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    Dementia Symptoms & Caregiver Strategies: Medications and Older Adults

    I have trouble keeping track of all my medicines. What do I need to know about them?

    It is important to know as much as you can about your medications to make sure your treatment is as safe as possible. Both your prescriber and your pharmacist can help. Try to get as much information as you can from them verbally and in writing, in the language you choose. Consider bringing a family member or friend when you see a healthcare provider to help you remember what they tell you. Take notes.

    For each medication, make sure you understand:

    • Both the brand and generic name, or the active ingredient(s) if it is an over-the-counter product
    • What condition the medication is meant to treat
    • When to take it and how much to take
    • Any special directions for taking, storing, or disposing of the medication
    • How long to take the medication, and if it is okay to stop taking it when you feel better or if you need to continue even when you feel well
    • What to do if you miss a dose or accidentally take too much
    • If it is okay to cut, chew, crush, and mix it in a liquid or food-such as apple sauce or pudding.
    • If there are any other medications, supplements, foods, or activities you need to avoid because of the medication
    • Side effects to watch for and what to do if one occurs, including common effects that should go away with time, and more serious effects that mean you need to contact your prescriber. If a measuring spoon, cup, or syringe, is needed to measure the dose of a liquid medication, ask your pharmacist for help choosing one. If you need to draw up a medication in a syringe, ask the pharmacist to show the correct dose line for you on the syringe. If you need to split or cut a pill, decide if you can do it on your own or whether you need a pill cutting tool. Ask your pharmacist for help choosing one before you leave the store. Finally, locate the pharmacy’s telephone number on the prescription bottle so you can call if you have questions later.
    What are the benefits of keeping a “medication list”?

    Keeping a list of every medication you use, including over-the-counter products, vitamins, supplements, creams, and eye or ear drops, is important. It helps your healthcare providers make sure that your medications can be used safely together, and whether any side effects you have could be caused by something on the list. It is also important to have a medication list in case you have to go to the emergency department or into the hospital.

    The information on your list should include:
    • All prescription and nonprescription medications you take; both brand and generic names
    • All vitamins, herbals, and supplements you take (including caffeine and alcohol)
    • The reason you take each medication, how much you take, how often you take it, the date you started it, and the prescriber’s name
    • Any allergic reactions or other problems that you have had with medicines or dietary supplements – including interactions between medicines and food, other medicines, or supplements
    • Anything that could interfere with your ability to use medications, such as problems swallowing, difficulty reading labels, struggling to remember to take medications, or trouble affording medications
    Several organizations provide forms that can help you make a medication list – some forms are available on the websites listed below. Choose a form that is easy for you to understand and fill out. Keep your list current; add new medicines when you start taking them and remove medicines you no longer take. Keep the list in your purse, wallet or pocket, and show it to all healthcare providers caring for you.

    Forms you can use to make a medication list are available on the following websites. If you do not have access to the internet or a printer, ask your pharmacist for a form.
    What can older adults do to help take their medications safely?

    Older adults may have special challenges to taking medications correctly. Trouble seeing may keep an elder from being able to read the small print on medication bottles. Arthritis or other joint problems may make opening medication bottles difficult. Memory problems may result in either forgetting to take medicines, or taking a medication more times in a day than is ordered.

    Older adults are often more sensitive to side effects, and as a result, may stop taking problematic medications. Using a medication box organizer divided by the days of the week and times of the day can be very helpful. If you or your loved one has poor eyesight, painful hands, or are easily confused, put the medications in the medication box. The box creates a visual reminder to take the medicines, and shows whether or not each dose has been taken.

    Elders often take many different medicines, each one having its own schedule and directions. Some may need to be taken before, with, or after a meal. Scheduling medications and taking them correctly can be complicated. Discuss your medications with your prescriber and pharmacist to see if there are ways to make the medication schedule simpler. You can ask for medication bottles that are not childproof  (you will be asked to sign for this) to make them easier to open, but make sure the medications are kept out of reach of children.

    Why does my prescriber want to know about all the vitamins and supplements I take?

    Just because a product can be bought without a prescription doesn’t mean it is completely safe. Certain vitamins, if used in excessive amounts (such as vitamin A and B6 (pyridoxine) can be harmful if you take too much. Over the counter products, including those made from plants and those labeled “natural,” can act like medicines in the body. That means that they can cause uncomfortable or even dangerous side effects, and can interact in harmful ways with the prescription drugs you take. Making sure your prescriber(s) know about everything you take, including anything considered a “supplement” or “medical food,” can help avoid these problems.

    I take so many medications. I worry about whether mixing all of them in my body is good for me.

    Many older adults have more than one health problem, and those health problems often require treatment with more than one medicine. While these medicines are prescribed to help, it’s true that the more medicine you take, the more likely it is that you will develop side effects – or that the medicines will combine to cause uncomfortable or dangerous side effects. Also, medications that are thought to be quite safe in younger people can be harmful in older people because of the body changes that occur as we age.

    For example, pain medicines such as ibuprofen or naproxen are more likely to cause stomach ulcers, raise blood pressure, and make heart failure worse in older people. Aspirin combined with other medicines that ‘thin the blood’ can cause serious bleeding. Many drugs have been shown to increase sleepiness, confusion, and falls in the elderly.

    There are now computer programs that can help your prescriber(s) and pharmacists discover and avoid drug interactions. See the Medication Tips for Elders below for things you can do to lower the chance of having a harmful side effect or drug interaction:

    General Medication Tips for Elders
    • Read the pharmacy label carefully for instructions about when and how to best take the medicine (for example, with food or on an empty stomach; not at the same time as certain other medications, etc.). Let your pharmacist know if you are having trouble reading the information on the bottle.
    • Printed Medication Information “hand-outs” will be provided by your pharmacist with each prescription. Information will list possible side effects of the medication. Ask the pharmacist to “circle with a pen” three or four of the most frequent side effects. This does not mean you will experience these side effects.
    • Aging skin is more fragile than younger skin. When using a medication that comes in a skin patch, make sure you use a different site each time you put on a new patch so your skin doesn’t break out in a rash or get irritated.
    • If swallowing is a problem, ask if the medication is available in another form.
      A liquid version may be available, or in some cases medications can be crushed and mixed with food. However, no pill or tablet should be crushed without first consulting your physician or pharmacist. Crushing some medications may cause them to be ineffective or unsafe
    • Coordinate with all healthcare providers. Make sure they know about all of the medicines you take, including vitamins and supplements; make a list, keep it up to date, and always carry it with you.
    • Always check with your healthcare provider or pharmacist before taking any over the counter (OTC) medicines. Even OTC medicines can have harmful side effects, and can interfere with the prescription medicines you take.
    • Try to get all your prescriptions filled at the same pharmacy so that the pharmacist can watch for duplication, allergies, and potential interactions.
    • Do not take medications that haven’t been prescribed for you.
    • Talk to your healthcare provider before stopping any of your medicines.
    • Make sure you understand what to do if you miss a dose of the medicine.
    • If you think you are having a bad reaction to a medicine or a side effect, let your prescriber know right away.
    • Review your medicine list with your healthcare provider(s) to see if there are any medications that can be reduced or eliminated.
    • Learn as much as you can about the drugs you take, including how they work and what side effects they might cause. Ask your pharmacist for a good objective, free and easy to access source for drug information.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: