medication that is being used faster than prescribed. Caregivers or patients may undermedicate because of the belief that the prescribed dosages are too high. Caregivers and physicians may also fail to adequately medicate patients that are believed to be nearing the end of life or that are suffering from dementia.
Unintentional undermedication may occur in institutional settings due to understaffing issues. Administrators of medications may accidentally miss medications for patients or make errors in administering dosages due to limited time or excessive stress. Unintentional undermedication at home can be caused by patient stress or decreasing cognitive functions, or by caregiver error. Unintentional undermedication may indicate neglectful care situations.
Undermedication Warning Signs
Patients that are not receiving adequate dosages of pain medication may exhibit signs of being in pain, such as moaning or clutching injured limbs or areas. Patients that are being undermedicated to treat ailments or conditions may show signs of worsening conditions or may fail to show improvement. Patients that are being undermedicated for cognitive or psychiatric conditions may become aggressive, disoriented, or reclusive.
Results of Undermedication
Chronic undermedication of pain can cause chronic pain, or can lead to impaired rehabilitation or impaired immune system. Undermedication of pain can also cause patients to develop psychological disorders stemming from the helplessness of the situation, or from lack of sleep caused by the pain. Patients dealing with chronic pain may not breathe properly or may hold the painful limb or area, which can lead to the development of conditions from lack of oxygen or blood flow.
Dementia and Cardiovascular Diseases
Studies indicate that patients that are being undermedicated for cardiovascular diseases are at a higher risk for developing dementia and other cognitive impairments. The link may stem from a lack of blood and oxygen circulation to the brain and central nervous system. Untreated or undertreated conditions that were associated with the cognitive decline included coronary heart disease, diabetes, hypertension, stroke, and congestive heart failure.
Patient’s family members should be especially diligent in reviewing diagnoses and medications for elderly patients that suffer from cognitive deficiencies. These patients are some of the most vulnerable to undermedication, and are often neglected due to fears of overmedication or the perception that the patient does not benefit from the medication. Patients not suffering from cognitive decline may be able to prevent undermedication by being aware of amounts and types of medications prescribed, and reporting any perceived errors.
Staff and Physician Role
Physicians may be able to prevent undermedicating patients by prescribing adequate dosages and making sure that caregivers are clear on instructions. Nursing home or other care facility staff members may be able to prevent undermedication by being careful to give prescribed dosages of medication. Staff members should also report any signs of possible undermedication to administration or medical professionals.
“Elder Abuse and Neglect.” HelpGuide.org. HelpGuide.org, n.d. Web. 2 Mar 2014. <http://www.helpguide.org/mental/elder_abuse_physical_emotional_sexual_neglect.htm>.
Lopponen, Minna, Ismo Raiha, et al. “Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly.” Dementia and Geriatric Cognitive Disorders. 22.February (2006): 132-141. Web. 2 Mar. 2014. <http://www.karger.com/Article/Pdf/93739>.