Episode 015: Day 6 – Medication Management

Episode Description:

Host Zack Demopoulos launches his 30 day preparation plan to care for an aging adult.  In Day 6, he talks about medication management, the risks of not complying, the polypharmacy issues, and the problems that can occur if medication is not managed correctly.

Show Notes:

Day 6:  Medication Managment

How many medications do you think older adults between the ages of 65 and 69 take on an average?  According to the HealthResearchFunding.org, it’s  an average of 14.  And that number climbs to 18 as seniors age into their 80s. Medication management is a struggle for any age.  Imagine complicating it with forgetfulness and cognitive or memory problems.  We’ll discuss this topic on Day Five of the 30 Day Preparation Plan To Care For An Aging Parent.

Welcome to the Raising ‘Rents Podcast.  This show is sponsored by ComForCare, a national home care provider that will help you live your best life possible.  Day Five of the 30 Day Preparation Plan is the next step in preparing a plan to become the best caregiver possible. Keep in mind as we go throughout this process that our primary goal for family caregiving, regardless of circumstances, is to provide a loved one with a comfortable, caring environment in which to grow old.

I confess.  I use a pill box and I only take one pill and one vitamin.  You know that little plastic container with boxes labeled by days of the week.  I will admit that sometimes I forget if I took a pill that day and this pill box does make sure I do not mix that up.  Imagine if you are prescribed many pills and some of them are critical that you take them.  It’s very likely that you may forget to take some.  Or worse, you may think you forget them and you take them….again, something that could cause harm.  And imagine if you have memory issues like many of our aging parents experience, or worse yet, suffer from early signs of dementia.  This is a big challenge with polypharmacy, or the need to be prescribed many different pills, and aging.

When is the last time you have checked in with your parents to see what kind of medication they are taking and how are they managing them?  When my Mom was visiting us here in New Jersey, she had a routine every day with her pills.  Luckily, she only has a few, but as I watched her process, I can visualize things going wrong.  I suggested a pill box and she immediately dismissed it, that she didn’t need it.  By the end of her visit, I at least had her trying one and she took it home with her back to North Carolina.  Whether she will continue to use it or not… time will tell.

It is highly recommended that you as a caregiver take control of the medication management of your aging parent.  Filling out pill boxes and establishing a way to ensure compliance is a very important measure and role of the adult kid.

There are some ways to help manage polypharmacy, especially if there are some memory issues involved.  Every person is different and so different approached may be necessary to try.

  • Establish a routine. Many aging adults really prefer routines so this is not a new concept.  But it might be helpful to document a schedule that needs to be adhered to, details down to the times of each day when the pills need to be taken.
  • Packaging and storage of pills—there are pharmacies that will deliver pills already pre-packed in designated daily and hourly doses. This is a great way to ensure that pills are taken or to identify if pills are being missed.
  • There are machines that will automatically dispense medication based on when it is to be taken. A light will flash or a sound is made when it is time to take a dose.  This is very effective for individuals who suffer from dementia and alarms can be set so that a family member is alerted if the pill is not taken at its designated time.  The problem with these though is that a person can put the pill aside and not take it. A witness may be needed or some kind of follow up to ensure it was taken.
  • Having someone help with the taking medication is a very effective option. This person can either be in person or perhaps call on the phone.  It can be anyone.  The caution though is if someone has dementia, and they have access to the medication, they may take more than they are supposed to when the person who is helping is not around.
  • Observe for any warning signs or missing and or unused pills. Warning signs could be confusion, drowsiness, depression, delirium, insomnia, incontinence, loss of appetite, muscle weakness, falls and fractures, and changes in speech and memory.  Keep track of expiration dates, inventory, and as you make your visits, check on whether or not pills are being taken as scheduled.

Perhaps a combination of options may be the best choice, especially in the situation where someone with dementia is having to take medications.

So, while getting your aging parent to comply with their medications, there are other things to keep an eye on and help out with potential poly-pharmacy issues.  A big problem I see for aging adults from our home care experience is coordination with all the doctors and medications being prescribed, especially after someone is hospitalized.  There may be new medications that are supposed to replace old ones.  There may be interaction issues with the various medications.  There may have been medications that were meant only to be given for a short-term period.  The most foolproof method I have seen work is that you must circle back to the primary physician for all medication management.  Regardless of the specialty, it is best that one doctor has knowledge of all medications, new and old, so that any potential complications can be identified ahead of any serious problems that can occur.

