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Bucks County Project MEDS (Medication Education Designed for Seniors)

Disruptive Innovations

The population of older adults has increased exponentially, as the baby boomer generation reaches the age of 60 and over. In fact, according to the 2010 census, Pennsylvania ranked fifth nationally in the number of residents age 62 and over, and eighth among states in the proportion of Baby Boomers to the total population. There are factors impacting older adults that put this generation at significant risk of death and disability. Older adults take more prescription and over-the-counter medications than any other age group, resulting in a greater risk of drug interactions, misuse, and accidental overdose. Frequently, this is the result of a lack of knowledge about the impact of multiple medical providers and dispensing pharmacies, alcohol use and drug interactions, and appropriate monitoring of side effects.    

Older adults are at significant risk of medication misuse and abuse for a variety of reasons that are specific to this stage of life. Generally, as compared to the whole, the older population experiences more chronic conditions and pain, frequently accepting treatment with prescription and over-the-counter medications, unregulated supplements, and holistic regimens. For many consumers, treatments are sourced from multiple pharmacies (due to insurance requirements/cost saving efforts), multiple physicians (as this population frequently has a variety of specialists involved in their health care), and over-the-counter medications, supplements, and holistic treatments that physicians and pharmacists may not know are included in the individual’s total plan of prescribed and discretionary treatments.    

Another common aging characteristic and risk factor is a decreased rate of metabolism, resulting in an individual’s prolonged exposure to each substance and often altering one’s sensitivity to its effects. For example, an older adult might drink the same amount of alcohol for many years but not realize that the impact of the drink is greater as they age. Some older adults experience some degree of cognitive decline, which impacts the administration of medication and monitoring of the effects. Finally, this stage of life can come with challenging emotional transitions.  Considering society’s general acceptance of alcohol and the burgeoning use of illicit drugs during the Boomer generation’s coming of age, a significant segment of this generation may be at an increased risk for alcohol misuse and substance abuse as a strategy to cope with the challenges of aging.  

In 1988, it had become apparent medication misuse among seniors was responsible for the deaths and disabilities of many and had in fact, taken on the proportions of a national tragedy. As a result, the Bucks County Area Agency on Aging (BCAAA), Bucks County Drug and Alcohol Commission, Inc., (BCDAC) and Bucks County Retired Senior Volunteer Program (RSVP) collaborated and developed a prevention program entitled Project MEDS (Medication Education Designed for Seniors). 

Project MEDS is a peer education program facilitated by senior volunteers to all older adults in Bucks County. This free, half-hour presentation addresses the life-threatening issues relating to the use and misuse of medication and alcohol among seniors. In addition, attendees are encouraged to develop a partnership between the 3 “P’s” -- patient, physician, and pharmacist. Tips for keeping medications organized, advocating for their health needs, and recognizing risky behaviors are key components of the curriculum. At the conclusion of the presentation, participants are given a free bag of resources. Project MEDS also attends health fairs throughout the county to disseminate educational resources and solicit presentations. It’s important to note, volunteers and staff are not trained medical professionals and never give medical advice. Anyone requiring such information is encouraged to contact their physician or pharmacist.

As a partner in Project MEDS’ development, BCAAA is primarily responsible for recruiting and training volunteer presenters, developing partnerships with community organizations, and scheduling presentations. The Agency recruits volunteers through its Positively Aging Bucks County (PABC) Volunteer program (fka RSVP) and trains the volunteers in accordance with a program developed with the considerable expertise of BCDAC. Funding is used for administrative time, advertising, training, printing, supplies, and more.

Project MEDS has experienced some challenges as it continues to evolve with current trends. Not only has there been an increase in the number of prescriptions written by medical providers since 1988, but also an increase in opioid prescriptions written. Additionally, the legalization of medical marijuana and the creation of vaping/e-cigarettes has brought new challenges to keeping staff, volunteers, and the curriculum current. Some other educational additions to the program include promotion of the Bucks County Medication Disposal Program, how to dispose of medications properly, awareness pertaining to the increase in prescription drug abuse by youth, and the importance of keeping medications under lock and key. Initially, the program’s format utilizes a lecture approach, which in time, seemed to fall flat on the Baby Boomer generation, whose numbers and culture overshadowed the dwindling number of their aging predecessors.  Consequently, securing both engagements and venues became progressively more difficult. A generation later, Project MEDS’ passionate and innovative group of volunteers, developed a new delivery mechanism by which to educate their peers.  

The new method incorporated the same prevention principles developed by BCDAC at its inception, but delivered the material in a more engaging format. The program (which features two presenters -- one serious and the other an impulsive, vibrant but uneducated older adult) now utilizes an interactive skit that demonstrates the many common pitfalls of medication administration that are so often underestimated. The audience is so taken in by the impromptu beginning of the program that many do not initially recognize the volunteer playing the role of an apparently late-attending audience member, as a presenter. The serious presenter, who is trying to persist with his didactic presentation must stop to manage the unorthodox behavior (demonstrating common medication errors) of the late audience member. The audience is frequently moved to assist him and are thereby engaged in the process long before they realize this IS the presentation. It is entertaining, comical, and very informative.

The effectiveness of the program is measured by use of a self-report, pre-survey, and post-survey instruments which serve two purposes. First, it evaluates the effectiveness of the presentation.  Pre- and post-survey findings gauge how much participants learn from the presentation and whether the audience is getting the message as it relates to each topic being addressed. The questions on the survey address common myths and misunderstandings about medication administration and late onset alcoholism. The survey highlights important truths about the topic that significantly impact health and safety, reinforcing the presentation’s key principles to the participant. Participants are also asked to fill out an evaluation, which staff use to gauge the abilities of peer volunteers.

Volunteers bring a wide array of experience to their role as presenters. Some are retired medical professionals or teachers, caregivers of older adults, and lay people. The volunteer presenters grew into a self-directed group. They come together monthly to exchange ideas and expertise.  The goals of Project MEDS is to increase awareness of issues related to prescribed and over-the-counter medications, as well as alcohol misuse and abuse. The program is peer directed as the information is best received when delivered by a member of the target audience. Utilization of volunteers from the county’s volunteer program meet yet another need, by providing an opportunity for seniors for meaningful civic engagement.  

Project MEDS is unique in its foundational partnership among three entities to bring it to fruition; its use of peer direction, its ability to change with the needs of the population it serves, and utilizing the gifts and talents of those volunteers committed to its cause.

Project MEDS continues to be funded by the Bucks County Alcohol and Drug Commission, Inc., programmatically facilitated by the Bucks County Area Agency on Aging, supported by the County’s volunteer program (PABC) and peer directed by volunteers with varying backgrounds and talents, all over the age of 50, with a passion for its message.

As the problem of alcohol misuse and inadvertent substance abuse grows due to growth in the population and treatment protocols for the varying illnesses faced by a people who are living longer with more complicated medical diagnoses, the need for awareness of the problem also grows. Project MEDS is a unique platform and model for building such awareness.  

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Issue 39 | Disruptive Innovations