Alzheimer’s Disease: Wandering and Getting Lost

(Alzheimer’s Association) Six in 10 people with dementia will wander. A person with Alzheimer’s may not remember his or her name or address, and can become disoriented, even in familiar places. Wandering among people with dementia is dangerous, but there are strategies and services to help prevent it.

Who is at Risk of Wandering?

Anyone who has memory problems and is able to walk is at risk for wandering. Even in the early stages of dementia, a person can become disoriented or confused for a period of time. It’s important to plan ahead for this type of situation. Be on the lookout for the following warning signs:

  • Returns from a regular walk or drive later than usual
  • Forgets how to get to familiar places.
  • Talks about fulfilling former obligations, such as going to work
  • Tries or wants to “go home,” even when at home
  • Is restless, paces or makes repetitive movements
  • Has difficulty locating familiar places like the bathroom, bedroom or dining room
  • Asks the whereabouts of past friends and family
  • Acts as if doing a hobby or chore, but nothing gets done (e.g., moves around pots and dirt without actually planting anything)
  • Acts nervous or anxious in crowded areas, such as shopping malls or restaurants.

We Can Help

The Alzheimer’s Association offers programs designed to assist in the monitoring and return of those who wander. MedicAlert® + Alzheimer’s Association Safe Return® is a nationwide identification program designed to save lives by facilitating the safe return of those who wander.

Tips to Prevent Wandering

Wandering can happen, even if you are the most diligent of caregivers. Use the following strategies to help lower the chances:

  • Carry out daily activities.
    Having a routine can provide structure. Learn about creating a daily plan.
  • Identify the most likely times of day that wandering may occur.
    Plan activities at that time. Activities and exercise can reduce anxiety, agitation and restlessness.
  • Reassure the person if he or she feels lost, abandoned or disoriented.
    If the person with dementia wants to leave to “go home” or “go to work,” use communication focused on exploration and validation. Refrain from correcting the person. For example, “We are staying here tonight. We are safe and I’ll be with you. We can go home in the morning after a good night’s rest.”
  • Ensure all basic needs are met.
    Has the person gone to the bathroom? Is he or she thirsty or hungry?
  • Avoid busy places that are confusing and can cause disorientation.
    This could be a shopping malls, grocery stores or other busy venues.
  • Place locks out of the line of sight.
    Install either high or low on exterior doors, and consider placing slide bolts at the top or bottom.
  • Use devices that signal when a door or window is opened. This can be as simple as a bell placed above a door or as sophisticated as an electronic home alarm.
  • Provide supervision. Do not leave someone with dementia unsupervised in new or changed surroundings. Never lock a person in at home or leave him or her in a car alone.
  • Keep car keys out of sight. If the person is no longer driving, remove access to car keys — a person with dementia may not just wander by foot. The person may forget that he or she can no longer drive. If the person is still able to drive, consider using a GPS device to help if they get lost.

Make a Plan

The stress experienced by families and caregivers when a person with dementia wanders and becomes lost is significant. Have a plan in place beforehand, so you know what to do in case of an emergency.

  • Keep a list of people to call on for help. Have telephone numbers easily accessible.
  • Ask neighbors, friends and family to call if they see the person alone.
  • Keep a recent, close-up photo and updated medical information on hand to give to police.
  • Know your neighborhood. Pinpoint dangerous areas near the home, such as bodies of water, open stairwells, dense foliage, tunnels, bus stops and roads with heavy traffic.
  • Is the individual right or left-handed? Wandering generally follows the direction of the dominant hand.
  • Keep a list of places where the person may wander. This could include past jobs, former homes, places of worship or a restaurant.
  • Provide the person with ID jewelry. Enroll the person in MedicAlert®+ Alzheimer’s Association Safe Return®.
  • If the person does wander, search the immediate area for no more than 15 minutes. Call “911” and report to the police that a person with Alzheimer’s disease — a “vulnerable adult” — is missing. A Missing Report should be filed and the police will begin to search for the individual. In addition, a report should be filed with MedicAlert+ Alzheimer’s Association Safe Return at 1.800.625.3780. First responders are trained to check with MedicAlert+ Alzheimer’s Association Safe Return when they locate a missing person with dementia. You do not need to be enrolled in MedicAlert+ Alzheimer’s Association Safe Return in order to file a missing report.

When Someone with Dementia is Missing

Begin search-and-rescue efforts immediately. Ninety-four percent of people who wander are found within 1.5 miles of where they disappeared.

Citation

http://alz.org/care/alzheimers-dementia-wandering.asp?WT.mc_id=enews2017_10_03&utm_source=enews-aff-20&utm_medium=email&utm_campaign=enews-2017-10-03

Copyright © 2017  Alzheimer’s Association®. All rights reserved.

 

Managing Medicines for a Person with Alzheimer’s

(National Institutes of Health) People with Alzheimer’s disease may take medicines to treat the disease itself, mood or behavior changes, and other medical conditions. Caregivers can ensure that medicines are taken safely and correctly. Here are some tips to help you manage medications for someone with Alzheimer’s disease.

Learn the Basics

Know each medicine (prescription and over-the-counter) the person with Alzheimer’s disease takes. Ask the doctor or pharmacist:

  • Why is this medicine being used?
  • What positive effects should I look for, and when?
  • How long will the person need to take it?
  • How much should he or she take each day?
  • When does the person need to take the medicine?
  • What if the person misses a dose?
  • What are the side effects, and what can I do about them?
  • Can this medicine cause problems if taken with other medicines?

Managing medications is easier if you have a complete list of them. The list should show the name of the medicine, the doctor who prescribed it, how much the person with Alzheimer’s takes, and how often. Visit Tracking Your Medications: Worksheet for a template. Keep the list in a safe place at home, and make a copy to keep in your purse or wallet. Bring it with you when you visit the person’s doctor or pharmacist.

People with Alzheimer’s should be monitored when they start taking a new drug. Follow the doctor’s instructions and report any unusual symptoms right away. Also, let the doctor know before adding or changing any medications.

Use Medicines Safely

People with Alzheimer’s disease often need help taking their medicine. If the person lives alone, you may need to call and remind him or her or leave notes around the home. A pillbox allows you to put pills for each day in one place. Some pillboxes come with alarms that remind a person to take the medicine.

As Alzheimer’s gets worse, you will need to keep track of the person’s medicines. You also will need to make sure the person takes the medicines or give the medicines to him or her.

