Managing medications in the home

[Jaded'n'faded]

We had two PWD at home with different presentations/issues.
MIL had dosset boxes for years but they didn't work too well as she was not orientated to days. We tried prompts but she would say that she had taken them and would argue that the days were wrong or that she had her own system of days. We found months worth of boxes hidden all over the house. We then tried an electronic dispenser for her but she was still insisting that it was wrong/ had given her them twice /she had already taken them and even went into kitchen to take them and put them in the bin! This went on for years. It is only now she is in a Nursing Home that she takes them daily. In total we had issues with her and medication for about 10 years.
FIL got mixed up with his medication as it changed monthly after warfarin blood tests - the more it altered the worse it got. We got the warfarin changed to Rivaroxaban and got dosset boxes. They didn't work too well so we got him an electronic dispenser which he loved, he always did like a gadget. He had his electronic box about 2 years before MIL and for 4 years in total. She got the tablets out for him everyday and he took them no problem. So even though she was used to the dispenser for her husband and continued to give him his tablets everyday until he went into care ( 6 months before her) she never engaged with it for herself.
I agree about regular reviews and removal of unnecessary medication - we also got everything to 'once a day' to minimise the battles with MIL but it still didn't work.

@milrose2021 This is what you're up against. A fine example of dementia logic!

 

[silkiest]

MIL used a dosette box and often missed days and if she dropped a tablet it was immediately forgotten. We tried recorded reminders via her carephone - she just used to swear at it ant tell it to shut up. We eventually had to lock medication up as she either took too much or too little and some of it was quite potent stuff.
On the other hand the vet understood our problems with her dementia and whenever her dog needed medication she tried to dive the dog a long acting version of the drug - eg one off antibiotic injections for a week, long acting ears drops.
If the vet can do this for animals why can't more of this be done for PWD. If mum or MIL needs antibiotics its then a separate medication to organise that is not in the dosette box and is almost impossible for us to deal with without carers.

 

[Bod]

Thank you, @Bod for sharing. It sounds like regular medication reviews, that should happen at least yearly, did not happen. I wondered whether you would trust another healthcare professional e.g. pharmacist working in the GP setting or community pharmacists to conduct medication reviews.

Medication Reviews, should really be done by the GP or Consultant, although a senior Pharmacist, should know if medications are working against each other, better than a younger GP.

Bod

 

[Banjomansmate]

@milrose2021 This is what you're up against. A fine example of dementia logic!

The Banjoman insisted he had his own time that was different from mine or everybody else’s.

 

[Sarasa]

@Sarasa What the GP did was very interesting and rather brave! There is now a move towards 'deprescribing' within the health system and it seems like this was needed at that time. Perhaps this could be a plausible area of research. Thank you for sharing.

That would be interesting. The GP certainly seemed to feel that once elderly people were put on a drug regime not enough was done to check that they were still suitable. I'd also like to back up @Banjomansmate point about the changes in packaging or maker of a product. Every time that happened my mother felt the new brand was less effective. Mainly I think as she saw any changes as an attempt to palm her off with cheaper drugs.

 

[Melles Belles]

My FIL was convinced that if the pharmacist did not have the right tablets available they would just put any old tablets into the dosset box and could not be convinced otherwise even by our daughter who is a pharmacist.
He was also further confused if the colour, shape or size of the tablets changed because they were made by a different manufacturer than the original ones. Again impossible to persuade him otherwise.
Also he would refuse to take any white tablets. White ones would be left in the dosset box.

 

[Grannie G]

Thank you so much for sharing @Grannie G What do you think could have helped both situations?

I don`t really know @milrose.

When my mother had dementia she was widowed and I lived 15 miles away and worked full time. I`m not a driver and relied on my husband to take me to her but he was still working too and it was quite difficult to monitor her.
Only when we moved to live nearer to her did we realise how bad the situation was and that was when I consulted her GP.

My husband believes in alternative remedies rather than pharma drugs and was always reluctant to take even an aspirin. He hated taking his diabetic medication but at least pre dementia realised they were helping him. Once the dementia set in he reverted back to his dislike of drugs and no longer had the appreciation of their value.

