Family Member Helps 86-Year-Old Iowan Take Control of Her Meds

By Don McCormick
“Plain & Simple” Health Literacy Coordinator, Iowa Department of Public Health
Des Moines, Iowa

When it comes to health issues, Marguerite Avant has been around the block a time or two. As a child, she had polio and endured several hospitalizations, including one that lasted an entire year. The Des Moines native learned about the health care system the hard way and became all-too familiar, all-too young with taking medications to help with the painful and debilitating effects of this terrible disease. No one needs to tell her how to take care of herself, she’d tell you.

But Marguerite isn’t a young girl any more. At 86 years old, her ability to make appropriate health decisions has understandably begun to decrease, though she might not be the first to admit it.

"When you’re in the hospital, they give you a little cup with all your pills at the same time, right? And they’re all are going to the same place," she reasoned as she rattled around a non-descript container filled with pills of various shapes, sizes and colors. "Look, I only have four medications and I take them all at the same time once a day."

Marguerite explained that she’d found it nearly impossible to remember each of her prescription medications by the difficult-to-pronounce pharmaceutical name on the bottle it came in. "Plus," she said, "the print’s too small. Those weekly pill cases are too confusing for me, so it’s easier to keep everything in this one bottle."

She then shook out four pills from the container until she had one of each type. Her sister’s grandchild looked on as she popped all the pills in her mouth and swallowed.

Luckily for Marguerite, her great-nephew Jason is also a pretty great nephew. After a quick on-the-spot health literacy assessment (he asked her if she knew what the medications were for and how they should be taken), Jason knew his great-aunt needed some help.

"I was worried," Jason said. "Marguerite still works full time at the YMCA and up until a few years ago, she was even swimming regularly. She’s always been in great shape, so there were no red flags that made us question the way she took care of herself. I was concerned, though, that storing her medications like this might eventually cause a problem."

According to estimates from the Institute of Medicine, as many as 98,000 people die each year in the United States from medical errors. Among them, about 7,000 are estimated to die from medication errors alone—about 16 percent more deaths than the number attributable to work-related injuries.*

It is important to recognize that Marguerite’s advanced age may be a factor in her ability to obtain, process, and understand health information to make appropriate health decisions—her health literacy level. According to the 2003 National Assessment of Adult Literacy, one’s ability to understand and use health information plummets after age 65. While 34 percent of adults aged 50 to 64 in the U.S. have only basic or below basic health literacy skills, that number climbs to 59 percent after age 65.** After age 75, that number shoots up to a staggering 70 percent.***

Thanks to Jason badgering her about the safety of her method for storing medicines, Marguerite eventually decided to talk to her physician. What happened next is another reason this is such a great health literacy success story.

Marguerite’s doctor picked up on the fact that she evidently preferred to learn and retain information using visual cues. He suggested she create a pill card that included visual representations of her medicine as well as dosage information. This would allow her to store her medicines safely in their original bottles while referring to a card that included a photo of each pill, its name and the reason for taking it.

After Marguerite told Jason what the doctor had recommended, he went to his computer, downloaded photos of all her pills, and typed up easy-to-understand descriptions for each one in large bold print. For example, alongside a picture of a small green pill and clip art of a blood pressure pump, are the words "Cozaar. To manage blood pressure. Take 1 pill in the morning."

Then, he did something similar to "teach-back," a patient education strategy health literacy advocates now recommend in all health care settings. "Just to make sure she hadn’t simply agreed to the idea of pill card to shut me up, I asked her about each of her medicines and what they were for," Jason said. "She passed with flying colors. She never admitted that her old system was unsafe, but I could tell this new tool had really empowered her."

Marguerite now keeps her new pill card on her dresser in her bedroom. It sits right next to all of her medications, each of which is stored safely in its original bottle.

* www.ahrq.gov/qual/errback.htm

** http://nces.ed.gov/pubs2006/2006483.pdf.

*** http://www.health.gov/communication/literacy/issuebrief/2008IssueBrief.pdf

Don McCormick is the Plain & Simple health literacy coordinator for the Iowa Department of Public Health. He also is a volunteer editor on this year's Health Literacy Month Storytelling project. You can contact him directly at dmccormi@idph.state.ia.us.

This article is also published in "Plain & Simple: A Health Literacy Project for Iowa." It is reprinted on this website with permission. For more information about Plain & Simple, visit www.idph.state.ia.us/health_literacy.

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