Caregiver advice: how do we get Grandma to take her pills?

In My Humble Opinion
1

My grandmother is into that slow decline that’s driving my mother absolutely frantic with worry. One particular I’m trying to help with is the pill taking situation. Or rather, of course, the not-taking pills situation. She’s (Grandma, that is, not Mom), on a number of pills for everything from high blood pressure to diabetes to early Alzheimer’s.

She lives mostly alone, with home health care aides there for a few hours a day (she wants them gone completely - this is a compromise because my mother wants someone there 24 hours) but despite repeat assurances that they’ll remind her to take her pills, the weekly pillbox is still often 1/3 full at the end of the week. I *think *she’s just not remembering, although it’s possible she’s trying to exert some independence here. If it’s the later, then there’s not much I can do, but if she’s just forgetting, I was wondering if there might be a technological solution to at least this part of my mom’s stress.

Has anyone used this Medcenter System? Was it too intimidating for your elder(s)? (Not to broad brush, of course, I know we have Dopers my grandmother’s age, but she never took to computers or anything more technologically advanced than a DVD player.)

Any other tips or advice? Mom’s really losing it trying to handle everything, and I’m not sure what to do to support her.

2

If your grandmother is not taking medications for whatever reason, there may be deeper problems than just that.

Your grandmother may benefit from a complete assessment to find out her overall condition since she’s not taking her meds. Her hypertension and diabetes may be uncontrolled,which, coupled with early Alzheimer’s, can contribute to safety issues such as an increased risk of falls.

I would definitely schedule a time for a complete physical and time with the doctor to address her overall needs. Also, if you can contact your local Department of Aging, they may be able to hook you and your grandmother up with appropriate services and guidance.

Airman’s family went through that with his grandmother. She deteriorated to the point where she fell. During her hospital assessment, she was found to be so deconditioned that she needed a three-week stay at a rehab facility, and round-the-clock care after that. The alternative was an assisted-living facility. Either way, there was no choice but that she needed to be looked after 24 hours a day, 7 days a week.

And it may be the same with your grandmother. I can understand you and your mother wanting to respect her wishes, but she may be at a point where her wishes may not be in her best interests, which means that you need to be able to find out what her best interests are and act appropriately.

Robin

3

Well, to give you a little more background, she has had two serious falls, and broken each hip - they were weird though. There’s no loss of bone density, no osteoporosis. She just slipped and fell - twice - and hit her hip on a sharp corner of cement. Same thing could have happened to you or I, according to her orthopedic surgeon. They aren’t “old lady broken hips” exactly, just…broken hips on a lady who happens to be old.

Anyway, the two falls were about a year apart. She fell once, spent about 8 months in hospital/nursing care/rehab, came home to 24 hour care, went down to partial home care, fell again a few months later on the other hip. Lather, rinse, repeat.

She’s had lots of medical visits, both to her GP and to specialists, in the last year. She got a medication review just before he put her on the Alzheimer’s med about three months ago. But that is a really great suggestion, thanks!

She’s at the point where, if you didn’t know her and spent less than an hour with her, you wouldn’t see anything wrong at all. Her confusion and memory loss is still on little things - days mixed up, conversations mis-remembered. Mom goes with her to all her doctor’s appointments so she can hear things from them, as Grandma’s reporting *sounds *accurate, but isn’t really at all.

Her home health care agency says she can cut down even further on hours, in their opinion. She’s moving around (slowly) pretty well, can use the toilet and wash her hands and heat things up for dinner in the microwave (although her days of cooking sauerbraten and red cabbage are probably over :frowning: ). They (and she) think that she could go down to one 8 hour day a week, for help with laundry and mopping and showering and that sort of thing.

I can see why Mom’s scared though - last time we got rid of the home health care, she fell again. (Mentioning that she currently has 18 unattended hours a day to fall in probably won’t help Mom gain some perspective!)

I know I can’t solve the whole thing - Mom’s not going to budge as primary caregiver, and I live too far away to be of daily use, anyway. But the medication thing seems like maybe one little piece I can help with in a practical way. I will also email Mom the Department of Aging info and see if there’s something similar in Grandma’s city. Thanks for that, too!

