Medication Management for Alzheimer’s & Dementia Caregivers

The Problem with Medication Management for Dementia

Someone with Alzheimer’s disease or other form of dementia is probably taking several medications, a regimen that might include prescription drugs, over-the-counter medications, herbal supplements, and daily vitamins. Knowing what to take, and when, is obviously made more difficult by the loss of focus and memory that are symptoms of Alzheimer’s. Even caregivers and family members might have challenges managing their loved one’s medications, especially when multiple, different caregivers assist throughout the days, nights, and on weekends.

Questions that come up include:

• How many kinds of medication do I take, and when?
• Did I already take my morning dose?
• Can I take these different prescriptions simultaneously?
• Does this need to be taken with food?

As the caregiver responsible for the health and safety of your loved one, knowing how to manage medications is important. Medication management, in fact, is one of the main reasons people with Alzheimer’s move into assisted living or memory care. If keeping prescriptions straight becomes too difficult, you might consider one of these options in long-term residential care.

But first, get organized by adopting a system with the tips below.

Understanding How To Manage Medications

As caregiver, it’s important you understand the medicines your loved one is taking. Speak with the doctor or pharmacist about:

• Why is this medication prescribed?
• What are the medication’s positive effects?
• What are the negative side effects?
• Is pill form the best version for your loved one? (Sometimes medicines can also come as a liquid, which is easier to swallow, especially in later stages of dementia.)
• Can the medicine be crushed and mixed with food? (This may also help in later stages.)
• For how long is the medication taken?
• What’s the daily dosage (how many pills and at what time of day)?
• What if a dose gets skipped?
• Is this medication OK when mixed with other medications?

If the doctor doesn’t present these answers in writing, write them down yourself. (See the Medication Management Worksheet below.) Be especially watchful when your loved one is beginning a new medication.

Solutions for Managing Medications for Dementia

Behavioral

After you’ve asked a doctor about all medications, and armed yourself with the right amount of knowledge on what to expect, there is more to keep in mind as caregiver:

Be Routine
Make medications a normal part of the daily routine by pairing dosing with events like mealtime, waking up or going to bed, or going for a walk.

Be Clear
Say aloud, very specifically, what a medicine is and how to take it. “This is your memantine. Put it in your mouth and swallow with this water.”

Try Again Later
If your loved one resists taking a medication at a particular time, try engaging in another activity and then offering the medicine later.

Alternative Approaches
Your loved may refuse to take a medication because it’s hard to swallow, tastes bad, or has unpleasant side effects. Talk to the prescriber about whether the medication is available as a liquid, or can be crushed and mixed with food (some can’t).

Get Organized
Pill boxes, envelopes, or other containers that can organize doses of medication by day and time can help someone with dementia keep track of when to take medicine, and tell whether a particular dose has already been taken. Simple organizers are useful in early stages of dementia, but in later stages you may need an electronic pill dispenser (see below).

Make Note
Keep a daily log of what medications need to be taken and when. A chart can be a quick visual reminder. Use the Medication Management Worksheet available below.

Hide Away
To prevent emergencies like an overdose, medication should be stored securely in a locked drawer or cabinet.

Numbers Ready
Keep emergency numbers easily accessible, perhaps on your refrigerator, in case of emergency.

Mind Signals
Signs that your loved one may have overdosed include uncharacteristic changes in behavior. Watch for extreme tiredness or agitation.

Make Note Again
Write down any changes in behavior and ability for your loved one, to share later with your doctor. The doctor may not be able to detect all problems (including related to medication) during a single appointment.

Technological Solution: Electronic Pill Dispensers

Labeled pillboxes can be difficult to open and easy to forget, so consider electronic pill dispensers (also known as “smart pill dispensers”) that are preprogrammed to deliver the correct medication at the correct time. Researchers found that seniors were very satisfied with electronic pill dispensers. Eighty-four percent of nearly 100 participants in a study said they would use the machine again. There are several options when it comes to electronic pill dispensers, including:

• Some dispensers will ring when it’s time for a medication. If your loved one misses the dosage a recorded message will play. If the medication is still not taken, the caregiver is notified.
• Dispensers can be set to sound an alarm or notify the caregiver if there’s an attempt to open it at the wrong time.
• Dispensers can provide the medication with instructions (on a screen or out loud) like “take with food.”

Some questions you will want answered when considering a dispenser:

• How easy or difficult is it to program?
• Do clock and notifications have a large, clear display screen?
• How many pills can the dispenser hold?
• Is it equipped to dispense multiple doses per day?
• Are pills dispensed into a cup, or does your loved one lift a lid? Are they easily accessed?
• Can the alarm be a recorded voice?
• Can the alarm be heard? Is there volume control?
• How does the dispenser notify the caregiver of an issue like missed medication? Must an app be downloaded?
• Is the dispenser portable?

The costs of these pill dispensers can run from just $40 to nearly $2,000. There are even subscription services with a monthly fee.

Medicare will not cover the cost of an electronic pill dispenser. It is possible Medicaid will help with costs, though that depends on state regulations. You may need to seek approval by arguing that a dispenser would save the state money by reducing the risk of calling emergency medical services.

Medication Management Worksheet

The National Institute on Aging has produced a printable Medication Management Worksheet (modified below) that can be shared or posted on the refrigerator or in the bathroom, to help caregivers and family members keep track of their loved one’s medication schedule.