“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.
Categories: Dementia Medication Refusal Behavior
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.
My spouse (now age 72) had ministrokes in 2013 and a Neurologist told him TO HIS FACE that he has Alzeimer’s, cannot be left alone, or create new memories! I was appalled and took that Dr aside..my poor husband was already anxious through the roof! Anyway, I took him to another hospital, where they transferred him from Neurology to a Psych hospital, which started years of psychiatric treatment, including ECT… Fast forward-2018 he had a seizure,was put on Vimpat then taken off, last month had another seizure, now back on anti-depressant (50 mg and Vimpat. His current behavior looks like Parkinson’s (by Dr Google)–is it good idea to insist on PETscan? He’s had many CT EEG, and MRIs.
I’m sorry to hear about your husband. Given his complex history, it would be best to ask his current neurologist this question.
Rita, My husband and I are at odds about his cleanliness. He will not take a shower. People tell me he smells. He tells me he is ready and gets quite angry if I tell him he is not. I have tried everything. Please help!!