 

[Duggies-girl]

Dad managed very well with the three tablets he took every morning like clockwork but when the donepezil tablet was introduced to be taken in the evening it completely messed up the system, we solved that for a while by having dad take all four tablets in the morning until the day I arrived to find he had removed every tablet from their packets and arranged them in neat piles by their colours. It took me some sorting out to get them back in the packs where they belonged but from then on I kept all of the pills and put his morning dose in his little dish the night before which also worked for a while.

His tablets were eventually reduced as he had cancer as well and his oncologist suggested that the statins and another one were of no benefit to him anymore. I clearly remember him saying 'I always have four tablets' and I told him 'the doctor said you only need two from now on' and he replied 'Well I must be getting better then' I didn't argue with him because he was obviously very happy with himself.

 

[Grannie G]

'Well I must be getting better then' I didn't argue with him because he was obviously very happy with himself.

That reminds me of my husband`s last MMSE test. He was asked to write a sentence and he wrote `i am getting better.`

 

[Duggies-girl]

That reminds me of my husband`s last MMSE test. He was asked to write a sentence and he wrote `i am getting better.`

 

[Duggies-girl]

@Grannie G It's so sad. I felt like I had been cut.

 

[Jaded'n'faded]

My FIL was convinced that if the pharmacist did not have the right tablets available they would just put any old tablets into the dosset box and could not be convinced otherwise even by our daughter who is a pharmacist.
He was also further confused if the colour, shape or size of the tablets changed because they were made by a different manufacturer than the original ones. Again impossible to persuade him otherwise.
Also he would refuse to take any white tablets. White ones would be left in the dosset box.

I don't like the white ones either ?

 

[Tealy]

I found the Nomad system provided by the chemist was very good.
However there was still an issue as the tablets were pierced I the packet but later I would find them in the house xx

 

[Life]

Thank you, @Bod for sharing. It sounds like regular medication reviews, that should happen at least yearly, did not happen. I wondered whether you would trust another healthcare professional e.g. pharmacist working in the GP setting or community pharmacists to conduct medication reviews.

The pharmacist attached to our GPs surgery reviewed my OH's medication without checking with me, the GP, the Neurologist or the Mental Health team. OH has LBD and suffers serious hallucinations, paranoia and delusions, but the pharmacist took him off the antipsychotic, because my OH said that he wasn't taking it.

 

[WJG]

Simple - I want a blister pack that makes sense! The ones Lloyds supply are an appalling piece of design that confuses left and right, day and night

 

[jennifer1967]

the ones we have have the day then morning, lunch, tea and bed on them going downwards. how could the design be made easier for you? how would it look?

 

[try again]

Simple - I want a blister pack that makes sense! The ones Lloyds supply are an appalling piece of design that confuses left and right, day and night

They are difficult to open. I used to transfer my mum's into a bought one that had red and blue print for am and pm and we're easier to open. Worked for a while.

 

[Mahonia]

Hi,
I am a researcher who really wants to use my research skills to support people with dementia and their family caregivers with managing medications whilst living in their own home. From my very little experience in a previous study that explored how people with dementia and family caregivers view and manage medications, I have a sense that this topic is a mindfield!

I wondered what are the most pressing issues related to medications that people would like solving/support with?

Many thanks in advance.
Rosemary

Electronic pill dispenser, it beeps and flashes so you can't miss them, then when you tip it and get the pills out it locks. There's an assistance device that helps tip it up when fingers get stiff. You can also some pharmacies to fill them as with a blister pack

But as with any technology it takes someone to stay at least a week with the person to get them used to using them.

 

[Mahonia]

Electronic pill dispenser, it beeps and flashes so you can't miss them, then when you tip it and get the pills out it locks. There's an assistance device that helps tip it up when fingers get stiff. You can also some pharmacies to fill them as with a blister pack

But as with any technology it takes someone to stay at least a week with the person to get them used to using them.

Pivotell

Pivotell Automatic Pill Dispensers - trusted by the NHS and Social Services.

www.pivotell.co.uk

 

[Sporadic gardener]

They are difficult to open. I used to transfer my mum's into a bought one that had red and blue print for am and pm and we're easier to open. Worked for a while.