4

One more thing to look into - this may not be possible, but there are often extended release versions available of many medications. They are generally more expensive, and so doctors are often reluctant to prescribe them without a specific need. I’m guessing that your grandmother is currently supposed to be taking several medications several times a day. If you could adjust her medications so that she’s just looking to take them all at once, one time per day, perhaps that would make things easier for her, and for your mother.

Alas, it may not be possible to do that. Not all medications can be made extended release, and even if the extended release version is available, it may not be covered by Medicare, or your grandmother’s health plan. But it may be another way to simplify things for your grandmother.

5

[QUOTE=OtakuLoki]
One more thing to look into - this may not be possible, but there are often extended release versions available of many medications.
[/QUOTE]

Oh, *great *idea! Thanks! Yes, simply cutting down on the number of pills would be wonderful, and cutting down on the number of times per day she’s taking medications would be spectacular! I’ll suggest it to Mom to bring up at the next doctor’s visit.

6

You all may want to look into whether or not she actually needs all of the medication she’s taking. When my father-in-law was at that point in his life, he had so many pills he was getting really confused - even with a pill organizer - about what he should take when. My MIL took him in to have his main doctor assess all of his medications. He had been prescribed different things by different doctors, none of whom had a really clear overall picture of his situation. It turned out that they were able to cut a lot of the pills out because there were some things overlapping or working against each other. Some of the confusion and other side effects he was suffering were improved and he had an easier time with the organization of it all.

That could be completely irrelevant to your situation, but it may be an idea if it’s at all applicable.

7

With my aunt, we simply have to gently persuade her each and every time for each and every pill and be there when she takes them. I suspect you are in a similar situation with your grandmother. The home help aides will have to do this if you cannot. If they are instructed to do so and do not, then you need to find other aides.

8

Is she bothered by side effects from the medications? If so, she might have the general idea that “her medicine is making her sick” and avoid all of it. Isolating the problem, if there is one, might help.

9

Older people, in general, do answer the telephone. I remember the telephone company offered a service where you could phone in, leave a message to yourself, and have the computer call you back at the appointed hour with the pre-recorded message. How about using that as an automated reminder?

You could also put a number of the pills in the Outlook Calendar reminder systems of different (grand)children. Suppose you as her granddaughter put the times in you outlook where your grandma should take medicin X. Then you get reminders from your Outlook Calender, you phone grandma, and invite her to take her pills, so you can have a little chitchat afterwards. That would take some of the strain of your mom, and the bonus for your grandma is that she talks to her (grand) children more often.

10

Would your grandmother be open to an “assisted living” home situation? My girlfriend’s mother is in one and it has given my friend a lot of peace of mind. The independence is there, but they are checked on twice a day and get help with stuff. My friend’s mom is on section 8, so even if Grandma is financially unable to move into one of those fancy-schmancy places, she can still get the help she needs.

11

[QUOTE=C3]
You all may want to look into whether or not she actually needs all of the medication she’s taking.
[/QUOTE]

Thanks. This is really important for people to do when they’re taking meds from more than one doctor. In her case, it was done about three months ago by her GP.

[QUOTE=Quartz]
The home help aides will have to do this if you cannot. If they are instructed to do so and do not, then you need to find other aides.
[/QUOTE]

Yeah, this is the weird thing: from what they’re telling us, they can not legally be responsible for this. Something about dispensing medicine without a license or some rot. Two companies have refused outright, and one has repeated the bit about how they can’t be responsible, and the girls can’t actually hand Grandma the pills, but if they’re there and if they remember, then they’ll probably say something to her. :rolleyes: It should be noted - they aren’t nurses, or nurses aides or anything. They’re laypeople being paid $15 an hour to help her to the bathroom and go downstairs to do a load of laundry. Skilled nursing care - which, except for the pills, she doesn’t need - runs closer to $75 an hour. We just can’t afford that, no matter how much we love her - we’d drain her bank account in a few months and then she’d have to sell her house and move anyway.

