How can we limit MIL's use of OTC meds as the doctor has ordered?

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My MIL is an OTC med junkie. For every minor ache or pain or the slightest discomfort, she has to run to her drawer to find alka-seltzer, immodium, tylenol, pepto bismol, and the biggy...orajel. She goes through a $10 bottle of orajel per day. I've seen her using it like mouth wash. Every day she talks about going back to CVS to buy more. I've talked to the nurse at her dr.'s office and she said to just take it away, but it's not that easy. She DEMANDS it. Luckily, she forgets about it when we're out and about. But sooner or later the subject of getting more orajel comes up. She is a regular patient at her dentist, so all sources of discomfort have been addressed over and over.

The same goes for tylenol. I've pretty much taken that away because she will ask for some and I'll give it to her and half an hour later, she'll ask for more. I feel that when I'm not there, she OD's on it, which is so dangerous. So now that she doesn't have tylenol, she will take her prn imitrex for a non-migraine headache! Who knows how many of those she takes? It's scary.

She will be moving to an assisted living facility later this month, thank God. I guess we'll just have to let the staff know that she is not to have these meds unless they give them to her. But I just know she will ask for them relentlessly and probably purchase them if they take her out shopping.

This has been a life-long problem. Only before, she was a prescription drug junkie. Xanax and ritalin. She is simply uwilling to deal with any little twinge that causes her even the slightest discomfort. After I told her she wasn't supposed to have immodium anymore, she asked, "well what do I do if I get diarrhea?" I told her, "Have diarrhea, I guess". Unfathomable. But, we are getting her meds changed and trying to figure out why she may has chronic diarrhea, so hopefully, she won't have to live with it like she has for years. (She has irritable bowel syndrome which is linked to her intense anxiety and the dr. says her addiction to immodium is actually making it worse)

She manipulates my SIL into getting these meds for her. It's an issue that needs to be addressed because I know she will be begging her for them when she gets to the ALF.

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Dementia does alter the picture considerably. People in their right minds should be able to make their own decisions, even life-shortening, self-destructive decisions.

But when someone is disabled by dementia, then they deserve our protection.

Sometimes it is a pretty tough call. If she has been doing this for years, it is not really dementia behavior, and yet dementia can make what was not a healthy approach to start with an even more dangerous situation.

I take it that she is going to be in a memory care unit, and that they will be responsible for dispensing her medications -- is that right? Or do they only take on prescribed meds?

Will the cost of drugs be a self-limiting factor? If she doesn't have $300 spending money each month, then no matter how often she is taken shopping, she can't be buying an item that costs $10/day. Dementia robs people of their ability to reason, but if she only has $8 in her purse, can she accept that can't buy a $10 med?

Might creative placebos satisfy her need to self-medicate in a safer, less costly way? For example, might she be happy rubbing her mouth with an Orajel product that comes in a bigger container and is less expensive? (And has an uncanny resemblence to tinted piping gel?)

With dementia, the chances of convincing her to change her ways are pretty small.

Good luck!
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Thing is, none of us realized how bad the situation is until now. She can't afford $10/day for orajel either. Because she has lived alone for the past 30 years, the only time we have made discoveries about these habits, is when she ends up in the hospital. Her short term memory is so impaired that she has no idea how much of these meds she's taking now. She may not have been so bad about the OTC drugs in the past, (but she was with the prescription drugs) we don't really know. All we know is that now that I have been staying with her off and on for the past 3 months, we have found out a lot of things about her that seem pretty dangerous to her health. I don't think a person with dementia should be in charge of their own medical care. When left to her own devices since the dementia started, she has been in the hospital multiple times. This last time because she forgot to eat and drink. I don't feel comfortable with allowing her to do things that shorten her life span because she can't remember what pills or medications she's taken. Yes, it's her life, but if we let her live her life the way she wanted, she would be dead. I'm thinking it's more of a habit than a dependence based on anxiety.
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Do hope you listen to Jeanne's advice - it is right on. While your heart is in the right place, you can't just take away medications that is making a person feel better for whatever reason. If she is damaging her body, there will be a price to pay for that - but, personally, I think you should let her make the choice. Pain meds can become a dependent source of relief. And who are we to take away someones pain relief; especially at an elderly age. Sorry, but have to agree with Jeanne on this one.
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You say that this has been a life-long problem. If you were not able to control it when she was middle aged, why do you think you can/should be able to control it now? Over use of OTC meds may shorten her life span. But short or long, it is hers and she is in charge of it.

Don't get me wrong. I am in favor of her cutting down on the massive meds. And your heart is absolutely in the right place on this issue. If you can influence even a slight improvement in her behavior that will be worthwhile. But, realistically, just because she is now declining and going into an ALF does not give you a desperate responsibility to reform her life-time bad habits. This is how she is. Do what (little) you can without alienating her or your SIL, and don't beat yourself up if the results are less than stellar.

If you are going to try to help her to healthier habits, I suggest picking your battles. Which of the many potients and pills are most harmful? Perhaps taking the entire list to a pharmacist would help you select one or two to start with. I'm sure that none of them gets a green light for unlimited use, but some are probably more danerous than others.

And here is a thought. If the drawers full of magic fixes have been her way of coping with anxiety for years, it might be dangerous to remove the coping mechanism without having something to replace it. Those pills are serving some need. Not the need she thinks she is taking them for, I would guess, but there is a reason for this dependence.

Good luck.
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