Some people with Alzheimer’s take medicines to treat behavior problems such as restlessness, anxiety, depression, trouble sleeping, and aggression. Experts agree that medicines to treat behavior problems should be used only after other strategies that don’t use medicine have been tried. Talk with the person’s doctor about which medicines are safest and most effective. With these types of medicines, it is important to:

  • Use the lowest dose possible
  • Watch for side effects such as confusion and falls
  • Allow the medicine a few weeks to take effect

People with Alzheimer’s should NOT take anticholinergic drugs. These drugs are used to treat many medical problems such as sleeping problems, stomach cramps, incontinence, asthma, motion sickness, and muscle spasms. Side effects, such as confusion, can be serious for a person with Alzheimer’s. These drugs should NOT be given to a person with Alzheimer’s disease. You might talk with the person’s doctor about other options. Examples of these drugs include:

  • Atrovent® (ipratropium)
  • Dramamine® (dimenhydrinate)
  • Diphenhydramine—includes brand names such as Benadryl® and Nytol®

Some people, especially those with late-stage Alzheimer’s, may have trouble swallowing pills. In this case, ask the pharmacist if the medicine can be crushed or taken in liquid form. Other ways to make sure medicines are taken safely:

  • Keep all medications locked up.
  • Check that the label on each prescription bottle has the drug name and dose, patient’s name, dosage frequency, and expiration date.
  • Call the doctor or pharmacist if you have questions about any medicine.

 

Medicines to Treat Alzheimer’s Disease

There are five medicines available to treat Alzheimer’s disease. It’s important to understand that none of these medicines can cure or stop the disease. What they can do, for some people, is help slow down certain problems, such as memory loss. Slowing down memory loss can allow many people with Alzheimer’s disease to be more comfortable and independent for a longer time.

Visit How Is Alzheimer’s Disease Treated? for more information on medicines to treat Alzheimer’s and behavior symptoms.

Medicines to Treat Other Medical Conditions

Many people with Alzheimer’s disease also have other medical conditions such as diabetes, high blood pressure, or heart disease. They may take different medicines for these conditions. It’s important to track all the medicines they take and take the list with you to every visit to a doctor.

For information about paying for medications, see Saving Money on Medicines.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Managing Medicines and Alzheimer’s

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Citation

https://www.nia.nih.gov/health/managing-medicines-person-alzheimers

National Institutes of Health

 

Alzheimer’s Disease and When to Stop Driving

(Mayo Clinic) If your loved one has Alzheimer’s, he or she may not be safe on the road. Explain the risks — then provide other ways to get around.

Driving is a powerful symbol of competence and independence, besides being a routine part of adult life. But the focused concentration and quick reaction time needed for safe driving tends to decline with age. Alzheimer’s disease accelerates this process dramatically. If you’re caring for a loved one living with Alzheimer’s, you may need to modify his or her driving – or stop his or her driving completely.

More than Memory Problems

Dimmed short-term memory makes it easy for a driver who has Alzheimer’s to get lost, even in familiar surroundings. Perhaps more dangerous, however, is a decline in the ability to judge distances and predict upcoming traffic problems. A driver who has Alzheimer’s may also have trouble prioritizing visual cues. An irrelevant sight, such as a dog jumping behind a fence, may distract the driver from important cues — such as brake lights or traffic signs.

When to Stop Driving

Driving concerns often surface during the early stages of memory changes. People with dementia are especially likely to minimize the complexity of driving and overestimate their abilities. Opinions vary on whether driving should be allowed at all after an Alzheimer’s diagnosis. Research indicates that drivers with Alzheimer’s disease are more likely to get into motor vehicle accidents. For some people, it may be easier to give up the wheel early on, when they can still grasp the potential hazards. On the other hand, people in the early stages of the disease may be able to safely limit their driving to short daytime trips in familiar surroundings.

If your loved one continues to drive, pay attention to warning signs of unsafe driving, such as:

  • Difficulty navigating to familiar places
  • Inappropriate lane changing
  • Confusing the brake and gas pedals
  • Failing to observe traffic signals
  • Making slow or poor decisions
  • Hitting the curb while driving
  • Driving at an inappropriate speed (often too slow)
  • Becoming angry or confused while driving

According to a report from the American Academy of Neurology, one of the more accurate predictors of driving trouble is a caregiver’s assessment. If a caregiver (generally a spouse) believes that his or her relative with dementia is driving unsafe, the caregiver is likely to be correct. If you’re not sure whether it’s safe for your loved one to drive, ask yourself whether you feel safe riding in a vehicle driven by the person who has Alzheimer’s — or if you’d feel safe having your children or others drive with that person. If the answer is no, then you know it’s time for him or her to retire from driving.

How to Ease the Transition

When your loved one stops driving, arrange for alternative transportation. Perhaps family members and friends can run errands with your loved one, or you can arrange transportation through a senior van route. You may be able to establish a payment account with a taxi service so that your loved one can go places, but won’t have to handle money.

Also consider ways to limit your loved one’s need to drive. Many items — such as groceries, meals and prescriptions — can be delivered to your loved one’s home. Some barbers and hairdressers make house calls as well.

Remain Firm as the Disease Progresses

If your loved one wants to continue driving despite the hazards — or begins driving again after a period off the road — consider these strategies to keep him or her out of the driver’s seat:

  • Get it in writing. Sometimes it helps if an authority figure — physician, lawyer or insurance agent — tells your loved one to stop driving. Having something in writing can be a useful reminder.
  • Keep keys out of sight. Park the vehicle around the corner or in a closed garage, and don’t keep keys in plain sight. If your loved one insists on carrying a set of keys, offer old keys that won’t start the vehicle.
  • Disable the vehicle. Remove a battery cable to prevent the car from starting, or ask a mechanic to install a “kill switch” that must be engaged before the car will start.
  • Sell the vehicle. If you can make do without your loved one’s vehicle, consider selling it.

Whether your loved one stops driving all at once or in stages, he or she will probably grieve the loss of independence. Be as patient as you can, but remember to stand firm. The consequences of unsafe driving can be devastating.

Citation

http://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20044924

References:

  1. Driving. Alzheimer’s Association. http://www.alz.org/care/alzheimers-dementia-and-driving.asp. Accessed March 14, 2013.
  2. Martin AJ, et al. Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006222.pub2/abstract. Accessed March 14, 2013.
  3. Snyder CH. Dementia and driving: Autonomy versus safety. Journal of the American Academy of Nurse Practitioners. 2005;17:393.
  4. Ott BR, et al. A longitudinal study of drivers with Alzheimer disease. Neurology. 2008;70:1171.
  5. Iverson DJ, et al. Practice parameter update: Evaluation and management of driving risk in dementia. Neurology. 2010;74:1316.
  6. AskMayoExpert. Alzheimer’s disease: Should patients with Alzheimer’s dementia be allowed to drive? Rochester, Minn.: Mayo Foundation for Medical Education and Research;2012.

© 1998-2017 Mayo Foundation for Medical Education and Research. All rights reserved.

 

Make Your Home Safe for Someone With Alzheimer’s

(WebMD) Home safety is always important, but it’s a special concern when you’re caring for a person with Alzheimer’s. You need to do what you can to make sure your loved one’s surroundings are as safe and comfortable as possible. A few basic changes can help.

Entrances and Exits

  • Make sure that doorways are well-lit and free of clutter. Sensors that turn on outside lights when someone approaches the house can be a good idea.
  • Check that door locks work well and can open easily in an emergency.
  • Make sure stairs or ramps are in good repair and have a secure hand rail.
  • Think about posting a “No Solicitors” sign for the front door.

