The signs can be subtle. Your loved one seems short of breath walking up stairs, even though her congestive heart disease has been well managed for years. Or you notice that her legs are more swollen than usual. You worry that the disease may be getting worse.
Before you jump to conclusions, first check to see if she’s taking her medications—the proper dose, at the proper time.
As our loved ones age, multiple medications may become harder to handle. Missing a pill, taking the wrong pill at the wrong time or taking the next day’s dosage when your loved one mistakenly thinks she’s missed today’s—any or all of these medication mishaps can worsen her health and lead to serious complications, such as confusion or falls.
Fortunately, there are a variety of options now available that can help your loved one—and you—to manage a complicated medication schedule. But be forewarned: Although these tools serve to remind her that it’s time to take medicine and to deliver the correct doses when required, no device can ensure that your loved one actually takes her medications. That is up to the individual and may involve caregiver supervision. (And even then, if your loved one is competent, she still has the right to refuse medications—a whole other topic.)
First Step: Weekly Pill Minder
At the most basic level, weekly pill minders are simple boxes with individual compartments for each day, with tabbed sections for doses in the morning, midday, evening and bedtime. These are available in most drugstores for a few dollars and can provide the first transition from a clutter of pill bottles on the nightstand to an organized system for dispensing medications. If your loved one is only having a little difficulty remembering whether he took his doses today, a pill minder is an easy way for him to quickly check if the correct compartment is full or empty.
Depending on his level of ability at this stage in the aging process, he may be able to set up the box himself or with your help. Or you may make a weekly practice of filling the box for him. Some pharmacies will also provide weekly medications in blister packaging labeled by day and time for each dose—which essentially replicates the pill minder box without the hassle of setting it up. (This format can present some challenges to older individuals for opening each dose, but it can be an excellent option when your loved one has a personal caregiver or has help in assisted living.)
In any case, it’s a good idea to check to be sure your loved one has been taking his medications on time. If you see that some pills are still in their compartments days later or if the pill compartments are opened in random order, it’s time for a more elaborate system.
When Memory Begins to Fail: Electronic Medication Management Systems
The newest medication management systems on the market combine a form of pill minder with a secure electronic dispenser and alerts. One such system looks like a box with a series of shelves, one for each week. The shelves are actually disks with individual compartments containing each dose for that particular week.
At the appropriate time of day, the system sounds an alert and a voice message that it’s time to take pills. The individual pushes a flashing button, and the system dispenses the dose into a small cup. You can fill the shelves each month, or in some cases, have a nursing service that will manage this step for you and your loved one.
As an additional safety check, if the individual doesn’t follow through within a set time period, a friend or relative can receive an alert on a smart phone that she missed a dose. This provides not only a chance to help your loved one take her pills on schedule, but also a way to monitor if she is struggling more to manage medications independently.
Limitations and Next Steps
Good as these systems are, they do have some important limitations. At present, electronic medication management systems do not dispense liquids or injections, such as insulin. Also, they cannot yet be programmed for medications “as needed,” such as ibuprofen, or for dosing adjustments when, for example, your loved one is being tested daily for the correct amount of warfarin to control blood clotting.
In addition, a medication management system is only as good as your loved one’s ability to use it. There is no “one size fits all.” Be prepared for trial and error until you find the best fit. Review your loved one’s patterns of taking medications with compassion and respect, while remaining vigilant about any changes in behavior.
It’s also essential to have regular conversations with your loved one and his physician, to be certain that all of his medications are actually necessary, helping him to manage symptoms and stay healthy. Especially if he has a variety of specialists, his primary physician needs to review medications and dosage levels for interactions and side effects—at least annually, if not several times a year if his health status changes.
As your loved one needs more support, the best way to ensure that he’s taking the right medications on time is with the help and supervision of a licensed caregiver. An Aging Life Care Professional™ can help you to determine when it’s time to take this step and how to choose the right level of support for your loved one’s unique situation.
President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.
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Image Credit: Adam Ciesielski