I've worked with the elderly and people with special needs for 20+ years. I have an awareness of some of the things that might help them.
A Bit of Background
The small physical problems that we begin experiencing in adulthood have a tendency to expand and become more problematic as we age. That stiffness turns to pain and even reduced mobility. The failure to stop smoking has resulted in some difficulty with breathing and maintaining a more active lifestyle. So on and so forth. Of course, as we get older, there are other things that may come along which are even less expected. High cholesterol, osteoporosis, heart disease, and other problems may show up and begin to gradually exert more control over our lives.
As these issues come to the surface, many older individuals find that medications become an important part of life. At some point, they can even become overwhelming. So many medications to remember and such a large volume to ingest.
I'm not a physician, nor am I a pharmacist or nurse. I can offer no advice regarding medications, their usefulness, or interactions. I also don't feel qualified to discuss alternatives to the pharmaceuticals that are prescribed by most physicians. However, I am someone who is involved in caring for elderly parents and wanted to offer some suggestions regarding steps that can be taken to improve the chances that an individual will be able to comply with a medication schedule and be as safe as possible with them. These suggestions are based only on my personal experience with my aging father and mother and are not medical advice.
Difficulty Ingesting Oral Medications
Pill size can be a problem for some people. There are of course a number of options if an elderly individual encounters pills that are simply too large for them to swallow. Pill splitters are one option that's inexpensive and simple to use.
There are special pill cutters available to do the job easily and to assure all of the material is ingested versus left on the counter or floor. Pills should be cut just before they are taken to assure any protective coating is intact as long as possible and pill contents aren't exposed for any longer than necessary.
Of course, it's important to split the pill in a manner that makes it small enough that it won't get lodged in the throat. However, it's possible to split a very large pill leaving it with a sharp edge which makes it more painful if indeed it does get stuck. Pill crushers or pulverizers are other options that can eliminate this problem.
It is important to check with a physician or pharmacist before electing to do this. Certainly, some pills are not ones that are amenable to splitting or crushing and it can alter absorption rate.
Another important reminder is to take pills with enough water. This will assure the pill passes through the esophagus and on down to the stomach without becoming stuck. A pill that becomes lodged can be both painful and even dangerous. They can wear away some of the linings of the esophagus, form fistulas, and create additional problems.
Some medications are available in other forms and if you're caring for an elderly individual who is having difficulty, you can inquire with the physician or pharmacist about this. Some may be available in smaller, coated capsules which make ingestion easier, but even more useful is a liquid form when possible. Sometimes the medication itself can be switched and administered by an entirely different route as you can see below.
Going a Different Route With Medications
My father had difficulty swallowing large pills, crushing was useful for him. My mother, on the other hand, could swallow a pill the size of a walnut and never complain. However, she simply had difficulty ingesting the large volume of medications she had to take on most days. Finding a way to get her to consistently take all of her medications and to avoid becoming too full to eat anything, required us to check with the physician about other routes for taking the necessary medications.
Because of her low nutritional intake, my mother needed supplemental B12. Luckily, one of her options was to get this via a once a month injection versus continuing to take it in pill form each day. In fact, her body seemed to make better use of the supplement when taken this way versus in pill form.
Some of her other medications were also able to be delivered by alternate routes. Instead of a daily pill, she switched one of her medications to a patch and another was administered as a once a year IV infusion. This switch not only reduced the number of oral medications she had to ingest but also reduced the number of medications she had to remember to take.
Her arthritis medication was shifted to one which could be delivered by nasal spray although it was still a daily dose. A word of caution here, however: if the medication will be self-administered, you need to be sure that the individual can dispense a nasal spray properly so that they get the full intended dose. The same would be true of eye drops and so forth. It can be difficult to operate the dispenser if there is tremor or other weakness.
Remembering to Take Medications
If you're caring for an elderly individual who is living independently and will be self administering their medications, being able to consistently remember them is critical. No medication is effective if the therapeutic level of it is not achieved and maintained. This means that it must be taken in the prescribed dosage, on the prescribed schedule; not just when it's remembered.
When my father was alive, we simply made a chart and my mother and he recorded on it each time he took a given pill. My mother was his reminder. Then, years later my mother was alone, and there was no one else there to act as her back up memory.
There are a number of products on the market that can help organize pills, act as a reminder, and even dispense pills so that there's no confusion about whether or not a pill scheduled for earlier in the day was taken. They range from simple containers to electronic devices that include an auditory reminder and visual alarm. They're even capable of dispensing up to 25 to 30 pills in a single day. Many of these require filling as infrequently as every two weeks, allowing a friend or relative to refresh it periodically if necessary.
For individuals who merely need an occasional reminder, there are apps for phones that can notify users of a medication that is due. There are also watches that will perform this same function. But for elderly individuals with more needs, stand alone devices can handle a large volume well, prevent unknowingly taking an extra dose, and eliminate the need for handling pill bottles each time a dose is taken.
Today, some medical alert systems even provide medication monitoring and can be set up to alert care givers or family members if a dose is missed.
Knowing Your Medications
Another thing I have learned is the importance of knowing all of the medications being taken and their dosage. My mother kept an updated list of all of her medications in her purse. Anytime we visited the doctor, they needed to know of any changes in medications and her handy list assured we made no errors. A complete list of medications is particularly critical if more than one physician prescribes drugs for the individual. Obviously, this information would also be important in an emergency.