Kitchen

  • Put child-proof latches on cabinets and drawers that have fragile, valuable, or dangerous items.
  • Lock up household cleaning products, matches, knives, scissors, and other hazards.
  • Keep your loved one from using dangerous appliances. Install safety knobs on the stove. Disconnect your garbage disposal. Get rid of anything that doesn’t work properly.
  • Remove fake fruits or decorations that look like food so your loved one doesn’t mistake them for something edible.
  • If you keep medications in the kitchen, store them in a locked cabinet or drawer.

Bedroom

  • Make sure your loved one can get in and out of bed safely. Consider putting mats on the floor next to the bed, as long as they’re not a trip or slip hazard.
  • Place lamps or light switches near the bed, or use a nightlight.
  • A monitoring system, like a baby monitor, can help you hear when your loved one gets out of bed or needs help.
  • Make a clear path to the bathroom.

Bathroom

  • Can your loved one safely get in and out of the shower or bathtub? If not, install grab bars on the inside and outside. Towel racks aren’t sturdy enough to be used as grab bars.
  • Use nonskid strips in the tub or shower. A shower stool can also help.
  • Install a safety frame, raised seat, or grab bar near the toilet.
  • Put medications in locked cabinets or drawers. Throw out any that have expired.
  • Lock up any bathroom cleaning products and small electrical appliances.
  • Think about getting a single faucet that mixes hot and cold water, instead of separate knobs, to avoid scalds.
  • Replace small bath mats with a large rug that covers most of the floor. Put an adhesive back on it to keep it from slipping.

General

  • Put smoke detectors and carbon monoxide alarms on each floor, and test them to be sure they work. You might need to change the batteries every few months.
  • Don’t keep any space heaters, electric blankets, or other fire hazards in your home. If you must use them, follow the safety instructions and keep them on a sturdy surface away from rugs, curtains, furniture, or papers.
  • Cover electrical outlets you’re not using, and take care of any wiring problems. Keep lamps and other appliances near outlets so you’re less likely to trip on the cords. You can also use tape to secure them to the floor.
  • Mark any glass doors, windows, or furniture with a sticker or decal at eye level to make sure your loved one can see the panes clearly.
  • Make sure your home is well-lit. Night-lights can help in bedrooms, bathrooms, hallways, and any areas your loved one might need to go at night.
  • Watch out for slippery or uneven surfaces, like throw rugs, tile, or rips in the carpet. Also, make sure any walkways are clutter-free.
  • Set your hot water heater to 120 degrees or lower to prevent burns from scalding tap water.
  • Post emergency phone numbers and your home address next to all the phones in your home.
Citation

http://www.webmd.com/alzheimers/guide/caregiving-preparing-home

Reviewed by Neil Lava, MD on 8/, 014

© 2016 WebMD, LLC. All rights reserved.

 

Do You Know About the Alzheimer’s Association Safe Return Service?

(Alzheimer’s Association) MedicAlert® + Alzheimer’s Association Safe Return® is a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency. We provide 24-hour assistance, no matter when or where the person is reported missing.

How It Works

If an individual with Alzheimer’s or a related dementia wanders and becomes lost, caregivers can call the 24-hour emergency response line (1.800.625.3780) to report it.

A community support network will be activated, including local Alzheimer Association chapters and law enforcement agencies, to help reunite the person who wandered with the caregiver or a family member. With this service, critical medical information will be provided to emergency responders when needed.

If a citizen or emergency personnel finds the person with dementia, they can call the toll-free number listed on person’s MedicAlert + Safe Return ID jewelry. MedicAlert + Safe Return will notify the listed contacts, making sure the person is returned home.

Report a wandering incident:

  • Call 911
  • Then call 800.625.3780, MedicAlert + Safe Return’s emergency response line

Cost and ID Jewelry

medicalertjewelryMedicAlert + Safe Return provide an ID bracelet or pendant to be worn by the individual with dementia.

$55 + $7 shipping and handling, you receive an enrollment package including:

  • Member’s ID jewelry with personalized information and MedicAlert + Safe Return’s 24-hour emergency toll-free number
  • Personalized emergency wallet card
  • 24-hour emergency response service
  • Personal health record (PHR)
  • Six Steps to a Safe Return magnet

(Optional) Add $35 for caregiver ID jewelry and membership

  • Membership includes everything listed above
  • The caregiver wears this worldwide-recognized ID jewelry to alert others that he or she provides care for a MedicAlert + Safe Return member, in case of an emergency

$35 annual renewal fee
An annual fee of $35 will be due after the first year for each membership.

Join

There are four easy ways to join MedicAlert + Safe Return:

  1. Online: medicalert.org/safereturn
  2. Call: 1.888.572.8566
  3. Mail: Complete and mail in the enrollment form.
  4. Enrollment Form: English | Spanish/Español | Chinese

Completed enrollment form and photos can be mailed to:

MedicAlert + Alzheimer’s Association Safe Return
2323 Colorado Blvd.
Turlock, CA 95380

Fax: Registration form to 1.800.863.3429

GPS Location Management Service

The Alzheimer’s Association offers safety services that use GPS and cellular technology. Comfort Zone® and Comfort Zone Check-In® can help you manage a person’s location. Comfort Zone includes MedicAlert + Safe Return.

Other Resources

Citation

http://www.alz.org/care/dementia-medic-alert-safe-return.asp

Copyright © 2016  Alzheimer’s Association®. All rights reserved.

 

Caregivers’ Guide to Medications and Aging

(Family Caregiver Alliance) Modern medicines have contributed to longer life spans, improved health and better quality of life. Medications are the most common treatment for many diseases and conditions seen in older people and persons with disabilities. Medicines now not only treat and cure diseases that were untreatable just a few years ago, they aid in the early diagnosis of disease; prevent life-threatening illnesses; relieve pain and suffering; and allow people with terminal illnesses to live more comfortably during their last days.

“Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”
Brown University Long-term Care Quality Letter, 1995.

However, for older adults and people with disabilities, medications—prescription, over-the-counter, social drugs such as alcohol, and herbal remedies/alternative medicines—can be a double-edged sword. When not used appropriately, effectively and safely, medications can have devastating consequences.

The changes that occur with aging and disability make people more likely to suffer medication-related problems (MRPs). Nevertheless, research has shown that medication-related problems are often preventable. Caregivers can play a key role in helping to identify when an actual or potential MRP is occurring. This assistance can help prevent the costly and unwanted negative consequences of medication use, such as admission to acute care hospitals, assisted living facilities or nursing homes. About one quarter of all nursing home admissions are due at least in part to the inability to take medication correctly.

Research has shown that a high percentage of caregivers help their friends or relatives manage medications. Caregivers for people with Alzheimer’s disease and other memory impairments commonly report problems with getting their relative or friend to take medications on time, in the right amount, and as directed. In surveys, caregivers often report that their knowledge of their loved one’s medications—intended uses, directions for use, side effects, possible interactions—is greater than that of the care recipients themselves.

