How to help aging parents manage medications (part 1 of 2)

When medicine is a mess.
Your mother sees doctors for several chronic conditions, and her latest checkup has you concerned. Her blood pressure is back on the rise, and not only that, her diabetes is no longer under control. When you check her kitchen/medicine cabinet, instead of the neat row of Rx vials you’ve come to expect, you find chaos: half-empty vials of outdated drugs, unopened prescriptions still in the pharmacy wrapping, packs of over-the-counter remedies and supplements – and a plastic baggie filled with assorted loose pills in rainbow colors, like so many jellybeans.
The touchy conversation that follows makes one thing clear – your mother needs help with her medication management. If you step up to take on that role, here’s how to get things sorted out.
Make a list
Start by playing detective – teasing out which medications your parent really is (or isn’t) taking. That means not just asking about prescription drugs, but also over-the-counter products, vitamins and herbal supplements, says Joan Baird, director of pharmacy practice for the American Society of Consultant Pharmacists. The complete list should include both daily drugs and occasional remedies such as sleep or cold medicines.
Look at labels
A person could use a cough and cold syrup containing acetaminophen, not realizing that’s the same ingredient as Tylenol, Baird says. A little later, that person might feel achy and take a couple Tylenol tablets. That’s just one example of drug duplication, or redundancy. You wouldn’t know that without reading labels, which could be challenging for people with vision problems or changes in comprehension. So you’ll want to be aware of ingredients for every product in your parent’s medicine cabinet.
Check with the pharmacist
Once you’ve compiled the complete medication list, share it with your parent’s pharmacist, who can pick up on redundancies, potential interactions and side effects. For instance, your mother might take Tylenol PM to help her sleep. But the medicine contains diphenhydramine – the same ingredient as Benadryl – which can contribute to falls in seniors. Because older adults metabolize (break down) medications more slowly, drugs can hang out in their body longer, Baird says – and a drug that might make a younger person feel slightly tired the next day could leave a senior lightheaded when they get out of bed.
Baird describes another risky scenario that can be avoided: “The patient is taking St. John’s wort, say, as an OTC supplement for depression, but is also taking Prozac. That would be a redundancy, and they can interact.”
Clean up and streamline
Multiple prescriptions from different doctors, so many pills on conflicting time schedules – it’s tempting to skip doses and easy to get confused. If a regimen is too complicated, other options usually exist, Baird says, such as switching to another drug in the same class or using extended-release alternatives for less-frequent dosing. On the other hand, with conditions such as cancer and HIV/AIDS, it may not be possible to alter complicated drug regimens.
Meanwhile, other drugs, like a heartburn medication, may no longer be needed, but the prescription just keeps getting refilled. Ask your parent’s geriatrician or other primary care provider what’s needed (and why) and what isn’t.
Too much to swallow
It can be daunting for anyone to polish off 20 or so pills at a time – even more so if you’re a senior with swallowing problems. Jodi Wood, a registered nurse and owner of the Akron, Ohio, branch of Visiting Angels, a home health provider, suggests asking doctors if pills can be spread throughout the day or taken in a different way. “There are other avenues for medication administration,” she says. “Some things come in a liquid form. Some things can be crushed and sprinkled into pudding or food if that makes it easier.”