[QUOTE=Harriet the Spry]
Is she bothered by side effects from the medications?
[/QUOTE]

You know, I don’t think anyone’s asked her. I’ll do that today and find out. Good idea!

[QUOTE=Maastricht]
Then you get reminders from your Outlook Calender, you phone grandma, and invite her to take her pills, so you can have a little chitchat afterwards.
[/QUOTE]

:eek: That’s a really great idea! I don’t know why I didn’t think of it.

[QUOTE=Kalhoun]
Would your grandmother be open to an “assisted living” home situation?
[/QUOTE]

Oh man, I wish. No, a thousand times no. She still thinks she’s going to get well enough to *drive *again. :frowning: She’s not willing to give up her house and she’s not willing to spend “her children’s inheritance” (not that there’s much of it left). Until she’s a clear and present danger to herself, we’re not going to force the issue. Considering that the home health people think she can do fine with *less *supervision, I don’t think we’re there yet.

12

I know she’s not there yet, and you’re not local so you can’t directly do this, but has she ever been to an assisted living community? Does she have any friends in one? Because I know that my grandparents think “old peoples’ home - ew” while we’re thinking “dorm life for grownups! Awesome!” because they haven’t seen the inside of one of the newfangled communities. If there’s one near her, maybe someone could take her to see that it’s not like it used to be. I wonder if there are even some activities that she could do there to help her make friends and get involved even though she doesn’t live there, to help encourage the move?

Sorry - this doesn’t directly help with the pill-taking issue!

13

[QUOTE=WhyNot]
Thanks. This is really important for people to do when they’re taking meds from more than one doctor. In her case, it was done about three months ago by her GP.

Yeah, this is the weird thing: from what they’re telling us, they can not legally be responsible for this. Something about dispensing medicine without a license or some rot. Two companies have refused outright, and one has repeated the bit about how they can’t be responsible, and the girls can’t actually hand Grandma the pills, but if they’re there and if they remember, then they’ll probably say something to her. :rolleyes: It should be noted - they aren’t nurses, or nurses aides or anything. They’re laypeople being paid $15 an hour to help her to the bathroom and go downstairs to do a load of laundry. Skilled nursing care - which, except for the pills, she doesn’t need - runs closer to $75 an hour. We just can’t afford that, no matter how much we love her - we’d drain her bank account in a few months and then she’d have to sell her house and move anyway.

You know, I don’t think anyone’s asked her. I’ll do that today and find out. Good idea!

:eek: That’s a really great idea! I don’t know why I didn’t think of it.

Oh man, I wish. No, a thousand times no. She still thinks she’s going to get well enough to *drive *again. :frowning: She’s not willing to give up her house and she’s not willing to spend “her children’s inheritance” (not that there’s much of it left). Until she’s a clear and present danger to herself, we’re not going to force the issue. Considering that the home health people think she can do fine with *less *supervision, I don’t think we’re there yet.
[/QUOTE]

That’s too bad. There’s far less “hovering” than one might think. I get where she’s coming from with regard to her home, though. Tough sitch. You hate to wait until it’s Too Late ™, but you don’t want to treat them like children. I suppose you could “gently threaten” (i.e., persuade her using examples of what might happen if she falls again, etc), but it doesn’t sound like she’s incapacitated enough for it to make a difference.

My dad is getting more forgetful all the time, so I know where you’re coming from. We are in a situation where we can stay with him (I could work from his house and my sister and niece could technically stay with him permanently if it got down to it).

The “less supervision” assessment kind of blows my mind.

It’s hell getting old… :frowning:

14

I didn’t see that pill system when I was on Amazon. I went with something more expensive. I think my Mom could have managed the system you’re looking at for a while, but would need something easier for her to use as time goes on. We’re really at the point where we need something really easy for her to manage.

I recently bought my mom this

My Mom is over 90 and having a hard time remembering to take her pills. It has become a real trial for my sister, who lives nearby. Our Mom gets really annoyed with my sister when she looks at her remaining pills to see what she’s taken. Asks if she’s “checking up on her again.”