Of course, medical alert bracelets and wallet cards can be a good idea for many individuals. These are often used for diabetics and patients on Coumadin, a "blood thinner". There are also medical alert signs that can be found online to put on your front door to alert any rescuers. A complete list of medications and so forth can the be kept on the refrigerator or medicine cabinet for their reference. Medical alert systems are also available which not only summon help in an emergency but often also keep a record of medications and medical information which can be used by rescuers.
Know the Danger Signs and Watch for Them
If you're caring for an elderly loved one, the only other medication tip I can give is to be sure you read up on any drugs they're taking. Acquaint yourself with the precautions, side effects, and any mention of drug interactions. Asking the physician about this is important, but talking to the pharmacist is sometimes easier, as getting time to talk to the physician when you aren't at an appointment can be difficult.
It's also important to know if a medication should be taken with food or without. It can determine how effectively the medication is absorbed. In addition, it can help guard against damage to the lining of the stomach. Many medications can cause stomach irritation if not taken with food. No one wants a situation where a medication causes further harm.
Any time a new medication is started, it's wise to monitor how the individual is responding. Are they having headaches, stomach upset, heart palpitations, loss of appetite, or anything else? It's important to keep tabs on things for a while. Of course, it's also possible that things can go fine for quite some time and only much later have problems arise when things seem to get out of balance. Medications can exceed their therapeutic level over time and need to be changed. Keep the doctor appraised! For elderly individuals who live far away, regular checks by the physician or a nurse are a good idea. Once a year visits aren't frequent enough for individuals with multiple medications or frail elderly individuals.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2009 Christine Mulberry
gottaloveit2 on October 16, 2014:
Excellent advice on medications for the elderly. I was my Mom's caregiver for the last 5 years of her life. You've nailed this topic!
PaperNotes on September 20, 2010:
Taking care of the elderly is sometimes similar to taking care of small children.. at times both are difficult to persuade in taking medications.
oldbooklover on August 26, 2010:
When an elderly person has become fragile, it is possible that the medications which are genuinely useful for stronger people will now be counterproductive for him/her.
Dr John Sloan, www.sunshiners.ca, has the facts. As a former family caregiver, I urge anyone in this position to check out this website and Dr Sloan’s book “A Bitter Pill.”
Peg Cole from North Dallas, Texas on July 08, 2010:
Mulberry1, How comforting to find someone else who shares in this responsibility. Your tips for monitoring medications are so incredibly important. I sometimes believe I'm more informed than some of the medical personnel we meet. Not in a medical sense, but in the knowledge of reactions to medicines, frequency, dosage and so on for my own parents. I switched my Mom's primary care Dr. after she was prescribed a new cholestral medication following a non-fasting blood test. Once retested with fasting beforehand, her readings were in the normal range. The side effects of the medication would have been worse than adding yet another pill to her day.
We must continue to question the authority of those who only see their patients every few months. We see them every day.
My heart goes out to you on the loss of your Dad, my deepest condolences. I lost my Dad in 2005 to non-Hodgkins Lymphoma. His last few days in the hospital were a nightmare. I found myself reminding the staff to wash their hands and wear masks before approaching him! I felt like such a jerk, but not only was it posted on the door to his room, it was for his protection. One time he was left lying in the hallway for over 20 minutes awaiting an xray. He should have been wearing a mask and someone had forgotten to put it on him.
Without an advocate, patients are at the mercy of anyone and face potential serious risk.
Good advice here for caregivers.
Nell Rose from England on January 01, 2010:
Hi, mulberry. A great hub. I wish we had known about all these different ways when my mum and dad were alive. My brother and I had to look after them for many years as my mother was over forty when she had me. The tablet dispensers and charts, where great but we always had to remember when we filled them. I think after a few years of doing this, we, and you are probably more qualified than the doctors! It was traumatic, but I wouldn't have changed it for the world. Love was the best medicine. Thanks Nell
Christine Mulberry (author) on September 07, 2009:
Glad it's working for you. Anything to separate them out and label them as you say is helpful!
Peggy on September 04, 2009:
We have found a way to help my mother-in-law take her medication. I bought small manilla envelopes (designed for coins). Each envelope has a label which says the date, day of the week, time meds should be taken, and how many pills are in the envelope. I prepare these. For example: the label will say "Friday, September 4, wake up, 1 pill" (on one envelope); Friday, September 4, morning,(on the next envelope) 8 pills; Friday, September 4, bedtime, 4 pills (on the last envelope). In this way, she cannot be confused whether or not she took her meds. It's been a great success.
Paula Atwell from Cleveland, OH on July 22, 2009:
My mother in law takes numerous medications each day and has a pill case to help, but she often forgets to take them and no one seems to be monitoring this well. This is excellent advice.
Frieda Babbley from Saint Louis, MO on April 26, 2009:
Important hub you have here, mulberry1! My father lives miles away from me, but he had some heart conditions. I have him give me all the details of his medicines and talk to his pharmicist and look everything I can on line. I keep up to date with everything and help to keep him informed. When first given medications, they're usually informed while under the fog of what they've just been through, so I make sure he gets all the info he needs along the way. Still I wish he were closer. But since he's not, this is the best I can do.
irenemaria from Sweden on April 13, 2009:
This is comforting to read. The worst situation is probably when YOU have to make all the descicions. When the loved sick one cannot.
Nancy's Niche on April 13, 2009:
Very informative with important points made. My children just went through a tough time when their father decided he refused all medications and any further treatment. Everything he tried made him feel worse and the loss of his independence was just too much. So, they moved him to a hospice center. He actually held on much longer than the doctors had predicted. He was determined to leave this earth on his terms and with dignity.
“The ultimate lesson all of us have to learn is unconditional love, which includes not only others but ourselves as well.” Dr. Elisabeth Kübler-Ross