Caring for the Elderly: Tips About Medications
A Bit of Background
The small physical problems that we begin experiencing in adulthood have a tendency to expand and become more problematic as we age. That stiffness turns to pain and even reduced mobility. The failure to stop smoking has resulted in some difficulty with breathing and maintaining a more active lifestyle. So on and so forth. Of course, as we get older, there are other things that may come along which are even less expected. High cholesterol, osteoporosis, heart disease, and other problems may show up and begin to gradually exert more control over our lives.
As these issues come to the surface, many older individuals find that medications become an important part of life. At some point, they can even become overwhelming. So many medications to remember and such a large volume to ingest.
I'm not a physician, nor am I a pharmacist or nurse. I can offer no advice regarding medications, their usefulness, or interactions. I also don't feel qualified to discuss alternatives to the pharmaceuticals that are prescribed by most physicians. However, I am someone who is involved in caring for elderly parents and wanted to offer some suggestions regarding steps that can be taken to improve the chances that an individual will be able to comply with a medication schedule and be as safe as possible with them. These suggestions are based only on my personal experience with my aging father and mother and are not medical advice.
Difficulty Ingesting Oral Medications
Pill size can be a problem for some people. There are of course a number of options if an elderly individual encounters pills that are simply too large for them to swallow. Pill splitters are one option that's inexpensive and simple to use.
There are special pill cutters available to do the job easily and to assure all of the material is ingested versus left on the counter or floor. Pills should be cut just before they are taken to assure any protective coating is intact as long as possible and pill contents aren't exposed for any longer than necessary.
Of course, it's important to split the pill in a manner that makes it small enough that it won't get lodged in the throat. However, it's possible to split a very large pill leaving it with a sharp edge which makes it more painful if indeed it does get stuck. Pill crushers or pulverizers are other options that can eliminate this problem.
It is important to check with a physician or pharmacist before electing to do this. Certainly, some pills are not ones that are amenable to splitting or crushing and it can alter absorption rate.
Another important reminder is to take pills with enough water. This will assure the pill passes through the esophagus and on down to the stomach without becoming stuck. A pill that becomes lodged can be both painful and even dangerous. They can wear away some of the linings of the esophagus, form fistulas, and create additional problems.
Some medications are available in other forms and if you're caring for an elderly individual who is having difficulty, you can inquire with the physician or pharmacist about this. Some may be available in smaller, coated capsules which make ingestion easier, but even more useful is a liquid form when possible. Sometimes the medication itself can be switched and administered by an entirely different route as you can see below.
Going a Different Route With Medications
My father had difficulty swallowing large pills, crushing was useful for him. My mother, on the other hand, could swallow a pill the size of a walnut and never complain. However, she simply had difficulty ingesting the large volume of medications she had to take on most days. Finding a way to get her to consistently take all of her medications and to avoid becoming too full to eat anything, required us to check with the physician about other routes for taking the necessary medications.
Because of her low nutritional intake, my mother needed supplemental B12. Luckily, one of her options was to get this via a once a month injection versus continuing to take it in pill form each day. In fact, her body seemed to make better use of the supplement when taken this way versus in pill form.
Some of her other medications were also able to be delivered by alternate routes. Instead of a daily pill, she switched one of her medications to a patch and another was administered as a once a year IV infusion. This switch not only reduced the number of oral medications she had to ingest but also reduced the number of medications she had to remember to take.
Her arthritis medication was shifted to one which could be delivered by nasal spray although it was still a daily dose. A word of caution here, however: if the medication will be self-administered, you need to be sure that the individual can dispense a nasal spray properly so that they get the full intended dose. The same would be true of eye drops and so forth. It can be difficult to operate the dispenser if there is tremor or other weakness.
Remembering to Take Medications
If you're caring for an elderly individual who is living independently and will be self administering their medications, being able to consistently remember them is critical. No medication is effective if the therapeutic level of it is not achieved and maintained. This means that it must be taken in the prescribed dosage, on the prescribed schedule; not just when it's remembered.
When my father was alive, we simply made a chart and my mother and he recorded on it each time he took a given pill. My mother was his reminder. Then, years later my mother was alone, and there was no one else there to act as her back up memory.
There are a number of products on the market that can help organize pills, act as a reminder, and even dispense pills so that there's no confusion about whether or not a pill scheduled for earlier in the day was taken. They range from simple containers to electronic devices that include an auditory reminder and visual alarm. They're even capable of dispensing up to 25 to 30 pills in a single day. Many of these require filling as infrequently as every two weeks, allowing a friend or relative to refresh it periodically if necessary.
For individuals who merely need an occasional reminder, there are apps for phones that can notify users of a medication that is due. There are also watches that will perform this same function. But for elderly individuals with more needs, stand alone devices can handle a large volume well, prevent unknowingly taking an extra dose, and eliminate the need for handling pill bottles each time a dose is taken.
Today, some medical alert systems even provide medication monitoring and can be set up to alert care givers or family members if a dose is missed.
I used this electronic pill dispenser for several years with my mom. She lived alone during that time and due to the number of medications she had, was unable to remember to take them all in a timely manner. I felt using this actually prolonged her ability to continue to live independently. I loaded it when I visited her but from there it required nothing else from me as the caregiver.
It was loud enough that it could not be missed and it held a large enough volume to handle her many pills. It was simple to load and program which saved me a great deal of frustration as well.
Knowing Your Medications
Another thing I have learned is the importance of knowing all of the medications being taken and their dosage. My mother kept an updated list of all of her medications in her purse. Anytime we visited the doctor, they needed to know of any changes in medications and her handy list assured we made no errors. A complete list of medications is particularly critical if more than one physician prescribes drugs for the individual. Obviously, this information would also be important in an emergency.
Of course, medical alert bracelets and wallet cards can be a good idea for many individuals. These are often used for diabetics and patients on Coumadin, a "blood thinner". There are also medical alert signs that can be found online to put on your front door to alert any rescuers. A complete list of medications and so forth can the be kept on the refrigerator or medicine cabinet for their reference. Medical alert systems are also available which not only summon help in an emergency but often also keep a record of medications and medical information which can be used by rescuers.
Know the Danger Signs and Watch for Them
If you're caring for an elderly loved one, the only other medication tip I can give is to be sure you read up on any drugs they're taking. Acquaint yourself with the precautions, side effects, and any mention of drug interactions. Asking the physician about this is important, but talking to the pharmacist is sometimes easier, as getting time to talk to the physician when you aren't at an appointment can be difficult.
It's also important to know if a medication should be taken with food or without. It can determine how effectively the medication is absorbed. In addition, it can help guard against damage to the lining of the stomach. Many medications can cause stomach irritation if not taken with food. No one wants a situation where a medication causes further harm.
Any time a new medication is started, it's wise to monitor how the individual is responding. Are they having headaches, stomach upset, heart palpitations, loss of appetite, or anything else? It's important to keep tabs on things for a while. Of course, it's also possible that things can go fine for quite some time and only much later have problems arise when things seem to get out of balance. Medications can exceed their therapeutic level over time and need to be changed. Keep the doctor appraised! For elderly individuals who live far away, regular checks by the physician or a nurse are a good idea. Once a year visits aren't frequent enough for individuals with multiple medications or frail elderly individuals.
© 2009 Christine Mulberry