This pill box is ridiculously expensive, but it will be worth it to us if it means my sister no longer has to be the pill police. My mom takes several pills that will do her harm if she takes more than her dosage. I think we’ve been seeing her take too many pills some days and not enough other days. She feels really sick in both situations. We need her to take her pill regularly or we can’t tell if the dosage is helping her or should be changed.

I had the thing shipped here for me to look at first, and then shipped it off to my sister a week ago. It’s really pretty clever; and smaller across than I had imagined. It’s six inches across, about the size of a small plate. It kind of reminds me of a smoke alarm that you’d put on your ceiling in size and shape. It has an alarm that sounds a bit like a warbly telephone ring, you can change the volume of the alarm if you need, but I’m sure this will be fine for us. That old lady has darned good hearing. The alarm rings for an hour, and the way you turn it off is to flip it over. The section with the pills you need to take is open, so the thing you need to do is to dump the pills into your hand to get the ringing to stop. Once the pills are sitting in her hand like that, she’ll probably take them.

The unit locks with a little key, so my sis can put enough pills into the thing for two weeks at a time and then lock it up. There are no buttons or dials or anything showing when its locked and ready for use. Its simple. The only way you could disarm it is to take the batteries out of it. If my mom takes the batteries out of it, we know we have a different problem.

We’ve had a mix of “don’t believe in pills so I’m not going to take them” and just plain forgetting. I think sometimes, the don’t believe in pills part is a screen for how often she just forgets to take them. Putting this thing into use will tell us what the biggest issue really is, and putting the ‘reminding’ on a machine instead of my sister will be easier for everyone. My Mom is becoming increasingly paranoid, so she does not react well to being reminded about medication. That’s really hard on my sister.

That reminds me, I have to phone my Mom today and let her know I’ve sent it. She’s going to be resistant to the idea, but once she gives it a try, I’m hopeful that she’ll find it to be helpful.

15

One of my father’s blood pressure medications is a patch that stays on for a week and then gets swapped out for another. You might ask if any of your grandmother’s medications can be handled that way. It’s even nicer than the extended release pills.

16

[QUOTE=WhyNot]
Yeah, this is the weird thing: from what they’re telling us, they can not legally be responsible for this. Something about dispensing medicine without a license or some rot. Two companies have refused outright, and one has repeated the bit about how they can’t be responsible, and the girls can’t actually hand Grandma the pills, but if they’re there and if they remember, then they’ll probably say something to her. It should be noted - they aren’t nurses, or nurses aides or anything. They’re laypeople being paid $15 an hour to help her to the bathroom and go downstairs to do a load of laundry. Skilled nursing care - which, except for the pills, she doesn’t need - runs closer to $75 an hour. We just can’t afford that, no matter how much we love her - we’d drain her bank account in a few months and then she’d have to sell her house and move anyway.
[/QUOTE]

Welcome to the not so wonderful world of home health care. In theory, it’s supposed to be great. In practice, it mainly sucks. It’s been a few years since I was a HHC nurse, and I’ll never do it again (the paperwork is unbelievable–even the computerized paperwork is unreal).

That said, you really DON’T want a HH aide telling your gma to take her pills. It’s a case of the blind leading the blind, really (and I mean no disrespect to either party when I say that). The aide does not have the qualifications to instruct gma, but she does open the company up to huge liability issues if she does so. If a family member messes up the dosage or the pills or both, it’s a tragic accident, if a HCW does it, it’s a legal issue. I’m not surprised that 2 companies refused to do what seems to be such a minor (and helpful) thing, but that’s 21st century American healthcare. :frowning:

I think you may need to have a talk with the PCP and see if these pills can be grouped together so that there is less to remember, if she can come off some of them (not likely, but worth a shot), or perhaps the reminders/alternatives as explored above. (there are a number of blood pressure patches on the market for one example).

Thing is, gma has a right to not take her pills. If she wants to be noncompliant, she can (and apparently is). Patient rights is huge in gerontology right now–they are even trying to do away with side rails in some places (we are removing the pt’s right to fall. No, I am not making this up or exaggerating. I wish I were).

Short of being there, on the scene, to “read” your gma and see what works best for her, I have no good advice. Most elderly pts take pills from me with no difficulty, but I am a figure of authority in a hospital, not their daughter or granddaughter etc. I don’t know what to tell you! Sorry.

