As caregivers, part of what we hope to do is enable and empower in the areas that we can. There are ways to address some care requirements that give the person we are caring for a feeling of personal control in their lives. With my mother, her ever-growing list of medications became an area of significant confusion for her; it wasn’t just what she was supposed to take and when, but knowing whether or not she had taken her pills already. This meant that keeping her medications in the prescription bottles wasn’t the correct solution for her anymore.
Some of the more obvious tools in this area include weekly pill organizers and digital calendars. The pill organizer we employed has color coded morning and evening compartments, with fairly large day of the week labels. But dementia can add a twist to even the simplest of things. My mother’s memory has gotten to a place where she doesn’t know what day of the week it is (despite having three calendars in her kitchen and dining room area), and depending on the season and length of the day she is sometimes uncertain if it’s morning, afternoon, or early evening. Focused research turned up a day of the week clock designed for the vision impaired. This remarkable device features a large, high-contrast display showing the day of the week, whether it’s morning, afternoon or evening, and even what time it is. I positioned her pill organizer in front of this clock in a highly visible position in the kitchen, and right where she has to pass it on the way to her sitting chair. I thought we had found our solution, but again, dementia changes everything.
The first problem was two-fold. First, she didn’t like that her prescription bottles weren’t where she expected them to be and that she didn’t feel in control of her medications now. The second part of this was her being angry because she didn’t know what the pills were that she was taking because they were already set out in the organizer. My attempt to resolve this was placing her pill bottles next to the organizer, so she could identify her pills if she really felt the need to. It wasn’t well accepted, but it kept us moving forward.
I have a full-time job that, thankfully, allows me to work from home for part of the week. On days I have to go in, I’m often not present to provide gentle reminders to take her medications. On these days it’s mostly up to chance if she’ll remember to take her medications despite having to walk right past them several times throughout the day. And when she did remember to take her meds, she’d most often take the one in the closest compartment with the right day of the week label. This left her taking her evening meds in the morning, so I tried orienting it with the morning compartment on the closest side – the problem with this was that the labels were then upside down, so she’d reverse it and take the evening dose anyway. Sometimes, with enough repetition, some things will stick in my mother’s mind, so each day over a period of several weeks I’d provide gentle instruction on how the pill organizer worked. Even so, it never did stick.
Then I discovered, quite by accident, that she was double-dosing on some days because she’d dose from her pill organizer then again from the prescription bottles when she would get confused. Missing doses and double-dosing made this an unworkable solution, leaving us looking for another option. Our next direction is seeing if I can get her to accept pill packs. Your local pharmacies may offer this service—putting all the pills for each dosing in a single plastic pouch labeled with the contents along with the date, day of the week, and time of day she needs to take it. On-line providers such as www.PillPack.com offer comprehensive prescription services as well, including automatic refills and home delivery. This is different from the pill organizer in that she won’t receive prescription bottles anymore, meaning no more possibility of double dosing from the bottles.
Where the challenge will be is in my mother accepting that the pharmacy has placed all the right pills in each pouch for her. After considering all the possibilities here, I’ve decided that I’ll create a cheat-sheet for her. Using the Pill.com Pill Identifier resources I can get images of her prescriptions and print out a large image of each pill with its name, what it does and any directions given by her doctor. This will be in an effort to help make her feel like she’s part of the solution and at least somewhat empowered regarding her medications. I’m hoping that with this solution, we can get a handle on the situation.
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