By Lauren Mahakian Contributing writer. Originally published in Palos Verdes Peninsula News on 1/11/22
Being a caregiver is hard, and caring for a loved one with dementia adds additional challenges.
As we try to care for nutrition, hydration, stimulation, physical therapy and overall home care, the essential component of medical care can become a huge challenge when pills are spit out or refused.
Providing medications to a loved one with dementia may require special care.
Nobody likes taking medications. By nature, it requires a level of trust in the prescriber, the medicine itself and who is serving it.
The only reason we take our prescribed medications is because we trust and understand their benefits to our health. Imagine if you could not connect that pill to a health improvement or prevention.
One of the most obvious reasons people with dementia may refuse to take medication is because they may not understand or have forgotten what it is for and what the benefits may be.
Another common reason is difficulty swallowing. A person may indicate that by grabbing their throat as a demonstration or with a facial expression of disgust.
Here are some tips for giving medications to dementia sufferers when trust is the key issue:
- Take some time to listen or find clues for the refusal. This information can be very real and even solvable (e.g. “My belly hurts. I think it’s this pill”)
- Talk to the provider or pharmacist. Be sure all medications are still truly necessary; reduce the number of pills, if possible (some supplements may already be part of a daily vitamin and may be able to be eliminated)
- Is there a special setting that may be helpful to administer the medication? Often, a calm setting with calm music may be helpful
- Ensure plenty of time is allocated to this process with minimal agitations or noises
- Try breaking the process down into steps, and reassuringly and calmly, explain what you are doing. Give them time. Any part of the process they can participate in should be encouraged
- Consider who is serving the medication and how it is served. Consider if it should be served in a plate, taken from a hand to create greater trust , or if there is room for playfulness and laying the pills on a plate in a design or color pattern
- It may be necessary to group the pills in how they should be taken: liquid, chewables, non-chewables to minimize confusion. Leave the harder pills for the end
- With the help of a pharmaceutical website (such as drugs.com), consider creating a poster with the picture of the pill, its name and what it is for. This may be a good reference for caregivers and reduce fear for the patient
- Stick to a daily routine of time and place, chair and liquid. Routines are important for those with dementia
- Treats might be a good reward at the end. Not only as a stimulation for completion but it might even help take away any bitter taste the medicine leaves and instead relate medicine to something positive
Here are some tips for giving medications to dementia sufferers when difficulty swallowing is the key issue:
- Ensure there is no problem with gums, teeth or dentures
- Ask the pharmacist if a pill can be cut in half for easier swallowing
- Ask the pharmacist if a pill may come in a different form (tablet or liquid or patch) to reduce the stress of swallowing. For example, some dementia and painkiller drugs are available as a patch
- Ask if there is any problem with the medication being administered in combination with a food such as applesauce, canned peaches or pudding. Try to also give that food without medication at other times so its taste association is not tainted by the medication
For those who have mild stages of dementia, forgetting to take their own pills can be a problem. Here are some tips:
- Set an alarm to call them and remind them to take their prescriptions
- Consider a pill box with day of the week and AM/PM designations. Some pillboxes even come with alarms and reminders
- Ensure they have the required dexterity for opening containers and pouring water
When there is complete refusal, you may have to evaluate with your care professionals if the person has the capacity to refuse medication. If the person does not have capacity, then the prescriber will be able to make a decision about what is in their best interests.
When making this decision, the prescriber should talk to the person’s relatives, and other professionals involved in the person’s care.
If a power of attorney for health has been set up, it is up to the POA to make the decision, with the help of the prescriber. If it is decided that taking the medication is the best option, then this should be done through the least restrictive means available.