Remembering which meds to take, the right dosage, and at what times of the day can be difficult for anyone – and a daunting or impossible task for a person with dementia. Without a medication system in place, things can go desperately wrong for a person with declining memory and organizations skills.
For example, he or she may take a medication, and then not know whether they’ve actually taken it. Pill bottle tops, difficult to remove, may be simply left off, allowing the bottles to spill. A person may sometimes take a medicine relying solely on the pill’s color, leading to confusion with similar pills. And they may forget – is it one or two of the pink or blue pills? In addition, pills may be hidden under clutter.
We all know how a person’s health can suffer if they forget a medication, take the wrong one, or take too many. That’s why it’s essential that the person you care for gets assistance in managing their meds.
The type of assistance needed depends on his/her stage of the disease, the complexity of their medication regimen, and whether or not they live alone. For example, in the early stages, he or she may be able to take medications independently, if you sort and organize their pills in a 7-day pillbox. But in the late stages, you’ll need to administer all medications and keep them in a safe place to reduce the risk of an overdose.
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Memory Aids & Dispensers
Below are a few ideas to help you think about how to manage your care receiver’s medications. The system you choose will depend on the person’s remaining memory and judgment skills. Regardless of which system you choose, be sure:
- They can read the labels – you may have to put larger labels on the bottles or pill boxes (and if they can no longer comprehend text, you’ll have to administer all medications.)
- They can open the pill boxes or pill bottles (or ask the pharmacist for easy-to-open bottle caps if there are no children living in the household).
- To check often that the current system is working, as their needs will change.
When it’s time for you to manage and dispense their medications, one of the systems below might also be helpful for you as the caregiver.
Notebooks Recording when meds are taken is helpful to some, especially for liquid medications such as eye drops; you can’t visually check to see if eye drops have been taken the way you can with a pill.
Reminder Notes Use large lettering and place the notes where the person will see them.
Reminder Phone Calls In the early stages, a daily reminder phone call may help. If you try this intervention, be sure the phones are located for safe, easy access and that the person can clearly hear what you are saying. Click here for more information on easy-to-use phones. You can either make the calls yourself or use an automated service.
Automated Voice Reminders This type of reminder can be made by using a device you purchase and attach to the phone or a remote service (similar to a voicemail system).
Both allow caregivers to record a reminder in their own voice and can be set to play throughout the day. For example, “Mom, it’s 1:00 o’clock, time to take your Coumadin.” If the person doesn’t acknowledge the voice reminder message, the caregiver is contacted with an alert.
7-Day Pill Boxes with Multiple Sections Best filled by you (the caregiver), at a glance the person can tell if they’ve taken their pills for a given time period. Some caregivers fill one or several boxes at a time (and put aside the others in a safe place). Choose the best location (e.g., kitchen table) to keep the pillbox. If the person takes meds before bedtime, consider getting a separate, smaller pill box for their bedside.
Pill Boxes with Alarms You can program these lockable devices to dispense pills at set times throughout the day. An alarm continues to sound (with a maximum time limit) until the person picks up the pill box.
Wrist Watches with Alarms These watches can be programmed to remind the person to take their medications at set times throughout the day. Some watches sound an audible alarm, while others vibrate and display a scrolling text for the medication to take.
Medication Management in Mid & Late Stage Dementia
In the later stages, if the person is resistant to taking their meds, spend a few minutes with them first, building rapport. You may need to encourage the person, even if you think they don’t understand. For example, it may be helpful to say something like “Your doctor said it’s very important to take this medication. Please take it.” Or, “I need your help. Here, please take this pill.” And, of course, you’ll need to keep all medications in a secure place and administer them to the person.
If the person refuses to take their medications –
Ask his/her doctor if it’s safe to mash up the medication into a food that the person enjoys (like apple sauce or pudding), but be sure the person eats all of the food. Before trying this intervention, be sure to check with the doctor for each medication individually to avoid making any unsafe assumptions.
If the person can’t or doesn’t swallow the pills –
Caregivers have told us of care receivers tucking away the pills in their cheeks, in their pockets, or under their pillows, and only finding the pills later on, thinking all along they had been swallowing them. So check regularly to see if he or she is actually swallowing the pills and encourage the person to do so if needed. The promise of a dessert or a favorite activity afterwards can sometimes help.