Managing Medications

Why Mom may not be taking her pills

You may be frustrated to realize that your loved one is skipping necessary medications. It may be that they are forgetting. But take the time to ask with genuine curiosity why they have stopped taking the medicines. They usually have a reason that is important to them. Their answer can help you work together to find a better solution so their issue can be addressed without jeopardizing their health.

• “It’s too costly.” Cost is a major barrier for many patients, even with Part D Medicare insurance. About one in five older adults say they skipped medications, or took less, or took someone else’s pills because of financial reasons. Eight percent report skipping other essentials (gas or groceries) to afford their medicine. To begin with, make sure all your family member’s drugs are on the insurance plan formulary of covered medications. Or ask about generics. Look for a discount pharmacy or consider mail order. Ask the doctor if it’s possible to order a stronger dose and cut the pills in half to make them last twice as long. (This is not recommended if your relative has cognitive impairments or arthritis that makes fine motor skills difficult.) At the least, when open enrollment comes around each year, shop for a better price. Many plans change the list of covered drugs from one year to the next, and the cost. It’s worth it to see what the options are for Plan D—drug insurance—rather than simply renewing with the same company because coverage has been good so far.
• “I feel fine.” Many illnesses lack noticeable symptoms. High blood pressure and high cholesterol, for example. It seems unnecessary to take medication for something that doesn’t “feel broken.” Many people don’t finish their antibiotics for similar reasons: The symptoms went away. Or they drop antidepressants because they aren’t depressed anymore. Ask the doctor or pharmacist to review with your loved one if it’s appropriate to stop. If it isn’t, ask them to explain why that medication is still necessary.
• “It made things worse.” Likely this is an issue of side effects. Consult with the doctor or pharmacist. Reducing the dose or changing from morning to evening may remedy the problem. Or taking a different medication may be advised.
• “It was too complicated.” Some drugs require multiple doses in a day. Others are restrictive (“30 minutes before eating”). Ask the doctor or pharmacist about alternatives. Is there an “extended release” version, for instance, that can be taken only once or twice a day? Or maybe there are combined medicines so your relative can take fewer pills overall.
• “I don’t want to become addicted.” This is a valid concern for many medications, especially those relating to sleep or pain. Ask the doctor if there are alternatives that are less addicting. If not, request that they provide reassurance and education concerning signs of addiction and what can be done to reduce the chance of dependency.
• “I can’t get the bottle open” or “I can’t read the label.” Arthritic hands and poor eyesight can make it difficult to follow directions. Ask the pharmacist for large type on the label and an easy-open, NON-childproof container.
• “Why bother?” Hopelessness and depression are common reasons why people don’t take their medications. If you suspect depression, ask the doctor to do an evaluation.
• “It won’t do anything.” Perhaps your loved one has an entirely different interpretation of what is causing their health issue. This is worth a sincere discussion with the doctor. If your loved one has discovered other activities that help them feel better, that would be good information for the physician to have. A discussion like this will also signal to the doctor that they need to provide more education about your relative’s condition.
• “I forgot.” Simple memory lapses happen to everyone. But there are many conditions that can cause an older adult to forget (including medications they are taking!). From apps to dispensers, there are many ways to support remembering to take medicines at the appropriate times and amounts.

Medication management tools

It seems that the older we get, the more pills we take. Remembering to take them, and to take them on time, can challenge even the sharpest mind. Close to half of adults in the United States take their medications incorrectly. Not following the doctor’s medication instructions leads to roughly 100,000 preventable deaths each year.

If your loved one has occasional memory lapses, getting into a good routine for taking medications might be all that’s necessary to stick with the doctor’s recommendations. Some suggestions:

• Keep pills in sight. Good places might include the kitchen table or counter, or a dresser top. Do not keep them in direct sunlight by a window or in a steamy room, such as a bathroom.
• Link with other habits. Taking medications at the same time every day helps reinforce the regimen. Work with your loved one to associate pill-taking time with other routines, such as morning coffee or brushing teeth.
• Use a pillbox. Pillboxes organize daily doses for a week. The simplest have seven compartments. Others have two or three compartments per day for am/pm doses. Be sure they are easy to read and easy to open (even for arthritic fingers).
• Add an alarm. Consider a pillbox or watch with an alarm. Or program your loved one’s smartphone to ring a specific tone when it’s time to take a pill. Or have a digital assistant such as Alexa produce a reminder.
• Post a calendar and keep track. Sometimes the issue is remembering whether the pills have been taken or not. Keeping a calendar in a prominent place can serve as a reminder. Diligently marking when meds are taken can reduce the chance of double dosing by accident!

It could be that more active support is necessary.

