I’ve been going on and on about nutrition. And, I’m probably not done with that. After caring for elders in a medical type of mind-set for so long, it still astounds me how much more important nutrition is to medical science. But, that doesn’t mean we should forget about the medical science.
If you have contemplated managing an elder’s medication regimen, and looked around for your Elder’s supplies and medications, you probably have already encountered my sentiments about the issue. It’s scary. No, that’s not the right word, really. More like Horrifying.
Elders, more often than not, require several different types of medications to manage several different disease processes. And then a few more, to manage the effects of the original medications. It can be very confusing, even if you aren’t demented.
Imagine trying to manage your medications if you are even mildly confused and/or forgetful:
• What do you take?
• Why do you take it?
• When do you take it?
• Should you take it with food, or on an empty stomach?
• Where do you go to get more?
• Are you supposed to take it forever, or just for a short time?
• Did you take it this morning? Maybe you should take it now?
• Will you remember to order more when you run out? (or will you forget about it and not take it anymore?)
• Will you remember what to ask your doctor if you have concerns?
• What are the side effects, and what should you do about them if you have them?
• If you have side effects, will you recognize it as a side effect, or just think you have developed another disease process?
• Where did you put that new bottle of medication?
• If you feel worse, does that mean you should take more of the medication?...or maybe none at all?
This list could go on and on and on…..in ever widening circles. Many times, elders have ended up having more problems with chronic diseases because of the medications they are not taking properly. The physician would call it “noncompliance with the medication regimen.” This can be disastrous to an elder, causing hospitalizations, acute confusional states with changes in behavior, or worsening of existing dementia. It could even result in death due to drug overdose or exacerbation of the disease process not being treated properly.
So, all that being said (and maybe, but hopefully not, experienced), now you have decided you want to manage your Elder’s medications.
There is a little bit of complexity involved in managing another person’s medications. But if you do all your homework and keep some records, keeping track can be easy to do.
You need to tackle this very large task one step at a time:
1. Find and gather up all the medications your Elder takes.
2. Attempt to determine if these are in fact the actual medications your Elder is supposed to take.
3. Become well informed about the health status of your Elder.
4. Become well informed about the medications your Elder is taking.
5. Organize the medications.
6. Dispense the medications to your Elder.
7. Monitor the effects the medications have on your Elder.
Ok, looks simple enough. Now, lets go into some detail.
1) Gather together all the medications your Elder takes. This includes herbal and vitamin supplements, and over-the-counter medications. Keep in mind that your Elder, especially if s/he is a little forgetful or confused at times, may not keep all the medications in one place. Some elders have a “gift” for finding new places to put things so they won’t forget. It may make you think your Elder used to be the Easter Bunny in a past life. Anyway, good luck.
2) Attempt to determine if these are in fact the actual medications your Elder is supposed to take. The easiest way to do this is to ask the Elder’s physician. Keep in mind, your Elder may have several physicians, and hopefully they all communicate with one another. But this is not always the case. Another way is to ask the pharmacist that fills your Elders prescriptions. Again, your Elder may go to more than one pharmacy, and/or use a mail type pharmacy service. The bottles of medications you find will have the name of the prescribing physician and the dispensing pharmacy. So that would be a start. And of course, this is all assuming your Elder can’t just tell you all of this.
3) Become well informed about your Elder’s health status. That is, you need to know what diagnoses the physician(s) are treating your Elder for, as well as those not being treated. This may necessitate you going to the physician’s office with your Elder and getting the Elder’s permission to access information about her/his health status, as all of this is confidential. Once you have determined what diseases and conditions your Elder is dealing with, educate yourself about these. There are plenty of resources online to help you. WebMD as well as Medline Plus are good resources for information about health conditions.
4) Become well informed about the medications your Elder is taking. Again, there are lots on online resources for you. The sites listed above have excellent information regarding medications, as well as herbal remedies and supplements. Your pharmacist can also give you informational pamphlets or printouts about each medication. You need to know:
• What condition/disease process is being treated with the medications.
• How does the medication work.
• What effect is the medication supposed to have on your Elder’s condition.
• How is the medication best administered (with food, without food, not in combination with certain meds, vitamins or foods, etc) and why.
• If your Elder can’t swallow pills, can you safety crush this medication (some meds, like time-release compounds should not be crushed), and mix it in applesauce or ice cream or some such thing. And if not, can you get it in a liquid form.