When patients, caregivers, doctors and pharmacists function as a team, medication-related problems can be avoided, contributing to better outcomes and improved daily functioning. This Fact Sheet serves as a caregiver’s guide to medication use and provides tips on what to do about the challenges of that use.

How a Pharmacist Can Help You

Older adults, people with disabilities and caregivers may encounter challenges when taking medications. Resolving these problems can lead to much better results from medicines. Consumers and caregivers must alert their doctors and pharmacists to any difficulties they have taking medications, including the following:

  • Memory: Difficulty remembering to take medications. The pharmacist can provide a variety of special pill boxes or other aids that remind a caregiver and senior to take medications. The devices range from low-tech, such as simple containers with compartments labeled for meals and bedtime, to high-tech, such as containers that beep when it’s time for a dose, or a special bottle cap that counts openings of a prescription bottle to tell if the day’s doses have been taken. For those with severe memory impairments, caregivers are key to the proper administration of all medicines. In addition, some aging-related service organizations offer medication reminder telephone calls for older persons with memory problems.
  • Vision: Difficulty reading labels on prescription labels and over-the-counter products. Pharmacists may be able to provide prescription labels in large print. Health care providers and caregivers can read the information on over-the-counter products for consumers with vision impairment. Magnifying glasses may also be helpful.
  • Hearing: Difficulty hearing instructions from health care professionals. Ask doctors, nurses, and pharmacists to speak louder and/or write down important information relevant to the safe use of medications. Caregivers can also be “the ears” for seniors with hearing impairments.
  • Dexterity: Difficulty opening bottles, inability to break tablets, problems handling medicines such as eye drops, inhalers for asthma and other lung disease, and insulin injections. These problems are common for people with arthritis and certain types of disabilities. Large, easy-open bottle tops are available for prescription medicines. If a prescription dose is one-half tablet, the pharmacist can split the tablets for you. Caregivers are key to assisting with the administration of eye drops, inhaled medications, injections, and other dosage forms that require fine motor skills. Again, pharmacies can provide instruction sheets on administration of medicines.
  • Swallowing: Difficulty swallowing tablets or capsules. Many prescription and over-the-counter products are available in a variety of dosage forms such as a liquid, skin patch, or suppository, greatly reducing difficulties associated with swallowing. Ask your pharmacist about alternative dosage forms.
  • Scheduling logistics: Scheduling many different medications throughout the day. One of the greatest challenges for older persons and caregivers is working medication schedules into daily routines. Special pill boxes and other aids, described above, can help. It’s essential that older people and caregivers devise a plan for medication administration that fits their daily schedule. For example, meal times or bedtimes can be used as cues for scheduling medication if mealtimes and bedtimes are regularly scheduled. Doctors and pharmacists can assist in developing a plan to best suit your daily schedule.

Too Many Medicines

One very common problem associated with medication use among older adults and many people with disabilities is the use of multiple medications at one time, also referred to as “polypharmacy.” Research has shown that the more medications a person takes, the greater the risk of experiencing a medication-related problem. For most older persons, multiple medication use is the norm. Many chronic conditions or diseases—diabetes, heart disease, Parkinson’s disease, arthritis, incontinence, high blood pressure, pulmonary disease, osteoporosis, Alzheimer’s disease—often require the use of multiple medications. The focus must be the appropriateness, effectiveness, and safety of all prescription and over-the-counter medications. Caregivers must ask questions about each medication, such as:

  • Is this medication really needed?
  • Is the medication the most appropriate for the medical condition being treated?
  • Will the medication be a problem with other medical conditions that are occurring at the same time?
  • Is the medication being prescribed at the right dose?
  • Does the medication interact with other medications?
  • Can the medication be taken correctly based on specific patient circumstances?

Some of the challenges faced by caregivers who must juggle multiple medications for their loved ones include keeping all the prescriptions filled, especially during weekends and holidays, and managing medications prescribed by multiple doctors. Planning ahead to refill prescriptions on time is essential; keeping an up-to-date medication record can inform doctors of all medicines prescribed by others. A “Caregiver’s Notebook”—a looseleaf binder maintained by a caregiver—is an ideal way to com-pile information on medical diagnoses, doctors’ appointments, questions, and medication history.

Preventing Medication-Related Problems

An important step to preventing problems is for health care professionals, consumers and caregivers to understand what medication-related problems are, to recognize the signs and symptoms of actual and potential MRPs, and to identify appropriate steps that can be taken to reduce the incidence of these common and costly problems.

It’s important to keep in mind that medication effects can directly impact the daily functioning of older and disabled persons. These 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” to caregivers that an MRP may be happening.

Need for New Medication

This medication-related problem occurs when a person has a medical condition that requires a new or additional medication, but none has been provided. Examples among the older and disabled population include pain and depression, which often go undiagnosed, undertreated or untreated. These conditions are frequently assumed by some health care professionals to be a “normal part of aging.” Inadequate treatment for pain and depression can lead to declines in functioning and participation in social activities.

Seniors often do not discuss all their symptoms with their health care professionals; many health care professionals do not adequately assess for all possible diseases and conditions. Proper assessment by health care professionals is essential so that symptoms can be identified and proper treatment initiated. Seniors and their caregivers must also feel comfortable discussing their symptoms—no matter how sensitive—with health care professionals.

Unnecessary Medication

This medication-related problem occurs when a patient is taking a medication that is unnecessary given the patient’s current medical problems—i.e., there is no longer a valid medical reason to use the medication. In addition, if a patient receives combination therapy when a single drug would be equally effective, then the patient would be receiving unnecessary medication. Patients who are exposed to unnecessary medications may experience toxic effects. The cost of unnecessary medications is also a consideration, especially for many seniors who have limited incomes.

Wrong Medication

This medication-related problem occurs when a person has a medical condition for which the wrong medication is being taken. When a patient is not experiencing the intended positive outcomes from a certain medication, then the wrong medication may have been prescribed. Examples include inappropriate dosage form; the condition is non-responsive to the medication; medication is not indicated for the condition being treated; or a more effective medication is available. Patients and their caregivers must have a clear understanding of what to expect—and when to expect it—when taking medications. When the result is different, the doctor should be contacted to make him or her aware of the situation.

Dose Too Low

This type of MRP occurs when a patient has a medical condition for which too little of the correct medication has been prescribed or too little is taken. Medication dosages are considered too low if a patient has an appropriate indication for a medication, is not experiencing any side effects from the medication, yet is not realizing the desired benefit. When the correct medication is prescribed and the dose is too low, the benefits of the medication can be minimal or none at all, and may result in serious unpleasant effects through poor treatment. Simply adjusting the dosage and/or dosage interval can improve the clinical outcomes. Again, patients and their caregivers must have a clear understanding of what to expect from their medications.

Dose Too High

Perhaps the most common medication-related problem among older persons is when the correct medication is prescribed, but the dose is too high. This MRP frequently occurs in older people because the physical changes of aging can alter the way our bodies process and react to medications. For example, in the aging body, the liver and kidneys may not as easily remove medications. In addition, changes in the distribution of fat and muscle can make seniors more susceptible to adverse drug events.

