Are you taking your medication correctly?

Q I'm taking more medicine as I get older. But it's hard to keep track of all the prescriptions and the instructions for taking them. Is this common?

A A systematic review of over 13,000 patients with hypertension from 15 countries found about half did not consistently take their medication. Taking your medications consistently is associated with a lower chance of hospitalization and even dying.

Physicians need to explain the importance of therapies. Insurance companies and pharmacies need to address access and costs.

You can also take corrective steps. Start by avoiding these common mistakes:

■ Using your inhalers incorrectly. Around nine out of 10 people using metered-dose inhalers, commonly prescribed for asthma or chronic obstructive pulmonary disease, err in their technique — such as failing to fire the canister entirely or not holding their breath long enough.

■ Taking heartburn meds at the wrong time. The majority of primary care physicians who prescribe proton pump inhibitors like omeprazole don't inform patients they need to take the medication 30 minutes before their meals.

■ Taking medications you don't need. Sixty-five per cent of older people may be on medications they don't need, which puts them at higher risk for adverse effects. Having a high number of prescriptions has been associated with impaired cognition and a higher chance of falls.

■ Taking pills at all times of day. Adding in a new medicine you'll need to take three times a day is more complicated than adding one more pill to your existing routine. There may be alternatives your doctor can consider.

■ Taking more pills than you may need to. In the case of hypertension, for example, researchers have found that a single pill that contains a combination of medications is more effective than taking multiple pills containing the exact same doses. Why? Because more people are more likely to stick with it.

WHAT SHOULD I DO IF MY MEDICINE IS TOO EXPENSIVE?

Here's a little secret: I hardly ever buy brand-name drugs. If there's a cheaper generic or drugstore version of the same medication, by all means, get that one instead.

Consider this study published in JAMA Internal Medicine in 2018 about anti-platelet medications.

For decades, doctors have recommended anti-platelet medications like clopidogrel ( brand name Plavix) to people who get a procedure to open a blocked coronary artery after a heart attack. In 2009 and 2011, two new anti-platelet drugs were approved by the FDA. Both boasted major randomized clinical trials that demonstrated their superiority to the generic medication clopidogrel.

By 2016, prescriptions for clopidogrel had plummeted while those for the new drugs soared. After all, the data showed they were the best option for patients.

But then something unexpected happened.

The group of people who didn't pick up their anti-platelet medications from the pharmacy just about tripled. And they became more likely to experience a second heart attack than people who did.

Why did so many people not fill lifesaving medications after almost dying? It turns out the out-of-pocket costs for the new drugs were more than twice as high for patients.

The lesson here: A medicine that is slightly less effective but you can afford may be better than the one that is the most effective but you can't afford.