“I don’t need to take that medication. There is nothing wrong with me.” Sound familiar?
1. Are the Medications ABSOLUTELY Necessary?
At least once a week I’m on the phone with a family caregiver dealing with that issue. One of the first things I talk about is which meds we can safely stop. Did you know that proton-pump inhibitors, such as Prilosec(TM) (omeprazole) are for short-term use (a couple of weeks, maybe a month or two) only? And that the rebound symptoms of really bad heartburn can be minimized by titrating (weaning down) the dosage? So yes, the first thing I do is work with the family member and strongly encourage him or her to speak with the primary care provider about reducing the number of medications. If the PCP is part of the larger health care system where I practice, I contact the clinician directly.
2. Entering THEIR Reality
Persons with dementia may forget that they have health issues that require medication. Sometimes, taking medication together may help normalize the experience. You may also need to repeat the short, simple explanations, and enter their reality. By “entering their reality,” you come up with reasons THAT MAKES SENSE to the person with dementia and REFLECTS HIS OR HER VALUES.
One of my patients, who had a heart attack as a young man, will take any pill if his wife tells him it is for his heart. THIS MAKES SENSE TO HIM. He has forgotten many things, but not that he had a heart attack.
One of my ladies told her husband that his pills were all various types of Viagra—I’m not sure I’d recommend that, because it may have another consequence. In this particular case, taking a pill that could enhance his performance MADE SENSE to this particular individual.
My personal favorite, because this reason would work with me, was provided by an adult caregiver: “Mom, these pills will help you to look younger.” Mom always took pride in her appearance, and she was a beautiful woman, so her daughter tapped into mom’s VALUE SYSTEM. And daughter was somewhat correct: if mom took her medication and felt better, she would look better, too. Maybe even younger.
3. Swallowing Problems
As dementia gets worse, some people begin to have problems with swallowing pills and will chew them. This is an example of forgetting how to do things in the reverse order of how they were learned. Children start with chewable vitamins, then progress to swallowing pills later. If swallowing a pill is the issue, talk to your provider about switching medications to liquid, chewable, or patch alternatives.
Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.