90-year-old Grandma with onset of dementia forgets to take her prescription medication! How do we solve this?

k18niwong, unfortunately when dementia is involved, there is very little that one can do to remind that person to take their pills. They would forget 5 minutes later that you told them.

My Dad's caregivers would set the pills in front of Dad while Dad ate, but at the end of the meal, there sat the pills. The next shift caregiver would come in, and Dad would always make an excuse, like saying "I'll take the pills later" and he never does. The caregivers would tape notes on the bathroom mirror to remind Dad. Didn't work.

Once Dad moved to Independent Living, I used the Medtech option, where a certified caregiver who is allowed to handle medicine, would come into Dad's apartment twice a day and hand him the pills along with a glass of water. She would wait until he took the pills. For some reason, he would gladly take the pills. Could be because she was dressed like a nurse.

Depending on how effected your grandmother is by dementia a daily check list may help, at least for a while. Particularly if memory is the major impact now, a checklist of all the things she needs to do each morning and/or evening including taking medication, brushing teeth, turning off lights, etc. may be helpful.

To be honest, the only solution is to hand them to her one at a time and watch her take them.

There are all kinds of pill minders and organisers and clever compartmentalised boxes with timers and nice big lettering; but even if your grandmother could cope with them now, she won't be able to for long. And that's not the only issue.

90 year old fingers are not usually as nimble as they were, and tablets are little and awkward to manipulate, and what happens when she drops one? Even if you liked the idea of her scrabbling around on the floor trying to find it, you probably wouldn't want her to swallow it after that.

There are autonomy issues here - you need to be conscientious about telling your grandmother what you are giving her and what it's for. But if you want to be sure that she is taking her medications as prescribed, and it's all being properly recorded, someone is going to have to be there to help.

There are electronic medication dispensers (we were given one by MedReady), they have timers and alarms, and they rotate and open when meds are to be taken. Something like this might help her stay independent a little longer.

I think that the caregiver needs to plan on handing the pills to grandma with water and watch her take them.

Has anyone done a back check of all her meds to ensure that they are all required and are all beneficial? Sometimes we end up with too many meds because they just get refilled and different doctors, so I would make sure that she even needs them all.

My dad has a pacemaker and he isn't on a bunch of meds. Just so you know that a pacemaker doesn't require tons of meds.

K, are your grandparents really able at this point to safely remain in their home without daily caregivers? I misunderstood your post and I thought that your mom was one of the caregivers.

I would recommend getting them an assessment through their local counsel on aging, this will help you understand what their needs are and what services are available to ensure that they are safe.

Has anyone looked into a caregiver or an assisted living facility? There are some really great facilities that could help them be more secure and safe, proper nutrition and social activities with skilled care a push button away.

I think that you need to encourage everyone to start looking at the reality of their age and condition.

It is difficult but lots of people thrive in care because they are eating, sleeping, socializing and getting their medications properly. Something to consider.

Hello again, K18 - just replying to your questions.

What do you have in mind if I can't be there to hand her pills for the three-times-a-day she takes them?

If there are three occasions during each day when your grandmother needs her medications, and you can't be there every time (fair enough, it's not easy!), your options are:
1. Share this task with somebody else who is able and willing to cover it;
2. Speak to your grandmother's doctor and pharmacist and see if it's possible to adjust her px. Most medications come in a range of formulations, which can certainly help to reduce the frequency of doses.

Would you be able to clarify what you mean when you say "and that's not the only issue?"

The main issue is remembering which medication to take, when; sure. But it's not as simple as having them prettily organised by day and time, in an organiser that pops open at the right moment. Your grandmother also has to recognise what the organiser itself is, and that it contains her medications; that today is Wednesday (or Monday, or Friday, whatever); that the pills inside belong to her; that she needs to take some with food, or before food, or with water, or not with grapefruit juice; that the whole kit and caboodle has anything to do with her. She also has to be able to get the pills out of the compartment, without dropping them; and, not least, she has to know where the organiser is and use it, and not sleep through her lunchtime dose.

And she has actually to be able to do all that. Not just promise you and your mother that she will.

What are the big flaws of these pill reminders and organizers?
I wouldn't say flaws, so much as limitations. There is only so much design and labelling can do. Take this description from a mid-range product from a reputable supplier:

"This pill organiser helps you to take your medicines correctly and at the right time. It has 28 compartments, four per day, each labelled with the day and times of when tablets are to be taken: 7am-9am: 11am-1pm; 4pm-6pm; 8pm-10pm. Only suitable for capsule tablets which are to be swallowed. Has a child safety lock to delay access by small children by locking all the sliding lids. Important, the lock does not make this pill organiser completely child-proof."

The product is even suitable for blind people! The days and times are marked in Braille as well as printed. Clever!

But

1. It has to be loaded. Of course that can be done; but once you've taken the medications out of their blister packs they are not in their sterile, dry, airtight environment, and in case of accident they are also not easily identifiable.
2. You would be surprised at how easy it is to make a mistake.
3. The compartments may not be big enough. If your grandmother has a longish px, I would even say the compartments won't be big enough.
4. What if your grandmother also needs to take medication in liquid form?

I don't mean to sound as if I just hate pill organisers. They can be extremely useful for people who know what they're doing and just want to avoid faffing around with half a dozen different containers three or four times a day, or want a compact way to store and carry their tablets. But for people who are becoming confused, whose fine motor skills are not what they were, and who can't readily remember all of the other things they may need to remember when taking their medication, they're no solution.

To assure your grandmother takes her medications as prescribed someone must prepare them, hand them to her at the proper time, and stay to watch that GM takes and swallows them.

Pill dispensers work ONLY if the person or people at the other end are comfortable using the device. In your opinion can grandpa or grandma do that?

If not there is chance of an error, as there is any time the medication is not offered by a reliable person who follow the steps described above.

A huge cause of hospitalization of the elderly is medication mismanagement.

It happens frequently. Even in a SNF. My mom was in a NH & many of the nurses simply dropped off the meds in the little white cup. I would have to remind her every 5 minutes to take them. One or two remained. Trying to assure she got them all in was always an issue as when she moved the breakfast tray they would occasionally fall loose in her sheets.
It is challenging even in a SNF.

Good luck to you!