These changes increase an older person’s sensitivity to a potential adverse effect. A “normal dose” of a medication can be an overdose for many older persons. Some medications, however, are used in the same doses for both older and younger adults. Medications that act on the central nervous system (CNS) are particularly problematic because older persons are extra sensitive to the adverse effects of these medications. Examples include antidepressants, sedatives, antipsychotics, and some blood pressure medications. Signs that a dose may be too high include dizziness, confusion, delirium, insomnia, Parkinson’s-like symptoms, loss of appetite, falls, and changes in memory.

Adverse Drug Reactions (ADRs)

ADRs can occur when a patient is receiving a medication considered to be unsafe based on:

  • the characteristics of the patient;
  • an allergic reaction to the medication;
  • an interaction with another medication or food;
  • the incorrect administration of the medication; or
  • a medication dosage increased or decreased too rapidly.

Drug interactions can produce uncomfortable or dangerous adverse effects. A very common drug interaction involves blood-thinning medications that can thin the blood even more when combined with aspirin and some other pain relievers. Before prescribing any new drug, the doctor should be aware of all the other drugs the patient may be taking.

Failure to Receive Drugs

For medications to be safe and effective, they must be taken at a particular dosage, at specified times, and for a specific period of time. There are many reasons why patients don’t receive medications as prescribed. A patient, for example, may perceive that the medication has caused or will cause some adverse event, is confused about why and how to take the medication, or finds it inconvenient to take the medication.

The high cost of medications and the limited coverage for prescription drugs in public and private health insurance are major causes people don’t take their medicines. The use of generic medications, if available, helps reduce out-of-pocket expenses. Many pharmaceutical companies provide free medications or special discounts to persons with low incomes. Call around for the lowest price; many pharmacies will match the prices of their competitors. Ask your doctor for samples.

Several states offer pharmaceutical assistance programs for low-income seniors who are not Medicaid-eligible. Pharmacists can assist seniors in obtaining medications through these programs. (Food stamps and rental assistance can also help by making additional money available for medications.) Medicare outpatient prescription drug benefit changes may also provide assistance with certain medication costs to a select group of older people when they go into effect in 2006.

“Natural” Does Not Necessarily Mean Safe and Effective

The sale of herbal products in the U.S. is largely unregulated. Companies that sell these products are not required to demonstrate their safety and effectiveness. Some herbal ingredients are not listed on the packaging or the listing may be incomplete or inaccurate, so you may not know what you are taking. Although some herbal and other natural products may be beneficial in some instances, they can have significant and sometimes unpredictable side effects. Many herbals also interact with prescription and over-the-counter medicines. For example, ginkgo biloba, frequently used for memory loss, may interact with blood thinners, high-blood pressure medications, and certain pain relievers such as ibuprofen and naproxen. To avoid problems with herbal medicines, talk to your doctor or pharmacist about any herbals you use or are considering using.

The Basics of Safe Medication Use

  • Keep updated lists of all medicines, both for yourself and for the person you are caring for. Keep the lists with you at all times (click here to download a sample Medication Record Form). Include prescription drugs, over-the-counter medicines, vitamins, other nutritional products, and herbal remedies on the list. Share the lists with your doctors or the doctors of the person you are caring for.
  • Some caregivers have to prepare and administer injectable medicines, such as insulin. Injections involve the use of a syringe and needle, which may be inserted under the skin or into a vein or muscle. Be certain that you understand and are comfortable with preparing the proper dosage and administering the injection. Nurses in doctors offices and pharmacists can and should instruct you on the proper techniques for injectable medicines.
  • Store all of your medications in a designated location in your home. Keep all medications stored together in one place unless they require refrigeration or are labeled “store in a cool place.” This will help if an emergency situation occurs and your doctor needs to review all your medications.
  • Be sure that your medications are stored out of reach of any children that may visit, especially if you have non-child proof containers. If you are caring for someone with cognitive or memory problems, be sure all medications are safely stored away.
  • Do not mix different medications together in one container; this will make it difficult if not impossible to identify your medications in an emergency.
  • Medicines should be stored in a cool, dry area. Do not store your medications in the medicine cabinet in the bathroom or in the kitchen because heat and moisture cause deterioration. Instead, store your medications in a designated area in your bedroom, dining room or living room.
  • Medications stored in the refrigerator should be separated from other items in the refrigerator. Consider keeping refrigerated medications in a plastic box or container in one consistent location in the refrigerator.
  • Medications taken by mouth should be kept separate from other items that are for external use only, such as creams and ointments.
  • Expired medications (there are expiration dates on all of your medications) and any medication that your doctor has discontinued should be discarded.
  • Never share or give your medications to another person.

Questions about Medications for Physicians and Pharmacists

One responsibility of patients and their caregivers is to fully prepare for medical appointments. Before visits, write down everything you want to talk about, including important questions related to medications. Take notes during appointments, and review the notes after the appointment. You may have additional questions to ask of doctors and pharmacists, such as:

  • Why is this medicine prescribed?
  • How does the medicine work in my body?
  • How can I expect to feel once I start taking this medicine?
  • How will I know that the medicine is working? Is there a typical time period after which my symptoms should improve?
  • How long will I have to take the medicine? Will I need a refill when I finish this prescription?
  • Will this medicine interact with other medications—prescription and nonprescription—that I am taking now?
  • Should I take this medicine with food? Are there any foods or beverages I should avoid? (Grapefruit, for example, may interfere with the action of certain medications.) Is it safe to drink alcohol while on this medicine?
  • Are there any activities I should avoid while taking this medicine?
  • Can this medicine be chewed, crushed, dissolved, or mixed with other medicines?
  • What possible problems might I experience with the medicine? How can I prevent these problems from occurring? At what point should I report problems with the medicine?
  • What should I do if I miss a dose of this medicine, or take too much?
  • What is the cost of the medicine prescribed? Is there a less expensive alternative prescription?
  • Is a generic version of this medicine available? If so, should I purchase the generic instead of the brand name medicine?
  • Do you have written information about the medicine that I can take home with me?
  • Does the pharmacy provide special services such as home delivery or comprehensive medication review and counseling?

Sharing the Responsibility

The scope and severity of problems that can occur with medication therapy are tremendous. To prevent these problems from occurring, consumers and caregivers, as well as their health care professionals, have a responsibility to ensure appropriate, safe and effective medication use. All professionals involved in prescribing and dispensing—as well as the consumer and caregiver—should consider themselves essential members of the health care team. The consumer or caregiver who alerts their doctor or nurse to the need for changes to medication therapy plays a vital role in getting the best treatment.

Consumer and caregiver responsibilities center on effective communication with the health care team. This includes presenting actual or potential medication-related problems in a timely manner to health care professionals, and participating in resolution of the problems. Before this can happen, consumers and caregivers must be able to recognize the possible signs and symptoms of a medication-related problem. For older adults, any symptom should be considered a medication-related problem until proved otherwise. When symptoms interfere with daily functioning and when the time sequence of the symptom indicates that it was caused by a medication, then a health care professional should be informed immediately.