What to look for in a medication app
Apps for smartphones abound. Of course, you need to match the features to your loved one’s capabilities. (Or use them yourself to keep track of the big picture.)

• Is it easy to enter the medications taken? Change dosages? Frequency?
• What is the reminder system like? Will it work if the person you care for has a hearing impairment? What if they don’t keep the phone on their body at all times?
• Can you get a summary list of medications? This is useful if you go to a new doctor or end up in the ER (as long as it’s kept up to date).
• How does it track whether medications were taken? And here is a downfall: What if the reminder was turned off but your relative forgot and didn’t actually take the pills?
• What happens if the reminder is not responded to? Do you or another family member get a text or some sort of notification?
• Does it alert you when a prescription may need to be refilled?
• Does it have advertisements or other distractions? Free apps are often funded through ads. This may cause trouble if your loved one has a cognitive impairment. Otherwise, it can just be downright annoying!

Other supportive technologies

• Prepackaged pills. If the person you care for has a stable routine, it might be worth having the pills delivered in packaged sets that are easy to take as a group.
• Telephone reminder. There are special services that, for a monthly fee, give your loved one timed, daily phone calls and an automated message to take their medications. Some services will notify you, the family caregiver, if the phone is not answered.
• Personal medical alert service. The companies that offer a button to push if there’s been a fall, frequently offer medication reminder calls as well.
• Automated pill dispenser. These dispensers are valuable for persons with cognitive impairments. Although there is no guarantee your loved one will take the medicine, the device can be programmed to sound an alarm and open a dispensing drawer when it is time to take a set of medications. Some can notify you if a dose is skipped.

Ask for a simpler regimen. It may be that doses can be adjusted so there are only morning and evening pills, no need for a midday reminder. Ask the doctor or pharmacist to review your loved one’s medications and simplify the prescriptions to make it easier to take them as directed.

When medicines change

There are many reasons why your loved one’s medicines might change. A stay in the hospital is one of the more common reasons. But sometimes a new drug comes on the market that the doctor thinks would be better. Or the pharmacist may have found one that has fewer side effects or is a more affordable option. Or that doesn’t have to be taken as often.

It can be confusing when routines change. But not taking all the medicines, or not taking them when they need to be taken, can result in the person you care for getting worse.

Be sure you understand:

• Which new medicines have been added. What are they for? What is the strength of the medicine? How often should it be taken?
• Which medicines have been dropped. (Or should be dropped if they are no longer needed.)
• Which medicines remain but have been modified in some way. For instance, they now should be taken at a different strength or at a different time.

And don’t forget over-the-counter and nonpill types of medicines. In addition to prescription medicines, you should ask about changes in over-the-counter preparations. The pattern of taking vitamins, herbs, and simple pain relievers may also need to be changed. Plus, don’t forget that some drugs now come in the form of a patch. Others are syrups. And still others are delivered through an ointment or cream. Be sure you include these when you confirm the new medication schedule.

Especially after a hospitalization, your loved one may need help keeping track of the new medications, until the new regimen becomes a habit. Here are other ways you can help ensure that the person you care for continues toward a strong recovery:

• Before leaving the hospital, make sure you understand the new medication schedule. What’s new, what’s been dropped, and what’s been modified.
• Get a good supply of any new medicines. If you don’t purchase a supply at the hospital pharmacy, stop by your pharmacy on the way home. Pick up enough so there is no gap in dosage.
• When you get home, compare the new medication schedule with the old one. Is there anything missing that surprises you? Studies show that up to 50 percent of discharge notes are inaccurate. Quite often the hospital didn’t know about a medicine your family member was taking when they were admitted. Just because it is not on the hospital discharge list does not mean the medicine should be stopped. If there are medicines your relative was taking before, call the doctor. It may be that it simply was forgotten in the hubbub of the admission process and needs to be restarted now that the person you care for is home. If you are not sure, try calling the pharmacy and ask for a medication list. (Ideally your relative gets all medicines from one pharmacy.) The pharmacist can also help you compare the old list with the new. They have a lot of experience with this!
• Set out at least a week’s worth of medicine. Use a pillbox that has a tray for each day. Preferably there’s even a tray for morning pills. One for midday. And one for evening or night. You may need to fill the pillbox until your loved one is fully recovered and has mastered all the changes.
• Write out the new medication schedule and post it by the pillbox. Put the date on it. Ideally, you would also keep a copy for yourself and have the person you care for carry a copy in their wallet. Be careful, though. Medications change often. If they do, you will want to update all the written lists. Or you might consider an online medication tool or app. That way you have to update the list only in one place—“the cloud”—and anyone with the password can access the most current list.