Refilling Prescriptions by Community‐dwelling Elderly

To the Editor: I am writing to recount a personal experience. I recently visited my elderly community-dwelling parents. My father is 84 years old and suffers from mild to moderate multiinfarct dementia. He is ambulatory and performs his own activities of daily living but is heavily dependent upon my mother for cuing. My mother (age 83) drives a car but suffers from easy fatigue from a cardiomyopathy with an ejection fraction of 15%. Between the two of them, they have 11 prescription medications. During one of my visits, they asked me to drive them to a pharmacy approximately 2 miles away from their home to pick up a single prescription. Before the drive, I reviewed all 11 prescription bottles and, to my surprise, found that they had been filled on nine completely separate dates. I asked the pharmacy technician if there was any way to have their prescriptions synchronized so that their trips could be limited to once every 30 days (in the absence of new prescriptions). I was told that the pharmacy had no specific mechanism for performing this service because insurance carriers obliged them to dispense a 30-day supply, allowing a refill 7 days earlier. I then returned to my parents' home and pulled out all the pill bottles, counted the pills, and determined the earliest fill dates and how to synchronize their medication pick-ups to every 30 days. This task involved relatively complex problem solving. Later, I learned of a pharmacy located a half a mile away from my parents' apartment that delivered medications. I contacted my parents' physicians and arranged a transfer of pharmacy provider. It is unclear how common this phenomenon may be in elderly outpatients with mild compromise in executive functions. It took me half an hour to plan a synchronized pick-up within 6 weeks. I would suggest that formal caregivers of elderly outpatients determine how widespread this phenomenon may be and assist patients in this area. In addition, insurance carriers and pharmacies may wish to implement programs to assist the community-dwelling elderly to prevent the need for multiple pharmacy visits within a 30-day period. This step is also expected to decrease pharmacy dispensing time.