• What to monitor while your Elder is taking it (such as changes in behavior, appetite, blood pressure, pulse rate, etc).
• And most importantly, know what the side effects or adverse reactions are likely to be, and watch for these. Elders are very prone to side effects and/or toxic levels of medications because they are not able to metabolize and/or excrete chemicals efficiently.
• Last, know what to do if you notice adverse effects or side effects. Some medications cannot be stopped abruptly, and some you must.
5) Obtain a pill organizer box that will handle the amount of medications you
need to organize. There are all kinds available. Use whatever makes the most sense for you and your Elder. Basically, you want to be able to organize medications by dose and by day. Example:
Monday am, noon, pm, bedtime
Tuesday am, noon, pm, bedtime…..etc
An example would be a pill organizer box with 7 days, and four dosing slots for each day. Or, obtain four pill organizer boxes with one dose every day for 7 days. Then label each box for the dose with an indelible pen. So you will have one box for “AM” Sunday through Saturday, one for “NOON” Sunday through Saturday, etc.
The organization depends on whether you will be dispensing the meds to your Elder, or whether the Elder will be choosing the box and dosing slot to get the meds from.
Set up the medications for a week at a time. To prevent mistakes, do this during a time when you will not be interrupted.
While you are setting up the medications the first time, count how many doses there are, and determine on a calendar when you will need to reorder. Give yourself at least a week, or however much time you think you need. Write this down. Keep this information on all the medications in one place, on one calendar, on one piece of paper, or on an internet calendar. Reference this every week when you set up the medication organizer.
The easiest way for me is to reorder when there are less than 7 days of medication doses left in the bottle after I have just set up a week's supply. So, I always have at least 7 days worth of doses before the bottle needs to be replaced. Plenty of time to get a refill.
On your ongoing medication list, you may also want to include information that may be needed later, if something happens, like a hospitalization. The hospital staff should be able to get medical information from the Elder’s physician, but they always rely on the family members anyway.
So on your list you will need to have
• Date to reorder (keep this is pencil, so you can update it when you get a new bottle of pill).
• Medication, dose, frequency
• Condition treated
• Date it was first ordered
• Any dosing changes, why and date
• Date it was discontinued, and why (this information can be important for a physician that is not familiar with the Elder’s ongoing treatment plan).
It easiest for me to keep a table with the above headings across the top, and then list each medication with the information as it comes up.
Use a highlighter to cross off a medication that has been changed or discontinued. This way, you can still read it, but when you set up medications you know it is no longer an active order. This information can be invaluable when you are managing medications for an elder that has frequent changes in doses and drugs. Keep this with you when you visit your Elder’s physician, and especially when your Elder needs hospitalization.
6) Now that all the hard work is done, all you have to do is make sure your Elder takes the medication correctly. I prefer to dispense the meds and watch the Elder swallow them. That way, there are no mistakes. The meds are not forgotten, thrown away, put down somewhere and a child, a pet, or another confused person takes them. No telling what can happen!!
7) There’s just a little more. Monitoring the effects of a medication is important for several reasons:
• You want to make sure it’s doing what is expected, and if not, you need to tell your Elder’s physician.
• You want to monitor for side effects, and if you notice any, tell your Elder’s physician.
• You want to monitor for allergic reactions, and if there is a reaction, tell your Elder’s physician.
• And finally, if the medication is not helping, you may wonder why your Elder should continue taking it and risk side effects or drug toxicity. You probably want to discuss this with your Elder’s physician.
You will probably need to watch your Elder's blood pressure and pulse rate on a weekly basis, at least. Your physician should tell you, along with parameters for when s/he should be called. For a diabetic, maybe you need to monitor blood sugars. These things are for obvious reasons. What is not so obvious, are things that may signal intolerance of the medication, toxic levels, or side effects. Watch for changes in appetite, bowel habits, behavior, cognitive function, ability to sleep, and functional ability (walking, toileting, eating, dressing, etc.) Elders quite frequently will become more confused and forgetful, and stop eating when a medication does not agree with them.
There are certain medications that must be handled very carefully with the elderly. But more about that at a later time. This article is already pretty long.
By managing your Elder's medications for them, you can avert disastrous and unpleasant moments, and maybe even hospitalizations. It does take some time and research initially, but it is well worth the effort.
As always, wishing you and your Elder Pleasant Days.
image by basykes
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