Careful Medication and Eldercare
A joyful heart is good medicine, but a crushed spirit dries up the bones. Proverbs 17:22
As caregivers, one very important task is to make sure that our care recipient remains safe to the best of our ability. Keeping hope and joy alive around them is also a vital component for their mental and spiritual well-being. Gracing them with unconditional love assures them that their comfort and best interests are a priority. As you well know, this is not always easy. “A joyful heart” is not always a simple matter to come by. And that “good medicine,” medications themselves, can either be a hindrance or a help to one’s joy or safety. A caregiver’s attentiveness to this most vital of issues is a must.
Most people, as they age, need medications. They are great if used correctly and safely. They also require caregivers to have a watchful eye as to what is happening to their care recipient:
- Are there changes in behavior and/or personality?
- Do they complain about their body, such as digestive tract issues or headaches?
- Are they sleepier than usual?
- Do they trip or even fall?
- If a new drug is added to the regimen, are they any side-effects or reactions?
- Be aware, and as up-to-date as possible, of side-effects, contraindications of drugs for diagnoses given for the care recipient. Many people become over or under medicated. When changes are noticed, and if they are self-medicating, question the ability of that person to dispense their own pills. Talk with other family members if they are a part of the caregiving team about what they might be noticing. Make notes. Keep an updated list of all medicines being taken, including prescription drugs, over-the-counter medicines, vitamins, other nutritional products and herbal remedies. Keep the list with you at all times.
Reactions to medications vary with each individual and with particular drugs. For older adults and people with disabilities, medications, whether prescription, over-the-counter, alcohol, herbal remedies or alternative-type medicines can help or they can harm. When not used appropriately or safely, medications can cause untold consequences. Changes that occur with aging and with disabilities can cause people to suffer what are called medication-related problems (MRPs). But these medication-related problems are often preventable. Caregivers can help to identify possible MRPs. Side-effects or “symptoms” of MRPs may include: excessive drowsiness, confusion, depression, delirium, insomnia, Parkinson’s-like symptoms, incontinence, muscle weakness, loss of appetite, falls and fractures, changes in speech and memory. When these symptoms appear, they should be considered “red flags” that an MRP may be occurring. Yet they may turn out to be unrelated as these same side-effects can occur under many physical or mental circumstances. But when these effects interfere with daily functioning, a health care professional should be informed immediately, just in case.
Before prescribing any new drug, the doctor should be aware of all the other drugs and over-the-counter medications the patient is taking. This is when having that list of medications with you is necessary. The doctor should want to know of any new symptoms or illnesses. If possible, care recipients should be given the opportunity to present the doctor (or other professional) with accurate and complete information about health conditions. It is important to share new medical problems by fully describing the problem, indicating how long it has been a problem, if the problem has been experienced before, how it started, what was done to relieve it, and what worked or didn’t work. For seniors with cognitive impairments, caregivers are the ones to describe the concerns. Often, the elderly do not tell the doctor the whole story either. Mama would go in and tell the doctor how great she was feeling, yet I knew better. She either had forgotten or she did not want him to know that she was less than perfect. This makes it very difficult for health care professionals to assess just what is going on for the proper treatment. So be prepared to step up to the plate.
Have conversations regularly with the professionals involved in your care recipient’s care. They may include a doctor, a physician’s assistant, a nurse, a pharmacist, an aide, or a host of others. This team should be available to you, the caregiver, providing support and knowledge. You gain confidence through the team and can then be ready to act, to assist, or to do it all. If you have concerns about the ability of your care recipient being able to give themselves the medications, you need to address those concerns with this team. It is so important to be on top of the medications and any problems because your attentiveness can lead to less medication-related problems, better outcomes, and improved daily functioning.
A few things to discuss with this team if the recipient is wanting to remain independent and handle the medicines themselves:
- Will their memory function allow them to take the right medicines at the right time, in the right amounts what it needs to be? Can they care of themselves?
- Can they read the labels or should a large print label be ordered for them, if available?
- Can they hear the provider’s instructions when given? Ask the doctor or pharmacist to speak louder, if need be.
- Does their dexterity (i.e., arthritis, Parkinson’s) allow them to open bottles, break tablets, prepare injections, eye drops, and inhalers well enough to do this themselves?
- Can they schedule the various medications themselves without making mistakes?
- One other question that needs to be asked but is not as pertinent to self-medicating as it is to just helping: Are they having difficulty swallowing pills? Are there other forms of this medicine that could be substituted?
- A caregiver is key to noting these types of problems, sharing them with the medical team. Being prepared to handle the medications may be your next step in the school of caregiving.
If you do become the medicine giver, you must be as sure about each drug as you were expecting your recipient to have been when they were self-medicating. When the drugs are purchased, ask any and all questions you can think of if you have not administered them before. Usually, there is a pharmacist available to go over the important aspects of administration and side-effects. You may need to prepare and administer injectable drugs, such as insulin. Be certain you understand the dosage and how to inject.
I began giving Mama her medication shortly after she moved to Texas. She had recently been diagnosed with vascular dementia, plus she had been diabetic for many years. Soon she was placed on insulin. Mama needed help in taking her glucose readings and then to establish the correct amount of insulin along with the correct type of insulin for a particular time of day. She was injecting two — a short acting and a long acting. She had blood pressure and cholesterol meds, thyroid plus a few other pills. It was very confusing for her. I also wanted her to maintain some independence while holding onto her dignity. As an example, I let Mama prick her own finger as she had done for years and place the blood on the glucometer. Then with the proper dosage and type of insulin in the syringe, I would hand it to her so that she could self-inject. She learned and remembered the sequence of needle placement which remained important. She had some control over this process for many years. Plus she seemed pleased to have me do the part that threw her for a loop. I believe she was relieved that there would not be a mistake for she also understood that concern.
- Store all of the medications in a designated location of the house, but not in the medicine cabinet of the bathroom or in the kitchen cupboard because heat and moisture can cause deterioration. Be sure that they are stored out of reach of children who may visit, especially if there are non-child proof containers. If the medication needs refrigeration, they should be placed in a container in one particular safe place in the refrigerator. Medications that are taken by mouth should be kept separate from those used externally, such as ointments or creams. Discard expired medications. Never give your care recipient’s meds to anyone else or vice versa.
- Medications are in high use these days. Be knowledgeable and careful, and most of all, handle this step of caregiving with love and a smile. Make it a light moment as you hand the pills to him or her with joy in your heart and that smile on your face. They need some parts of their days to be joyful for both themselves and for you.
…even to your old age I am He, and to gray hairs I will carry you. I have made, and I will bear; I will carry and will save. Isaiah 46:4 ESV
Father God, we ask Your guidance in all we do for the precious ones You have placed in our care. May we hear Your voice as You tell us just what to do for each one of Your children. May we be available to Your call. I pray for each one of us who has stood to Your call and said, “Count me in for I will be obedient to You, Father God.” Let us have eyes and ears open to be aware of those things which are so vitally important. Let us not fall down on this beautiful, although difficult at times, calling. Let Your love flow through us to the one we are to care for. Should we become weary, hold us up as well, LORD. In the Sweet and Healing Name of Jesus. Amen.