Medication Safety for People With Dementia

Published In Blog

September 6th, 2018

It’s important for all people, especially seniors, to find safe and effective ways to manage their medications. But people with Alzheimer’s disease and other forms of dementia most often need special help.

People who have mild dementia are often able to live on their own and function independently. But progressive cognitive losses affecting memory, attention, language and decision-making often make it impossible for them to continue managing their own medications — and do it safely.

Family caregivers are most often called upon to help manage and oversee the process, which can be particularly tricky, as the disease often progresses in unpredictable ways. It also present practical challenges. In a study commissioned by the AARP not long ago, more than three-quarters of family caregivers said they were managing medications, including intravenous fluids and injections; almost half were administering five to nine prescription medications a day. They said the task was difficult because it took so much time, created anxiety about making a mistake, and some care recipients were uncooperative.

Medication Management Challenges

A person in early stages of Alzheimer’s may simply feel apprehensive about turning over control of the medication regimen to a family member. In later stages, he or she may feel threatened or frightened when a caregiver attempts to help administer medication, making the process stressful for all involved.

Researchers recently striving to produce a resource aimed to help people with dementia live independently as long as possible identified medication management as the most critical role — and found it is most often a source of stress for family caregivers as well as a “point of familial conflict that needs to be carefully controlled.”

While “careful control” may be an impossible dream in such a stress-laden situation, there are a number of steps you can take to help make the process easier.

Steps Toward Effective Medication Management

Get organized. People in the early stages of dementia may simply need help remembering to take medications. For this, there is no shortage of devices to help caregivers get organized — from labeled pill containers to daily checklists to prepackaged pill packs to automated reminders and wearables now beginning to flood the market.

Establish a routine.  Since people with dementia often find predictable, consistent routines to be calming and reassuring, it is often good to establish a common routine for taking medications. Check with the prescribing doctor or a pharmacist to find out whether any of the medications need to be taken at a certain time of day or must be taken with food or on an empty stomach. Then establish a ritual for taking them in the same place in the home and at the same time: right before meals, before going to bed, before or after brushing teeth.

Communicate. Make sure the person who needs care is wearing his or her glasses or hearing aids if needed before administering or distributing medications. Approach the person from the front and make eye contact. Then explain what needs to happen, speaking slowly and using clear and simple language. For example, you might say: “Here is the big white pill you take in the morning. It helps with the pain in your back.  Put one in your mouth. Take a sip of water. Swallow.”

All together now. If the person with dementia seems confused about taking medication and the caregiver also has medications to take, it may be beneficial to take them together at the same time. This helps normalize the event, rather than making it seem like a chore or something “being done to” the person who needs care.

Distract. If there is resistance, it is more important for the caregiver to stay calm. It often helps to divert the person to a more pleasant thought for a while such as reminiscing about early school days or a calming activity such as listening to music to distract from the drudgery or scariness of the medication regime. Then try administering the medication again.

Find another form. People with dementia may find it difficult to swallow pills, especially in the later stages of the disease. Find out whether the medication comes in another form such as a disintegrating tablet, a powder, liquid, or patch.

Prioritize the medications. If the person in need of care objects strenuously, making the process onerous, find out from the prescribing doctor or a pharmacist which of the medications are essential and whether any of those prescribed can be skipped, at least occasionally. Try to give the most essential medications first — and if possible, earlier in the day, when most people with dementia experience less agitation.

Hide it. A somewhat controversial approach is to give medications covertly, by hiding them in food or dissolving them in drinks. This commonly happens, whether admitted or not, in nursing homes and other care facilities. Family members, however, often say they are not comfortable with this bit of stealth. A majority say they approve of the practice, however, if the medication is helpful and used to manage mental distress — and a great many say that doctors are the ones who should make the call about whether to be covert. An added caveat: Be sure to consult with a doctor or physician before deciding to crush a pill or tablet, since it may render some medications unsafe or ineffective.

Take safety precautions.  Store medications in a locked drawer or cabinet to avoid confusion or an accidental overdose — and be sure to safely discard medications that are expired or no longer needed. Keep the number of the local poison control center handy in case of an emergency.

For more help. Join the Alzheimer’s Association’s online community for people with Alzheimer’s and their caregivers, who often share personal tips and advice on managing medications.

The American Journal of Nursing has produced a video that demonstrates tools to use when helping to administer medications to a person with dementia.

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