Some other things you can do to help avoid any issues:

  1. 1. Maintain a Listkeep a list of all medications including over the counter drugs and herbal supplements. Document it any way you want it but make sure it is always current and it is handy to anyone who needs it, especially in an emergency and during doctor visits. AARP has a good example of a record if you want some ideas on how to do this.  http://www.aarp.org/health/drugs-supplements/info-2007/my_personal_medication_record.html
  2. Ask Questions. Be sure your parent has a good understanding about the pills they are taking, importance of taking them as prescribed with or without food, morning noon or night time, and what to expect in terms of side effects. It’s a very good idea that you get involved by asking questions about the medications so you can help your parent be fully aware of their medication.  Doctors and of course pharmacists are very good sources for this information.
  3. Speaking of Pharmacists, it is also a good idea to fill all medications at one pharmacy. This will help minimize any risk of mixing drugs that may be potentially dangerous.

Of course, having good communication with your parents will help prevent issues too.  Sometimes our parents are a little embarrassed with taking so many medications or they hear things about a drug and will take themselves off it without consulting with a doctor or pharmacist.  By staying in touch and talking about their medications, especially if you are helping to organize them, it will help stay on top of any issues.

There is one final topic I want to share with you, a pretty serious one that I would like to make you aware of.  It’s substance abuse—both alcohol and drug.  approximately 20-30% of people ages 75 to 85 have had drinking problems, while 3.6% of adults ages 60 to 64 have used illicit drugs, according to the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse & Mental Health Services Administration, respectively.  Reasons for some of this abuse can be a way of coping with grief, anxiety, depression or pain.  The problem is that doctors as well as caregivers can overlook signs and symptoms of abuse because they mimic some of the conditions that aging adults experience such as dementia.  And if not recognized as substance abuse and left untreated, there is a higher risk of injuries and severe side effects.

So what should caregivers look for when attempting to determine whether seniors in their care may have a drug or alcohol problem? Warning signs include:

  • solitary (or secret) drinking
  • slurred speech and/or alcohol smell
  • empty bottles around living space
  • changes in personal appearance
  • drinking-related rituals
  • loss of interest in pleasurable activities
  • drinking despite warning labels
  • increased falling
  • frequent use of tranquilizers
  • memory loss, confusion, irritation and agitation
  • depression

Filling prescriptions at multiple pharmacies and frequently changing physicians may also be signs of alcohol or substance abuse.

While substance abuse among seniors is a very real problem, caregivers can play a vital role in helping them address and overcome these issues. One last thing to keep in mind: Whichever course of treatment is necessary, clear communications and a respectful manner by the caregiving team are essential parts of the recovery process. The holidays are a time of homecoming, when we gather with family and share good food, good times and good conversations, but for people who don’t live near their parents, going home for the holidays can also provide time to assess how elderly parents are doing living independently at home.

So that’s Day 6.  Join us for Day 7 as we talk about doctors—and yes, the number of doctors your parents see does increase with age!

Thank you for listening to the Raising ‘Rents podcast.  This was Episode 14.  If you have any questions or feedback, please go to our website www.raisingrents.com and click on the “Contact” tab.  You can also find the show notes and references to anything we talked about.  Until we talk again, remember that our parents raised us, the least we can do is help raise them. Talk to you later.

Links Referenced:

AARP medication record 
• AAAseniors.com and seniordrivers.org.
• Alzheimers Association http://www.alz.org/georgia/in_my_community_16195.asp
Learn Not To Fall 
National Council On Aging
Family Caregiver Alliance National Center on Caregiving
Today’s Caregiver
• Caregiving in the U.S. (2015). The National Alliance for Caregiving (NAC) and AARP
• Dictionary.com
National Center on Caregiving
Eldercare Locator
• Intro/outro music: Arthaiz
• Daughter Anastasia Demopoulos does the opening voice over
• Website developed and managed by Philip Golden