I will tell you that trickery, lies, duping or hiding pills in anything else will destroy all trust and chance of getting her to take her pills at all. (not that you and yours would do that, just saying).

17

[QUOTE=jeepus]
I didn’t see that pill system when I was on Amazon. I went with something more expensive. I think my Mom could have managed the system you’re looking at for a while, but would need something easier for her to use as time goes on. We’re really at the point where we need something really easy for her to manage.

I recently bought my mom this

[/QUOTE]

I saw that one too, but the price scared me away. It does look simple, though. I think I’ll email that link to Mom, too, and see what she’s willing to pay for less stress.

[QUOTE=phouka]
One of my father’s blood pressure medications is a patch that stays on for a week and then gets swapped out for another. You might ask if any of your grandmother’s medications can be handled that way. It’s even nicer than the extended release pills.
[/QUOTE]

Ooh, another good idea! I love the SDMB so much!

[QUOTE=eleanorigby]

Thing is, gma has a right to not take her pills. If she wants to be noncompliant, she can (and apparently is).
[/QUOTE]

Yep, you’re right. And if she were *choosing *not to take them in an intentional, active sense, then I would honor that choice. But it really does seem that she’s just forgetting.

There’s a whole 'nother chapter in the saga involving her desperate desire for a dog and my mom’s refusal to drive her to the shelter to get one. Now Grandma’s begging her son to do it, and Mom’s getting weepy and saying that we’re all making *her *out to be the bad guy. Me, I just see lonely Grandma who wants a dog like she’s always had - Mom sees a shitload more work for her if the dog trips Grandma and she falls again. I get it, I do, but I think she’s infantalizing Grandma by telling her she can’t have a dog. Personally, I think for her *emotional *health, she needs some living thing in her house to fuss over and nurture, and if she gets hurt, so the dog goes back to the (no-kill) shelter, big deal. I’m trying to keep my mouth shut on that one, but I slipped last week (Grandma jokingly asked *me *to take her to the shelter and pick out a dog and I joked back, “I’d love to, but while she’s your daughter, she’s my mom, and I won’t cross her!” before thinking) and now Mom’s mad at me.

18

[QUOTE=WhyNot]
I saw that one too, but the price scared me away. It does look simple, though. I think I’ll email that link to Mom, too, and see what she’s willing to pay for less stress.
[/QUOTE]

Yeah, you’re right, it’s a lot of money. My Mom is in Canada, so maybe this won’t apply in the US, but we will be able to write off this pill box as a medical supply purchase. Is that possible where you are?

My Mom has talked about wanting to take less pills. Some days, she believes that they cause her more harm than good. She doesn’t really remember from one moment to the next well enough to judge though. Especially when she hasn’t been taking her pills regularly. She blames the blood pressure pills for headaches that she’s had for years before she took the pills. It’s not easy to treat her like an adult sometimes. It’s my hope that if we get her medication to her on a more regular basis, we can see if the doc thinks we can cut back on some of the pills.

I wonder how she’d do with a patch instead of pills for her blood pressure. Aren’t patches hard on frail old skin?

19

No, the patches are not. They are usually applied to the chest wall and upper shoulder region (collarbone area, deltoid).

If it’s just simple forgetting, I’m afraid supervision may be the only answer (not what you wanted to hear). The bit about the dog… that’s rough. I completely understand your mom’s POV there, but feel sympathy for a lonely old woman, too. Have you googled pet therapy? I believe that some dogs do make house calls. Depends on your area etc. Dogs are routinely taken into nursing homes now, with much good done the residents there. It might be best if gma gets a visiting dog. Any way Mom can borrow a dog for a few hours a week?

Sounds weird, but that might help gma settle and that might make the forgetfulness abate a bit. <crosses fingers>

20

Maybe what’s needed is an older, small dog, one that is well behaved and not likely to be a tripping hazard. If your mom did the choosing, would that solve anything or just be the start of another argument?

I sympathize with you and with all of your family. It must be difficult for everyone.