Sometimes caregiving feels like just one crisis after the next. But it is often the day-to-day hassles that wear you down. Take managing medications, for example. Many caregivers feel frustrated when a parent or other family member rearranges the pill box, forgets to take medications or just says "No!"
"Nonadherence" — failure to take medications on time or in the proper dosages — can lead to serious side effects, such as confusion, dizziness or falls, which result in emergency room visits or hospitalization.
What can you do to help? Let's start with what you shouldn't do. Don't get into an emotional struggle with your family member. Arguing or coaxing will end in bad feelings, often spilling over into other aspects of your relationship. And it won't alter anyone's behavior anyway.
Here are some suggestions for a better approach:
1. Consider an evaluation. Your family member may have an undiagnosed depression or cognitive impairment that is affecting his or her ability to follow the prescribed regimen. Ask the doctor for an evaluation.
2. Create an up-to-date medication list. Make sure you include everything your family member takes — not just doctor-prescribed drugs but also over-the-counter preparations like aspirin, laxatives, vitamins, herbal supplements and others. There are many online tools to help, such as the UHF Next Step in Care medication management form.
3. Find out which medications are necessary. When you have an accurate and complete list, work with the doctor to reduce it to the bare minimum. Anne Myrka, a pharmacist at IPRO, the Medicare Quality Improvement Organization for New York state, in contract with the Centers for Medicare & Medicaid Services, advises, "Ask the doctor if each drug is necessary, whether it is appropriate for the person you are caring for, and whether it can be administered once a day instead of, say, every four hours." Just cutting down on the number of medications can help reduce the hassle.
4. Centralize pharmacy records. If possible, use only one pharmacy so that all your family member's records are in one place. If you obtain drugs through a mail order plan, there are pharmacists on call who can discuss the prescriptions with you.
5. Talk with your loved one. Now comes the hard part. Talk with your family member about why he or she doesn't like certain drugs or forgets to take them. Here are some common reasons:
- I don't like the way the drugs make me feel.
- The pills are hard to swallow.
- My neighbor took this drug and had a stroke.
- I feel better, so why do I need to take any medications?
- I can't afford all these pills.
The list goes on and on. Recognize that there may be valid reasons — what Myrka calls "intelligent nonadherence." "This is not willful bad behavior on your parent's part," she says. "It is the person's sense that something is wrong and that a drug may be the cause." In each case, perhaps the doctor or pharmacist can offer a solution — a different formulation, a different drug, an easier-to-open bottle, a better explanation of why the drug is important, a source for financial help in paying for drugs.
With a reduced and appropriate list in place, set up a simple reminder process. There are many different types of pill boxes, notifications and other devices that can help.
Review the medication list frequently, especially after an emergency room visit or hospitalization, or when a new doctor is consulted.
In this ongoing negotiation, you should aim for compromise. Your part will be to reduce the pill burden. In exchange, it is more likely that your family member will follow the directions carefully. You will both be better off.