Managing Medications

Why Mom may not be taking her pills

Did your parent teach you to “do what the doctor says”? If he or she is 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: 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. The next article discusses ways you can help your parent to remember.

Tips for remembering

It seems that the older we get, the more pills we take. Remembering to take them, and to take them on time, can challenge even the sharpest mind.

If your loved one has occasional memory lapses, getting into a good routine for taking medications might be all that’s necessary to stick with the doctor’s recommendations. Some suggestions:

• Keep pills in sight. Good places might include the kitchen table or counter, or a bureau top. Keep them away from direct sunlight by a window or a steamy room, such as a bathroom.
• Link with other habits. Work with your loved one to associate pill-taking time with other routines, such as morning coffee or brushing teeth.
• Use a pill box. Pill boxes organize daily doses for a week. The simplest have seven compartments. Others have two or three compartments per day for am/pm doses.
• Add an alarm. Consider a pill box or a wristwatch with an alarm. Or program your loved one’s cell phone to ring a specific tone when it’s time to take a pill.

More active support may be necessary if your loved one has ongoing memory issues. Among the options available:

• Automated pill dispenser. These dispensers sound an alarm and open a dispensing drawer when it is time to take a pill. Some can notify you if a dose is skipped. Check the federal government’s database of available products.
• Telephone reminder. There are special, national services you can sign up for, where, for a monthly fee, your loved one receives timed, daily phone calls and an automated message to take his or her medications. Some services will notify you if the phone is not answered.
• Email or text message. MyMedSchedule is a no-cost, online service that provides email or text reminders. Or check online for smart phone medication apps.
• Personal medical alert. Many home-based medical alert systems include an optional medication reminder service.

When medicines change

There are many reasons why your loved one’s medicines might change. A stay in the hospital is one of the more common reasons. But sometimes a new drug comes on the market that the doctor thinks would be better. Or the pharmacist may have found one that has fewer side effects, or is a more affordable option.

It can be confusing when routines change. But not taking all the medicines, or not taking them when they need to be taken, can result in your loved one getting worse.

Be sure you understand:

• Which new medicines have been added (what they are for, the strength of the medicine and how often it should be taken).
• Which medicines have been dropped.
• Which medicines remain but have been modified in some way. For instance, they now should be taken at a different strength or at a different time.

And don’t forget over-the-counter and non-pill types of medicines. In addition to prescription medicines, you should ask about changes in over-the-counter preparations. The pattern of taking vitamins, herbs, and simple pain relievers may also need to be changed. Plus, don’t forget that some drugs now come in the form of a patch. Others are syrups. And still others are delivered through an ointment or cream. Be sure you include these in your thoughts as you confirm the new medication schedule.

Especially after a hospitalization, your loved one may need help keeping track of the new medications, until the new regimen becomes a habit. Here are other ways you can help to be sure that your loved one continues toward a strong recovery:

• Before leaving the hospital, make sure you understand the new medication schedule: what’s new, what’s been dropped and what’s been modified.
• Be sure to get a good supply of any new medicines. If you don’t purchase this at the hospital pharmacy, stop by your pharmacy on the way home. Pick up a solid supply so there is no gap in dosage when your loved one gets home.
• When you get home, compare the new medication schedule with the old one. Is there anything missing that surprises you? Quite often the hospital didn’t know about a medicine your loved one was taking when he or she was admitted. Just because it is not on the hospital discharge list does not mean the medicine should be stopped. If there are medicines your loved one was taking before, call the doctor. It may be that it simply was forgotten in the hubbub of the admission process and needs to be restarted now that your relative is home. If you are not sure, try calling the pharmacy and ask for a medication list. (Ideally your relative gets all medicines from one place.) The pharmacist can also help you compare the old list with the new. They have a lot of experience with this!
• Set out a good week’s worth of medicine ahead of time. Use a pillbox that has a tray for each day. Preferably there’s even a tray for morning pills. One for mid-day. And one for evening or night.  You may need to fill the pillbox until your loved one is fully recovered and has mastered all the changes.
• There is a much smaller chance for errors if you reduce distractions when filling the pillbox. The television, conversations or trying to do other things at the same time simply increases the chance of error. Medication errors are one of the most common causes of hospitalization, and re-hospitalization. You can avoid that by giving the pillbox your undivided attention when you fill it once a week.
• Write out the new medication schedule and post it by the pillbox. Put the date on it. Ideally, you would also keep a copy for yourself and have your loved one carry a copy in his or her wallet. Be careful, though. Medications change often. If they do, you will want to update all the written lists. Or, you might consider an online medication tool. That way you only have to update the list in one place and anyone with the password can access the most current list from anyplace where there is an Internet computer.

Online tools for managing medications

Older adults with chronic disease commonly take at least five medications daily. That’s a lot to keep track of! And it’s one reason seniors are at high risk of medication misuse and side effects.

To safeguard your loved one and minimize the hassle of medication management, check out free web-based and smartphone apps. Each one has its advantages and disadvantages. For example:

Caring Village offers a medication list and refill tracker as part of their free set of online tools for family caregivers. You can create a medication list with dosages, images of the pills, and even the ability to upload a photo of the pill bottle.

• Advantages. This information is accessible from a computer from anywhere, by anyone you have given the password to. Good for your loved one if he/she is not smartphone savvy.
• Disadvantages. The printout is primarily a list of the medications—good for doctor visits—but not a schedule of what to take when. The pill images and pill bottle photos do not come through on the printout.

MyMedSchedule Plus is a mobile app downloadable from the Apple Store or Google Play. It allows you to carry all medication information in your phone. Among its features, you can:

Create an at-a-glance chart of medications to be taken daily.

• You enter the medication, dosage, and time(s) it should be taken. The program adds generic and trademark names and a color photo of the pill.
• Charts include a summary list, a list by time of day (great for filling pill boxes), and a checklist for keeping track of which pills are taken when each day.
• Email charts so you can print out a full-size, wallet-size, or even large-print version for easy reference.

Update information quickly and easily. When a prescription changes, make the change in the existing schedule and print a fresh copy. No more rewriting of lists!

Receive a reminder to take a medication. It’s easy to help Mom stay on track—from across town or across country. Have reminders automatically sent by email or by text.

Refill reminders are available by email or text message.

Keep everyone informed. You can readily share information by emailing or texting printable schedules to others. Before Dad goes to visit your sister this summer, bring her quickly up to speed.

• Advantages. Many different formats with very useful views (for filling pill boxes, talking to the doctor, etc.)
• Disadvantages. If the person you care for does not have a smartphone, they will be dependent on you to keep them supplied with current, printed out schedules.