Consumers and caregivers share responsibilities by expressing their concerns, expectations, and any lack of understanding about medication therapy and demanding answers to their questions. Consumers need to be able to present health care professionals with accurate and complete information about health conditions. It is important for consumers with new medical problems to fully describe the problem, indicate 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 play a vital role in recognizing changes in health conditions and effectively describing problems to health care professionals.

Resources

Family Caregiver Alliance
785 Market Street, Suite 750
San Francisco, CA 94103
(415) 434-3388
(800) 445-8106
Web Site: www.caregiver.org
E-mail: info@caregiver.org

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.

FCA’s National Center on Caregiving offers information on current social, public policy and caregiving issues and provides assistance in the development of public and private programs for caregivers.

For residents of the greater San Francisco Bay Area, FCA provides direct family support services for caregivers of those with Alzheimer’s disease, stroke, ALS, head injury, Parkinson’s and other debilitating brain disorders that strike adults.

American Society of Consultant Pharmacists (ASCP) and the ASCP Research and Education Foundation
www.ascp.com and www.ascpfoundation.org
Toll Free: (800) 355-2727

ASCP is the international professional association that works to advance the practice of senior care pharmacy. ASCP’s 6,500+ members manage and improve drug therapy and improve the quality of life of geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home and community-based care.

SeniorCarePharmacist.com
www.SeniorCarePharmacist.com

This web site provides practical information about safe medication use for older persons and includes a directory of senior care pharmacists across the country who are specialists in geriatric drug therapy and the unique medication-related needs of older persons. Senior Care Pharmacists can identify and prevent medication-related problems through careful evaluation and monitoring of patients’ drug regimens.

American Geriatrics Society
www.americangeriatrics.org/products/booktoc.shtml
(212) 308-1414

The American Geriatrics Society’s Complete Guide to Aging & Health is a comprehensive resource for the lay audience that includes invaluable and expert advice for those of us who want to prepare ourselves for a healthy old age or ensure proper care for our older loved ones.

Food and Drug Administration
www.fda.gov/cder/consumerinfo/DPAdefault.htm
Toll Free: (888) 463-6332

FDA provides consumers with information on pre-scription, generic, and over-the-counter drug products. The Center for Drug Evaluation and Research has developed numerous informational materials to help consumers make informed decisions about using medicines.

National Council on Patient Information and Education (NCPIE)
www.talkaboutrx.org
(301) 656-8565

NCPIE is a coalition of over 130 organizations committed to safer, more effective medicine use through better communication. NCPIE’s information is designed to help consumers make sound decisions about the use of medicines.

Peter Lamy Center for Drug Therapy and Aging, School of Pharmacy, University of Maryland
www.pharmacy.umaryland.edu/lamy/
Toll Free: (877) 706-2434

The Center is dedicated to improving drug therapy for aging adults through programs and publications including a series called the ElderCare Brochures, intended to address the complexities of medications and multiple disease states.

For information on Medicare prescription coverage, visit www.medicare.gov and www.medicarerights.org.

References

Cipolle, R. J., Strand, L. M., & Morley P. C. (1998). Pharmaceutical Care Practice. New York: McGraw Hill.

Hanlon, J. T., et al. (1997). Adverse drug events in high risk older outpatients. Journal of the American Geriatric Society, 45, 945-948.

National Alliance for Caregiving, AARP. (1997, June). Family caregiving in the U.S.: findings from a national survey.

Travis, S. S., et al. (2003). Development of the family caregiver medication administration hassles scale. The Gerontologist, 43, 360-368.

Williams, R.D. (1997, September/October). Medication and older adults. FDA Consumer.

Citation

https://www.caregiver.org/caregivers-guide-medications-and-aging

Copyright © 2015 Family Caregiver Alliance. All rights reserved.

 

Alzheimer’s and Safeproofing Your Surroundings

(Alzheimer’s Foundation of America) Turning a home into one that is dementia-friendly can help minimize accidents and maximize well-being. It can also give peace of mind and reduce stress for at-home and long-distance caregivers.

Act Before a Crisis

In safeproofing surroundings, it is best to take preventative steps, rather than scramble around to solve an immediate crisis. This way, options can be more carefully weighed. The challenge is to balance a desire to keep individuals with dementia as functional as possible against the hazards posed by their cognitive decline, which may include poor judgment, difficulty with spatial perception and inability to react appropriately. Observing an individual’s patterns and how they navigate their environment, looking for red flags, and pinpointing causes and effects are all very telling.

Professionals or family caregivers themselves should survey a home three times, progressing in security at each inspection. Look for safe, safer and safest.

  • Safe involves detecting basic dangers and fixing or removing those items, such as movable furniture that people wrongly rely on for support, chairs that blend in with the walls behind them, and loose extension cords and telephone wires;
  • Safer means locating ways to minimize injury in the event of accidents, like replacing glass tables with furniture that has blunt edges, and locating a soft rubber mat by the bed in case of a fall; and
  • Safest is maximizing access to help in an emergency, such as installing a monitoring device.

Look at critical areas. Since people with dementia need a quiet, orderly environment, it is critical to address factors such as noise, color and lighting. Modifying kitchens and bathrooms, and taking steps to deter wandering are primary concerns. The key is to pay special attention to lighting, furnishings, textures, changes in elevation, handrails, and types of flooring, and to remove hazardous clutter from floors, stairways, etc. Often, small changes can make big differences. For example, reducing the level of light during meals may prompt better eating habits; camouflaging an exit door with a curtain may prevent wandering; and removing clutter and unnecessary furniture may reduce confusion.

Be creative. Products do not have to be taken at face value; rather, consider a person’s specific condition and further adapt products for an even greater sense of security. And always keep in mind that, with this progressive disease, what works one day may not the next.

Consider redundant strategies for life-threatening situations. For example, to help prevent wandering, install multiple locks on a door, each at varying heights out of direct sight and requiring different skill sets to open, and supplement them with an alarm. Or when buying a personal response system that uses pendants with a call button to alert a central monitoring station, spring for extras. Use one as a pendant, and cut off the strings from the others and use double-sided tape to install the help buttons to base moldings in key spots. This way, if the individual falls while not wearing the pendant, he could crawl to an emergency button in, say, the foyer or shower.

Walk gently. While many changes sound easy enough, convincing the at-home caregiver and/or their loved one to alter their environment can be the hard part. Often, their reluctance boils down to a sense of shame or the feeling that many assistive devices are unattractive.

Look for designs and assistive devices that give people independent functioning while maintaining privacy and dignity. One example of a perfect solution: grab bars so individuals can get on and off the toilet by themselves. Manufacturers are increasingly designing products without a medical-type appearance, addressing the “shame” issue for both caregivers and those with dementia. Products are nicer looking, boasting decorative colors and style.

