When medicine is a mess.
Your mother sees doctors for several chronic conditions, and her latest checkup has you concerned. Her blood pressure is back on the rise, and not only that, her diabetes is no longer under control. When you check her kitchen/medicine cabinet, instead of the neat row of Rx vials you've come to expect, you find chaos: half-empty vials of outdated drugs, unopened prescriptions still in the pharmacy wrapping, packs of over-the-counter remedies and supplements -- and a plastic baggie filled with assorted loose pills in rainbow colors, like so many jellybeans.
The touchy conversation that follows makes one thing clear -- your mother needs help with her medication management. If you step up to take on that role, here's how to get things sorted out.
Make a list.
Start by playing detective -- teasing out which medications your parent really is (or isn't) taking. That means not just asking about prescription drugs, but also over-the-counter products, vitamins and herbal supplements, says Joan Baird, director of pharmacy practice for the American Society of Consultant Pharmacists. The complete list should include both daily drugs and occasional remedies such as sleep or cold medicines.
Look at labels.
A person could use a cough and cold syrup containing acetaminophen, not realizing that's the same ingredient as Tylenol, Baird says. A little later, that person might feel achy and take a couple Tylenol tablets. That's just one example of drug duplication, or redundancy. You wouldn't know that without reading labels, which could be challenging for people with vision problems or changes in comprehension. So you'll want to be aware of ingredients for every product in your parent's medicine cabinet.
Check with the pharmacist.
Once you've compiled the complete medication list, share it with your parent's pharmacist, who can pick up on redundancies, potential interactions and side effects. For instance, your mother might take Tylenol PM to help her sleep. But the medicine contains diphenhydramine -- the same ingredient as Benadryl -- which can contribute to falls in seniors. Because older adults metabolize (break down) medications more slowly, drugs can hang out in their body longer, Baird says -- and a drug that might make a younger person feel slightly tired the next day could leave a senior lightheaded when they get out of bed.
Baird describes another risky scenario that can be avoided: "The patient is taking St. John's wort, say, as an OTC supplement for depression, but is also taking Prozac. That would be a redundancy, and they can interact."
Clean up and streamline.
Multiple prescriptions from different doctors, so many pills on conflicting time schedules -- it's tempting to skip doses and easy to get confused. If a regimen is too complicated, other options usually exist, Baird says, such as switching to another drug in the same class or using extended-release alternatives for less-frequent dosing. On the other hand, with conditions such as cancer and HIV/AIDS, it may not be possible to alter complicated drug regimens.
Meanwhile, other drugs, like a heartburn medication, may no longer be needed, but the prescription just keeps getting refilled. Ask your parent's geriatrician or other primary care provider what's needed (and why) and what isn't.
Too much to swallow.
It can be daunting for anyone to polish off 20 or so pills at a time -- even more so if you're a senior with swallowing problems. Jodi Wood, a registered nurse and owner of the Akron, Ohio, branch of Visiting Angels, a home health provider, suggests asking doctors if pills can be spread throughout the day or taken in a different way. "There are other avenues for medication administration," she says. "Some things come in a liquid form. Some things can be crushed and sprinkled into pudding or food if that makes it easier."
Consult before making changes.
Your father takes Xanax to control his anxiety but you think it's making him too sleepy, so you decide he should only have it every other day. Or you alter your mother's water pill schedule to keep her from needing the bathroom so much at night. Making these changes on your own isn't a good idea, Baird and Wood agree. Instead, share your insights on how drugs affect your parent with health care providers, who can suggest the safest solutions.
Pick your pillbox.
You can choose from a variety of dispensers, with pharmacies stocking everything from basic day-of-the-week cups to four-times-a-day expanded versions. Color-coded dispensers often work well, and you can go online for dispensers with bilingual labels. Electronic versions come with alarms to remind patients and let others know when doses are missed. Talking pillboxes can be helpful for patients with vision loss. But "when you're working with someone who's 75 to 100 years old, sometimes the technology can be overwhelming," Wood says. "So you might meet some resistance."
Expect some push-back.
"Being a caregiver and being a daughter [or son] are two completely different things -- and when those roles cross, there's often friction," Wood says. Tackling medication issues is a "tough subject," she adds, similar to talking to parents about their driving ability. Wood says adult children should make sure parents always have a role in the decision-making process and feel like they still maintain some control.
Enlist outside support.
It helps to include siblings and other family members with medication management, especially if you're doing it from a distance. And you'll need backup at times, like when you go on vacation. If you want to bring in outside help, home health agencies provide a variety of care options, Wood says. It could be a combination of nurses coming in weekly or monthly to set up weekly pillboxes and coordinate with doctors and pharmacies, and non-skilled caregivers checking in on parents more often. A single RN visit costs about $100, she says, while charges for caregiver services range somewhere from $17 to $20 an hour.
Tweak as you go.
Medication management is an ongoing process, one you'll continually tweak and adapt, especially as parents' physical or mental condition changes. It's a painstaking and sometimes challenging role, but by making sure parents take medications the right way, you're helping them stay healthy and independent at home for as long as possible.