Management of Expectations and adaptation to change

Possible changes to consider with medication management  

Medication management is an important part of post-injury care, and it changes over time as needs and abilities change. Several factors can influence how assistance with medication management may change over time post-injury, including changes in dexterity The ability to use one’s hands or body with skill and ease. (i.e. hand and body function), caregiving support, recovery, and overall health.

Muscle strength and fatigue depend on age and use. Lower energy levels and muscle strength due to aging plus SCI/D Spinal cord injury or dysfunction. can reduce physical ability, particularly dexterity The ability to use one’s hands or body with skill and ease. , and make everyday tasks more challenging. As such, older individuals may require additional physical support for taking medications.

As people age, there is often a decrease in energy levels, muscle strength, and endurance (i.e. muscles fatigue quickly), and that decline is more noticeable in individuals with SCI/D Spinal cord injury or dysfunction. . Muscle changes begin around 45 years of age, but may depend on when you sustained the SCI/D Spinal cord injury or dysfunction. . For example, muscles are weaker among individuals who sustained a SCI/D Spinal cord injury or dysfunction. at an older age (>25 years of age) versus a younger age (≤25 years).

In addition to energy levels and muscle changes, other age-related factors can impact medication self-management An individual’s ability to manage the symptoms, side effects, treatment, and physical and social consequences of taking medications. . Factors may include:

  • Cognitive decline: Older age can decrease comprehension of medication instructions and lower adherence The act of taking medications as prescribed based on timing, dosage, and frequency of medication use.
    • Strategies: Use a dosette or blister pack, set-up a medication schedule, use reminder apps, seek assistance from a family member or caregiver
  • Decline in vision: Difficulty reading medication labels can impact medication adherence The act of taking medications as prescribed based on timing, dosage, and frequency of medication use.
    • Strategies: Ask for large print on medication labels, use a dosette or blister pack
  • Complex medication regimens: As you get older, you may be required to take a higher number of medications, and your dosages may also increase. This may make it more difficult to take your medications
    • Strategies: Use a dosette or blister pack, set-up a medication schedule, use reminder apps

In addition to age, people with a longer duration of a SCI/D Spinal cord injury or dysfunction. may experience greater functional decline over the years and thus require additional support. Overall, it is important to be aware that assistance with medication management may change over time post-injury. This could mean that additional caregiver or personal support worker (PSW) support is required.

References

Amsters, D. I., Pershouse, K. J., Price, G. L., and Kendall, M. B. (2005). Long duration spinal cord injury: perceptions of functional change over time. Disabil. Rehabil. 27, 489–497. Doi: 10.1080/09638280400018478

Charlifue, S., Jha, A., and Lammertse, D. (2010). Aging with spinal cord injury. Phys. Med. Rehabil. Clin. N. Am. 21, 383–402. Doi: 10.1016/j.pmr.2009.12.002

Gerhart, K. A., Bergstrom, E., Charlifue, S. W., Menter, R. R., and Whiteneck, G. G. (1993). Long-term spinal cord injury: functional changes over time. Arch. Phys. Med. Rehabil. 74, 1030–1034. Doi: 10.1016/0003-9993(93)90057-h

Kemp, B., and Thompson, L. (2002). Aging and spinal cord injury: medical, functional and psychosocial changes. SCI Nurs. 19, 51–60.

Krause, J. S., and Coker, J. L. (2006). Aging after spinal cord injury: a 30-year longitudinal study. J. Spinal Cord Med. 29, 371–376.

Marek, K., & Antle, L. (2008). Chapter 18: Medication Management of the Community-Dwelling Older Adult. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter, Agency for Healthcare Research and Quality.

McColl, M. A., Charlifue, S., Glass, C., Savic, G., and Meehan, M. (2002). International differences in ageing and spinal cord injury. Spinal Cord 40, 128–136. Doi: 10.1038/sj.sc.3101264

Thomas, C. K., & Grumbles, R. M. (2014). Age at spinal cord injury determines muscle strength. Frontiers in Integrative Neuroscience, 8. https://doi.org/10.3389/fnint.2014.00002