In presenting home safety features to individuals with dementia, be delicate. Since most people do not welcome change, caregivers may need to broach the subject on several occasions and make gentle suggestions. Also, try to include the person with dementia in the decision-making process. And use language that empowers the person to agree to the safety features for someone else’s sake, such as, “It’s not for you; it’s for me so I don’t worry so much.” Another effective strategy is to call solutions by another name—gifts.

Safety Checklist

  • Clear all passageways.
  • Remove unnecessary furniture, knickknacks, clutter and items that may cause confusion.
  • Fix loose or uneven steps, and loose or broken handrails.
  • Put gates at the top of stairways.
  • Install safety latches on cabinets that store dangerous items, such as knives, firearms, medications and cleaning products.
  • Place guards around radiators and other heaters.
  • Install secure locks that are higher or lower than eye level on outside doors and windows.
  • Eliminate poisonous houseplants.
  • Keep small objects that may be swallowed out of sight.
  • Make sure electrical wires and phone cords are secured and cannot be tripped over, and that lamps cannot fall over.
  • Remove or fasten down scatter rugs to prevent slipping.
  • Put nightlights in bathrooms, hallways and bedrooms.
  • Make sure light fixtures are easy to turn on, such as switches near doorways and glow-switches.
  • Use maximum wattage allowed by fixtures.
  • Reduce glare with frosted bulbs.
  • Ensure adequate lighting by stairways and passageways.
  • Remove stove and oven knobs when not in use.
  • Install an automatic shut-off switch on the stove.
  • Put away kitchen appliances such as blenders and toasters.
  • Use non-slip decals or mats in the tub and shower.
  • Install grab bars around the tub, shower and toilet.
  • Try a bathtub bench or a hand-held shower.
  • Keep the temperature gauge on the hot water heater at 120 degrees or lower to prevent scalding.
  • Remove locks on bathroom doors.
  • Outfit the individual with an ID bracelet or some other form of identification.
  • Obtain a wristband transmitter or other tracking device to locate wanderers.
  • Post emergency telephone numbers in large print near phones.
  • Prepare and practice an emergency exit plan.

Note: Don’t leave someone home alone—even for a few minutes—if they cannot respond to an emergency situation.

Falls Prevention

Both fear of falling and a fall itself are real concerns for older Americans. The domino effects can be enormous, often resulting in injuries, an emergency department visit, hospitalization and even death. And, individuals who have Alzheimer’s disease may face a greater risk of falling. There are some simple strategies to help reduce risk of a fall:

  • Clear out the clutter. Excess clutter increases the likelihood that someone will trip. Get in the habit of putting things away immediately and keep pathways clear.
  • Light the way. Place night lights or motion-sensitive lights strategically throughout the living space.
  • Bump-proof the bathroom. Use a slip-resistant rubber mat or textured adhesive on tub and shower falls to help reduce slips. Install grab bars and/or a durable seat in the tub or shower to ease access.
  • Keep it within reach. In the kitchen, keep dishes, pots, utensils and food within reach to reduce the likelihood of stepping on a stool, chair or countertop to grab something.

Click here to read more.

Home Supervision

A person’s right to dignity and need for independence complicate the decisions surrounding home safety and supervision. Individuals with Alzheimer’s disease and other dementias are likely to be convinced that it is safe to be alone long after it has clearly become unsafe-even after several accidents or injuries have occurred. Always ask yourself: Is it still harmless for my loved one to be alone? If it is, these steps can help:

  • Provide reassurance before you leave the house, since being alone can cause anxiety and fear for those with dementia.
  • Explain that you are only running out for a minute, and remind your loved one that he can call you or another family member if he feels concerned.
  • Put important telephone numbers and step-by-step instructions at each phone.
  • Make some simple activities, like a favorite movie or puzzle, readily available to provide distraction.
  • Ask a friend or another family member to call to chat while you are out, and to reorient your loved one and provide reassurances.
  • Leave large, simple notes around the home, such as “Joan is at the store and will be home soon” or “Joan will be home when this clock says 4:30.”
  • To ward off wandering, put up visual cues on the exits, like “Stop” or “Do Not Leave.”
  • Make sure that your loved one has some type of identification bracelet, such as those available from local Alzheimer’s agencies.
  • Consider enrolling in Project Lifesaver, which uses state-of-the-art radio technology to quickly locate wanderers.

Heightened anxiety can indicate that it is no longer okay for your loved one to be home alone. Then, consider making other arrangements, such as:

  • Ask a neighbor or family friend to visit in your absence.
  • Invite a friend to accompany you and your loved one outdoors, running errands together as a group.
  • Hire a trustworthy individual from the community—a high school student or member of your congregation, for example—to come in for a few hours.
  • Bring in trained dementia care professionals.

Note:
As a caregiver, you must assess when to change routines to assure adequate supervision. The last thing that a well-intended caregiver needs is a crisis situation that could have been prevented. These crises can also be construed as neglectful, possibly leading to a Protective Services investigation. It is the caregiver’s legal and ethical responsibility to intervene when supervision is needed.

Survival Guide to Hospitalization

A hospital stay can be frightening, confusing and risky for anyone. But for people with Alzheimer’s disease or a related dementia, it can be downright dangerous—and even deadly. It is critical to take steps that can help prevent conditions that would land a person in a hospital, or should an admission be unavoidable, help keep the person safe while there.

Preventing Hospitalization

  • Check symptoms, such as coughs and congestion, immediately with a phone call or visit to a physician to reduce the likelihood they will progress into something more dangerous, like pneumonia.
  • Urinary tract infections are another common culprit for hospitalizations. Encourage the person to drink six to eight eight-ounce glasses of water or other non-caffeinated fluid per day

Tolerating Hospitalization

  • Strive to ensure a smooth transition between care settings, (i.e., between home or skilled nursing facility and the hospital).
  • Supply hospital personnel with a list of the individual’s current medications and dosages, over-the-counter medications, supplements and allergies—and make sure this is included on the patient’s chart.
  • Get to know the attending nurses and doctors. Try to be present during doctors’ rounds to have face-to-face interactions with the patient’s medical professionals.

Click here to read more.

For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.232.8484. Real People. Real Care.

Citation

http://www.alzfdn.org/EducationandCare/

©2015 Alzheimer’s Foundation of America. All rights reserved.

 

Medicines: Use Them Safely

(NIH) When Jerry, age 71, came home from the drug store with his latest prescription, he placed all his pill bottles on the kitchen counter and counted them. “I take five different medications, and you take four,” he said to his wife. “We need a system. We need to know what medicines we have, what they’re for, and when we should take them.

Modern medicine has made our lives better in many ways. It has helped us live longer, healthier lives. But people over 65 have to be careful when taking medications, especially when they’re taking many different drugs.

What Are Medicines? What Are Drugs?

