October/November 2010 Print - Aging Well Rochester

Managing medications: Why Mom doesn't take her pills

Did your mom teach you to “do what the doctor says”? If she’s not following doctor’s orders for medications now, you’re probably feeling confused. And concerned.

It’s common for patients not to take pills as directed. Some reasons include:

“It’s too costly.” One quarter of new prescriptions are never filled because of cost. Make sure the drug is on the insurance plan formulary. Or ask about generics. Find a discount pharmacy, or consider mail order.
“I feel fine.” Many illnesses lack noticeable symptoms. High blood pressure and high cholesterol, for example. These prescriptions often go unfilled. Many people don’t finish their antibiotics for similar reasons: the symptoms went away. Ask the doctor or pharmacist to review with your loved one why a medication is necessary.
“It made things worse.” Consult with the doctor or pharmacist. Reducing the dose or changing from morning to evening may fix the problem. Or taking a different medication may be advised.
“It was too complicated.” Some drugs require multiple doses in a day. Others are restrictive (“30 minutes before eating”). Ask the doctor or pharmacist about alternatives.
“I can’t get the bottle open” or “I can’t read the label.” Arthritic hands and poor eyesight can make it difficult to follow directions. Ask the pharmacist for large type on the label and a NON-child-proof container.
“Why bother?” Hopelessness and depression are common reasons why people don’t take their medications. If you suspect depression, ask the doctor to do an evaluation.
“It won’t do anything.” Perhaps your loved one has an entirely different interpretation of what is wrong. Consider using the motivational interviewing techniques described in our article, “Your changing role: Becoming a partner-in-care.” The discoveries you make in the conversation can help you increase the likelihood that he or she will follow the doctor’s orders.
“I forgot.” Simple memory lapses are a fact of aging. Look for solutions to forgetfulness in next month’s newsletter.

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Should Dad still be driving?

Some people maintain strong driving skills as they age. But over time, most of us lose physical abilities that are key to safe driving. Indeed, only teens have more accidents per mile than do adults over age 65.

Advanced years alone are not a reason to stop driving, however. Health, fitness, and thinking power, not age, determine a person’s ability.

Following are signs of possible problems:

Trouble with vision or hearing. Watch for problems seeing lane lines or pedestrians, overlooking stop signs, or judging the speed of oncoming traffic. Other signs include discomfort with glare or driving at night.
Inability to twist or turn easily. Arthritis and stiff muscles can make it painful to turn and look when needed. This can lead to trouble when backing up, changing lanes, or merging with traffic.
Medication use. Many medicines can slow thinking and response time. Drugs for depression and anxiety can do this, as can sleeping pills and medicines for heart conditions, colds, and allergies.
Dementia. At “early” stages, many individuals can still drive safely. Talk to your loved one’s doctor about a driving skills evaluation.
Two or more recent tickets. Consider tickets a yellow, warning light. Common infractions include poor parking, running a stop sign, or going the wrong way.
Two or more recent accidents. Parking lot and sideswipe accidents indicate driver error. Poor depth perception also causes seniors to have a very high rate of left turn accidents.

Take regular ride-along outings. Notice your loved one’s skill level and confidence level. Ask for input from friends and neighbors.

In the next issue, we will discuss things you can do if there is reason for concern. It is important to approach this subject with sensitivity. In the meantime, you may want to explore self-assessments your loved one can take privately, at home. These two were created by the American Automobile Association’s Foundation for Traffic Safety.

AAA Roadwise Review (30-minute multimedia screening tool measuring specific mental and physical capabilities)

AAA Drivers 55 Plus: Self-Rating Form (15 multiple choice, text-based questions)

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The four stages of hope

Is life with a terminal illness hopeless? Not at all. Seriously ill individuals thrive on hope, just like the rest of us. It gives us a sense of purpose.

According to hospice expert Cathleen Fanslow-Brunjes, hope in serious illness typically has four main stages:

Hope for a cure. “I’m not going to let this stop me.”
Hope for treatment. “I think the radiation is really working!”
Hope for prolongation of life. “I want to go to the family reunion.”
Hope for a peaceful death. “I’m hoping for no pain in my final days.”

The four stages often align with disease progression. But it’s not uncommon for a person to move back and forth among them.

Knowing the four stages, you can better support your family member in sustaining his or her hope. Listen carefully for comments that indicate hope.

Many families are concerned about “realistic hope.” Find out what your loved one is hoping for and ask the doctor if it is feasible. If so, then all of you can work toward this shared goal.

If the hope is not realistic, it may signal the need for a change in care goals. But it does not mean your loved one must be without hope! Instead, it means you need to talk together with the doctor and come up with a more achievable project or purpose.

Dr. David Casarett, a hospice physician, wrote an insightful book about this topic called “Last Acts.” It specifically looks at the many ways his patients chose to find meaning in their last few months, weeks, and days.

Hope is always available. We just need help knowing how to look for it.

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