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What to Do When Your Parents Refuse to Take Their Pills

Try these solutions if your loved one is having trouble managing medications

spinner image Adult daughter sorts through prescription pills with her mother
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Not taking prescriptions properly can affect your loved one’s quality of life.

The problem often happens when a disease or several diseases — such as diabetes, high blood pressure and high cholesterol — are chronic. Researchers have estimated up to half of those with long-term conditions stop, reduce or irregularly take their medications.

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“Depending on the medication, not taking it as prescribed can be dangerous and even life threatening,” says Nancy Avitabile, a social worker and geriatric care manager in New York. According to the Centers for Disease Control and Prevention, nearly half a million people over 65 visit emergency rooms every year due to adverse effects from medication, and they are seven times as likely to need hospitalization from these events as a younger person. “That’s why it’s important to … recognize when your loved one isn’t taking medicines as prescribed [and learn] what you can do about it,” Avitabile says.

1. Recognize the signs of missed doses

If you’re worried your loved one isn’t taking their medication, look for indications of problems, such as prescriptions overdue for a refill with a large number of pills remaining, or complaints about symptoms that the medicine should have alleviated, says Kemi Reeves, a nurse practitioner at UCLA Health in Los Angeles. Ask the pharmacy how often refills are being requested.

“Just because someone isn’t taking medications doesn’t mean they don’t want to,” says Reeves, whose specialty is geriatrics and dementia. They may be concerned about the expense, in denial about their illness, have memory lapses, be struggling with depression or face unpleasant side effects such as dizziness, lingering bad taste, bloating or upset stomach.

2. Converse with your loved one

Strive for undivided attention. Start by finding a quiet place to talk, turning off radios and TVs, and keeping other distractions at bay. You may be upset, but keep your body language relaxed.

Some Medicare recipients qualify for free drug management assistance

Participants in Medicare drug plans who take as few as two prescriptions, have multiple chronic conditions and expect prescription costs to exceed $4,935 in 2023 and $5,330 in 2024 may be eligible for medication therapy management services through their Part D or Medicare Advantage plans.

The program includes a yearly comprehensive medication review with a pharmacist, a written summary, and quarterly targeted medication reviews to address problems or potential problems. Qualifications differ depending on the prescription drug plan provider, so learn more from your loved one’s insurer.

Pay attention. “To understand why the medication isn’t being taken properly, listen actively and respectfully,” says Mari Umpierre, a psychotherapist and a director of employee wellness programs at Mount Sinai Health System in New York.

Acknowledge your loved one’s point of view, she says. But point out that a pharmacist’s instructions must be followed for a medicine to be effective.

Look for solutions together. Offer to work on reminders for pills and remedies to combat side effects. If you get pushback, return to the discussion later.

“Avoid a power struggle and distract them by doing something else, like taking a walk,” Umpierre says. “Then come back and use a different strategy.”

3. Review prescriptions with a doctor

Use one pharmacy. Fill all the prescriptions at one drugstore and choose it from the list of preferred pharmacies if your loved one has a Medicare Part D plan or a Medicare Advantage plan. That way, your first line of defense against drug interactions will be a pharmacist and the company’s computer system.

But don’t stop there.

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Tote the bottles around. “At every doctor’s appointment, a recheck of medications is essential,” Umpierre says. Bring a list of medications, or even better, the prescription bottles and any over-the-counter remedies or vitamins in their original packaging.

Consult the family doctor. If multiple specialists are prescribing medications, make an appointment with your loved one’s primary care physician to review all drugs and recent health problems such as forgetfulness or falls that could be side effects or a result of reactions among the medicines. Johns Hopkins Medicine in Baltimore suggests a once-a-year evaluation.

Ask which medications are neccessary. The doctor can determine which medications are a priority, UCLA’s Reeves says. It’s possible that some pills can be eliminated or replaced by a less expensive drug or one with fewer side effects.

“Often people are taking medications they no longer need because they may not any longer be at risk for the condition … or treatments have changed,” says Rosanne Leipzig, M.D., professor in the department of geriatrics and palliative medicine at Mount Sinai in New York.

Know the treatments. Be sure you understand what each medication is designed to remedy. Double-check that different doctors aren’t prescribing medicines for the same condition.

While reviewing drugs, urge the doctor to explain the benefit of each of the pills to your loved one and what could happen if they are skipped. Reading the information isn’t enough. For some older adults, unfamiliarity with medical terms is a big barrier to understanding instructions.

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4. Lean on a pharmacist’s expertise

Explore new forms for meds. If your loved one is struggling with swallowing a pill, ask if it is available as a liquid, a skin patch or a tablet that can dissolve under the tongue.

“Pharmacists can be very helpful in reducing barriers to taking medications,” says Grace Cheng, a clinical pharmacist at UCLA Health in Los Angeles. They’re “familiar with different options.”

Chop it. Grind it. If nothing other than a pill is available, you may be able to break a caplet, a tablet that’s oblong like a capsule, or a round tablet into smaller pieces using a pill cutter. You also may be able to crush it to add to ice cream or applesauce.

But discuss the idea with a pharmacist first and get a doctor’s approval if you want to change how or when a prescription is taken, Cheng says. Some medicines shouldn’t be split or pulverized. Some may have their effectiveness reduced if they are taken with food. Some may work better at night than in the morning or vice versa.

Medication Literacy Video Series: Medicine Management

How to help your loved ones remember their medicine

More than 4 of every 5 caregivers help manage medications , sometimes including intravenous fluids and injections, according to a 2019 AARP study. The percentage increased slightly from the results of a similar 2012 AARP study.

The rising number of those medications can make this task daunting: Nearly 42 percent of adults 65 and older take five or more prescriptions, a rise of more than 25 percentage points in about 25 years, according to the federal government’s 2019 National Health and Nutrition Examination Survey, the latest data available. About two-thirds of older adults take three or more prescriptions, and that doesn’t count over-the-counter medicines such as aspirin or antihistamines.

To help loved ones stay on track:

Make a list. Write down all prescriptions, over-the-counter drugs and other supplements that need to be taken, their doses and when they should be taken. You can get the information from the original bottles and boxes. Post it prominently.

Help with preparation. Once a week, you or a paid caregiver can fill pillboxes organized by day of the week or time of day. Or ask the pharmacist about medications in blister packs with individual pills sealed in a plastic grid to make it easy for your loved one to keep track of pills. Several internet pharmacies also can do the sorting for you for a price, delivering sealed and labeled medication packets organized by date and time.

Use prompts. Medications can be placed next to a coffee machine or a toothbrush as a visual reminder to take them. 

Toss out the old. If a medication has been discontinued, remove it from the home to avoid confusion.

Explore timers. Start with some simple technology, and you can gradually increase the amount of supervision as necessary:

  • If your loved one uses a smartphone, use the phone’s calendar app to set reminders.
  • smart speaker can do audio duty to suggest the time is now to pop a prescription.
  • A plastic pillbox that you stock is an inexpensive option to add if individual medicine bottles become unmanageable.
  • Medication organizers with electronic alarms can boost the level of nudges.
  • “Smart” pillboxes that pair with smartphone apps not only deliver reminders to your loved one on when medication needs to be taken but also tell you quickly and remotely if a dose has been skipped.

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