Some people refer to the pills, liquids, creams, or sprays they take as “medicine,” and other people call them “drugs.” Both words can mean:

  • Medicines you get from a pharmacy with a doctor’s prescription
  • Pills, liquids, or creams you buy without a prescription to use now and then, for example, for aches and pains, colds, or heartburn
  • Vitamins or dietary supplements you take regularly

Drugs you get without a doctor’s prescription are called over-the-counter medicines. Because mixing certain medicines can cause problems, be sure to let your doctor know about all the prescription and over-the-counter drugs you are taking.

At Your Doctor’s Office

If you’ve gone to your doctor because you don’t feel well, the doctor might decide a medicine will help and will write a prescription. Be sure you:

  • Tell your doctor or nurse about all the medicines you take whenever a new drug is prescribed.
  • Remind your doctor or nurse about your allergies and any problems you have had with medicines, such as rashes, indigestion, dizziness, or mood changes.
  • Understand how to take the medicine before you start using it. Ask questions. It might help to write down the answers.

Questions To Ask Your Doctor About A New Medicine

  • What is the name of the medicine, and why am I taking it?
  • How many times a day should I take it? At what times? If the bottle says take “4 times a day,” does that mean 4 times in 24 hours or 4 times during the daytime?
  • Should I take the medicine with food or without? Is there anything I should not eat or drink when taking this medicine?
  • What does “as needed” mean?
  • When should I stop taking the medicine?
  • If I forget to take my medicine, what should I do?
  • What side effects can I expect? What should I do if I have a problem?

Ask Your Pharmacist

Your pharmacist is an important part of your healthcare team. If you have questions about your medicine after you leave the doctor’s office, the pharmacist can answer many of them. For example, a pharmacist can tell you how and when to take your medicine, whether a drug may change how another medicine you are taking works, and any side effects you might have. Also, the pharmacist can answer questions about over-the-counter medications.

Try to have all your prescriptions filled at the same pharmacy so your records are in one place. The pharmacist will keep track of all your medications and will be able to tell you if a new drug might cause problems. If you’re not able to use just one pharmacy, show the new pharmacist your list of medicines and over-the-counter drugs when you drop off your prescription.

When you have a prescription filled:

  • Tell the pharmacist if you have trouble swallowing pills. There may be liquid medicine available. Do not chew, break, or crush tablets without first finding out if the drug will still work.
  • Make sure you can read and understand the name of the medicine and the directions on the container and on the color-coded warning stickers on the bottle. If the label is hard to read, ask your pharmacist to use larger type.
  • Check that you can open the container. If not, ask the pharmacist to put your medicines in bottles that are easier to open.
  • Ask about special instructions on where to store a medicine. For example, should it be kept in the refrigerator or in a dry place?
  • Check the label on your medicine before leaving the pharmacy. It should have your name on it and the directions given by your doctor. If it doesn’t, don’t take it, and talk with the pharmacist.

Generic Or Brand Name?

When getting a prescription filled, sometimes you can choose between either a generic or brand-name drug. Generic and brand-name medicines are alike because they act the same way in the body. They contain the same active ingredients—the part of the medicine that makes it work. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Generic drugs usually cost less.

If you want a generic drug, ask your healthcare provider if that’s a choice. Not all drugs are available in the generic form, and there might be medical reasons your doctor prefers the brand-name medicine.

Now, It’s Your Turn

Your doctor has prescribed a medication. The pharmacist has filled the prescription. Now it’s up to you to take the medicine safely. Here are some tips that can help:

  • Make a list of all the medicines you take, including over-the-counter products and dietary supplements. Show it to all of your healthcare providers including physical therapists and dentists. Keep one copy in your medicine cabinet and one in your wallet or pocketbook. The list should include the: name of each medicine, doctor who prescribed it, reason it was prescribed, amount you take, and time(s) you take it.
  • Read and save in one place all written information that comes with the medicine.
  • Take your medicine in the exact amount and at the time your doctor prescribes.
  • Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to change your prescription to a different one that will work better for you.
  • Use a memory aid to take your medicines on time. Some people use meals or bedtime as reminders to take their medicine. Other people use charts, calendars, and weekly pill boxes. Find a system that works for you.
  • Do not skip doses of medication or take half doses to save money. Talk with your doctor or pharmacist if you can’t afford the prescribed medicine. There may be less costly choices or special programs to help with the cost of certain drugs.
  • Avoid mixing alcohol and medicine. Some medicines may not work correctly or may make you sick if taken with alcohol.
  • Take your medicine until it’s finished or until your doctor says it’s okay to stop.
  • Don’t take medicines prescribed for another person or give yours to someone else.
  • Don’t take medicine in the dark. To avoid making a mistake, turn your light on before reaching for your pills.
  • Check the expiration dates on your medicine bottles. Your pharmacist can probably tell you how to safely get rid of medicine you no longer need or that is out of date. The pharmacist might be able to dispose of it for you.
  • Make sure you store all medicines and supplements out of sight and out of reach of children. And don’t take your medicines in front of young children. They might try to copy you.

Shopping For Medicines Online

Medicines can cost a lot. If you have a drug plan through your insurance, you can probably save money by ordering yours from them rather than at your neighborhood pharmacy. Or, you might be thinking about buying yours on the Internet. But how can you tell which websites are safe and reliable? The Food and Drug Administration (see For More Information) has more information on buying medicines and medical products online.

Medicare Prescription Drug Plans

Medicare has prescription drug plans for people with Medicare to help save money on medicines. For information please call 1-800-633-4227 (1-800-MEDICARE) or visit the Medicare website at www.medicare.gov.

What About Over-The-Counter Medicines?

Many of the ideas in this AgePage are also true for over-the-counter (OTC) drugs, like medicines to relieve coughs, cold, allergies, pain, and heartburn. Be careful when taking an OTC drug. For example, don’t take a cough and cold product if you only have a runny nose and no cough. And, check with your doctor before taking aspirin if you are on a blood-thinning medicine, because aspirin also slows blood clotting.

Other things to remember:

  • Measure the dose of a liquid OTC medicine as carefully as you would a prescription drug. Use a measuring spoon, since spoons you eat with vary in size.
  • Be careful—OTC medicines can have side effects.
  • Take the amount suggested on the label. If you don’t get better, see your doctor.
  • Read the label—even if you have used the OTC product in the past. Important information can change.

Remember, medicines—whether prescription or over-the-counter—can hurt you if they aren’t used the right way. Learn to be a smart consumer of medicine.

For More Information

Here are some helpful resources:

Agency for Healthcare Research and Quality 
540 Gaither Road
Rockville, MD 20850
1-301-427-1104
www.ahrq.gov

Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
1-800-633-4227 (1-800-MEDICARE/toll-free)
www.medicare.gov

Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
1-888-463-6332 (toll-free)
www.fda.gov

Partnership for Prescription Assistance
1-888-477-2669 (toll-free)
www.pparx.org

For more information on health and aging, contact:

National Institute on Aging
Information Center 

P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)
www.nia.nih.gov/health
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.

Visit www.nihseniorhealth.gov, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.

Citation

National Institute on Aging

National Institutes of Health

U.S. Department of Health & Human Services