Those Aren’t My Pills

It’s common for individuals with dementia to begin refusing their medications. In order to address this issue, we must approach it in several different ways.

Firstly, we must consider whether we are violating the rights of this individual. Despite having dementia, they still possess the same rights to make their own decisions as anyone else. However, one of the symptoms of dementia is impaired decision-making. Those with a diagnosis may be at a stage where they lack the ability to understand that not taking necessary medications could have harmful or even deadly consequences.

Is this decision going against someone's personal desires? Absolutely. But is it in the best interest of their health? I believe so. As the designated durable power of attorney or health surrogate, it is your responsibility to make decisions that are in their best interest, even if it goes against their wishes.

In the advanced stages of dementia-related diseases, it is not uncommon to develop urinary tract infections (UTIs). Antibiotics are necessary to treat UTIs and the sooner they are taken, the better. Unfortunately, this infection can worsen the already-present confusion in a person with dementia. So, what can we do if this person refuses to take their medications? We must explore all possible solutions and try to persuade them that taking these antibiotics is crucial for their health.

If the medication is not being taken as prescribed in pill form, it may be worth asking the pharmacist if it is available in a liquid or gel form. This could potentially make it easier to swallow and more palatable for the patient. If needed, we can also attempt to hide it in food. Confirming whether the medication is time-released before making any changes is important. The pharmacist will have this information and can provide further guidance.

The pharmacist is an essential member of your healthcare team. With multiple doctors involved in your loved one's care - a general physician, a neurologist, and possibly a cardiologist - it can be difficult to ensure they are all communicating effectively. Thankfully, all the prescribed medications are likely coming from one pharmacy.

It would be wise to schedule a meeting with the pharmacist every three or four months to ensure all medications are still appropriate. Mixing certain medications can have adverse effects and should be avoided. If the doctors had not communicated with each other, they could have prescribed medications that would not work well when taken together.

Also, consider the environment in which the individual refuses to take medications.  Are there other individuals present who could create distractions or make the person feel uncomfortable? Is the setting peaceful and conducive to taking medication? These seemingly small factors can have a significant impact on the situation.

Establishing a routine was crucial for me when it came to caring for my father. I made sure to give him his pills at the same time every day using the same small blue bowl for them each morning and night. If I tried to hand them to him in any other way he would accuse me of trying to harm him. It hurt to be accused by my own father, whom I loved and cared for. I can vividly recall him yelling, "You're trying to poison me. These aren’t the pills I took yesterday!" even though they were the exact same ones he had been taking for months.

It's essential to keep a calm setting and demeanor when dealing with those living with dementia. If you become frustrated or angry, they will sense it and will be less likely to take their medications. Remember to take deep breaths in and out to release any building anxiety, allowing you to approach the situation calmly and try again.

Another tactic to consider is taking your medication at the same time as your loved one. You could use the approach of saying, "I have to take mine too," to make it less awkward.

Timing can also play a factor in the effectiveness of this approach. If your loved one experiences sundowning symptoms, it’s best to avoid implementing this strategy during their usual late afternoon or evening medication schedule. It could be beneficial to speak with the doctor about adjusting the timing of the medication.

When caring for someone with dementia, there will always be instances of trial and error. It is important to adapt and find what works best for the individual.

– Gary Joseph LeBlanc, Director of Education, Dementia Spotlight Foundation, dementiaspotlightfoundation.org