Self-Assessment Questionnaire to Identify Risk for Medication-Related Problems
Click here to download this as an Acrobat PDF document.
If you are older than the age of 65 and can answer YES
to most of these questions, you should consider making an appointment with a senior care pharmacist to determine what steps can be taken to decrease your risks. While these risk factors are not a definitive list, they have been found to correlate with the risk of medication-related problems.
- Do you currently take five or more medications?
- Do you take 12 or more medication doses each day?
- Do you take any of the following medications?
- carbamazepine (e.g.Tegretol®)
- lithium (e.g. Eskalith®)
- phenytoin (e.g. Dilantin®, Phenytek®)
- quinidine (e.g. Quinidex®)
- warfarin (e.g. Coumadin®)
- digoxin (e.g. Lanoxin®, Lanoxicaps®)
- phenobarbital
- procainamide (e.g. Procanabid®, Pronestyl®)
- theopylline (e.g. Theo-dur®, Theo-24®, Slo-bid™, Theospan®, Uniphyl®)
- Are you currently taking medications for three or more medical problems?
- Have your medications or the instructions on how to take them been changed four or more times this past year?
- Does more than one physician prescribe medications for you on a regular basis?
- Do you get your prescriptions filled at more than one pharmacy?
- Does someone else bring any of your medications to your home for you (such as a delivery person from the pharmacy, a spouse, friend, or a neighbor)?
- Is it difficult for you to follow your medication regimen or do you sometimes choose not to?
- Of all your medications, is there any particular medicine for which you do not know the reason for taking it?
If you answered YES
to many of these questions, gather the following information and contact a senior care pharmacist:
- Current medication list that includes not only prescription drugs but also over-the-counter items and herbal products
- Drugs you have taken in the past that have caused allergic reactions, adverse reactions, or intolerable side effect(s)
- Physicians and other prescribers and which medicines they have prescribed
- Pharmacy or pharmacies you have used to fill each prescription
- List of your medical conditions and diseases.
How can a senior care pharmacist help you?
Senior care pharmacists provide an array of services such as managing a patient's medications, advice on the correct way to administer medications, guidance for caregivers, and assessment of a patient's drug regimen. More specifically they:
- Provide professional, unhurried visits, and understandable patient and caregiver information
- Identify and reduce medication-related problems, such as side effects and drug interactions
- Eliminate unnecessary medications, simplify taking medications and reduce medication costs
- Serve as your advocate with your physicians to ensure the use of the most appropriate medications
- Promote wellness and disease prevention
- Identify untreated problems (such as incontinence, depression, osteoporosis)
- Recommend appropriate packaging and dosage forms for easier use of medications
You can find a senior care pharmacist in our online directory of senior care pharmacists from across the U.S. and Canada, who have expertise in geriatrics, geriatric pharmacotherapy, and the unique medication-related needs of older adults.
- References
- Levy, H.B. Self-administered medication-risk questionnaire in an elderly population. Ann Pharmacother 2003; 37:982-7.
